paroxysmal atrial fibrillation (AF)

Last edited 07/2022 and last reviewed 08/2022

Paroxysmal atrial fibrillation is often more symptomatic than stable fibrillation, and it is often difficult to distinguish from frequent atrial ectopics.

It is a common cause of palpitations in middle age and the elderly. It may cause stroke.

Classification of AF (1):

• atrial fibrillation is classified as "paroxysmal" if episodes terminate spontaneously or after targeted intervention within seven days, whereas atrial fibrillation lasting more than seven days without termination is considered "persistent" and often requires electrical or pharmacological cardioversion for termination
• atrial fibrillation that persists continuously for longer than a year is termed "longstanding persistent atrial fibrillation"
• when the patient and clinician decide not to pursue anyany attempt to restore normal rhythm, atrial fibrillation is considered "permanent"

Risk of progression of paroxysmal AF (2):

• interim analysis of the RACE V study (n=417) found AF progression in 5.5% of patients/year
• predictors included markers for atrial remodelling, sex, mitral valve regurgitation, waist circumference & biomarkers linked to coagulation, inflammation, cardiomyocyte stretch & atherosclerosis

Reference:

• Ponamgi SP et al. Screening and management of atrial fibrillation in primary care. BMJ 2021;372:mn379 http://dx.doi.org/10.1136/bmj.mn379
• Nguyen B, Weberndorfer V, Crijns HJ, et al. Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation.Heart Published Online First: 20 July 2022. doi: 10.1136/heartjnl-2022-321027.