Paroxysmal atrial fibrillation

Paroxysmal atrial fibrillation

Description, Causes and Risk Factors:

The word paroxysmal means recurring sudden episodes of symptoms. If you have paroxysmal atrial fibrillation (PAF) it means that you have episodes of AF that come and go. Each episode comes on suddenly, but will stop without treatment within seven days (usually within two days). Each episode stops just as suddenly as it starts and the heartbeat goes back to a normal rate and rhythm. The period of time between each episode (each paroxysm) can vary greatly from case-to-case. Although PAF means that it will stop on its own, some people with PAF take treatment as soon as the AF develops, to stop it as quickly as possible after it starts.

In paroxysmal atrial fibrillation, the faulty electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe. They stop within about a week, but usually in less than 24 hours.

Causes & Risk Factors:

    High blood pressure.

  • Hyperthyroidism.

  • Coronary heart disease (CHD).

  • Heart failure.

  • Rheumatic heart disease.

  • Structural heart defects, such as mitral valve prolapse (MVP).

  • Pericarditis.

  • Congenital heart defects.

  • Sick sinus syndrome (a condition in which the heart's electrical signals don't fire properly and the heart rate slows down; sometimes the heart will switch back and forth between a slow rate and a fast rate).

  • Metabolic syndrome.

  • Genetic factors also play a role in PAF.

PAF affects millions of people, and the number is rising. There is no gender predilection. PAF is more common among African-Americans, Caucasian & Hispanics, and those of Asian, Europeans, and Americans' origin.


Symptoms include,

    Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or fast).

  • Shortness of breath.

  • Weakness or problems exercising.

  • Chest pain.

  • Dizziness or fainting.

  • Fatigue (tiredness).

  • Confusion.


Diagnostic Tests and Procedures

EKG: An EKG is a simple, painless test that records the heart's electrical activity. It's the most useful test for diagnosing AF.An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.A standard EKG only records the heartbeat for a few seconds. It won't detect AF that doesn't happen during the test. To diagnose PAF, your doctor may ask you to wear a portable EKG monitor that can record your heartbeat for longer periods.

The two most common types of portable EKGs are Holter and Event monitors.

    Holter Monitors: A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period. You wear small patches called electrodes on your chest. Wires connect these patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.You wear the Holter monitor while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.

  • Event Monitors: An Event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.You can wear an event monitor for weeks or until symptoms occur.

Stress Test: Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast.

Echocardiography: Echocardiography (ECHO) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working.ECHO also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.This test sometimes is called transthoracic echocardiography. It's painless and non-invasive (no instruments are inserted into the body). For the test, a device called a transducer is moved back and forth over your chest. The device sends special sound waves through your chest wall to your heart.The sound waves bounce off the structures of your heart, and a computer converts them into pictures on a screen.

Transesophageal Echocardiography: Transesophageal echo, or TEE, uses sound waves to take pictures of your heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach.Your heart's upper chambers, the atria, are deep in your chest. They often can't be seen very well using transthoracic echo. Your doctor can see the atria much better using TEE.During this test, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus. You'll likely be given medicine to help you relax during the procedure.TEE is used to detect blood clots that may be forming in the atria because of AF.

Chest X-ray: A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show fluid buildup in the lungs and signs of other AF complications.

Blood Tests: Blood tests check the level of thyroid hormone in your body and the balance of your body's electrolytes. Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body. They're essential for normal health and functioning of your body's cells and organs.


Atrial fibrillation (AF) is the commonest sustained disorder of cardiac rhythm, which is often associated with a high risk of morbidity and mortality from heart failure, stroke and thromboembolic complications. There have been significant advances in our understanding of AF, but much of our knowledge of the epidemiology, clinical presentation and management strategies of these atrial fibrillations have been based on studies of patients predominantly with chronic (sustained) AF.

Nevertheless, AF may also occur intermittently, and the importance of PAF has recently gained prominence. A common error in clinical management is to treat chronic sustained AF and PAF similarly, despite some differences in management objectives. PAF may be associated with risks of stroke and thromboembolism similar to those for sustained AF, and many patients suffer significant morbidity. Recent advances in areas of Electrophysiology & pathophysiology of AF have also re-kindled much interest in PAF.

There has been a tendency to treat PAF in a similar way to sustained AF, but treatment objectives may be very different. The main objective of management is prevention of paroxysms and long-term maintenance of sinus rhythm, and Class 1c drugs are highly effective, although beta-blockers are useful alternatives. If patients have severe coronary artery disease or poor ventricular function, amiodarone is probably the drug of choice. Although randomized controlled trials of thromboprophylaxis in patients with PAF per se are lacking, the approach to patients with PAF should be similar to that in patients with sustained AF, with warfarin for 'high risk' patients and aspirin for those at 'low risk.' Non-pharmacological therapeutic options, including pacemakers, electrophysiological techniques and the implantable atrial defibrillator, show great promise. Despite PAF being a common condition, management strategies are limited by evidence from small randomized trials, with inconsistencies over the definition of the arrhythmia and the inclusion of only symptomatic subjects. Evidence for anti-thrombotic therapy is also based on epidemiological studies and subgroup analyses of the large randomized trials.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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