Atrial Fibrillation Video Series: Day Six
What Type of AF Do You Have?
Atrial fibrillation isn’t a one-size-fits-all condition. There are different types of AF, and understanding which type you have can help tailor the right treatment approach. You may have heard your doctor use words like “paroxysmal” or “persistent.” Let’s break down these terms in plain language.
- Paroxysmal AF: This type of AF comes and goes in episodes. The word “paroxysmal” essentially means sudden or sporadic. If you have paroxysmal AF, your heart will go into AF for a short time and then return to a normal rhythm on its own. Episodes can last anywhere from just a few seconds to as long as a week, but often they stop within a day. You might go days or weeks without any AF in between episodes. Many people with paroxysmal AF feel when it happens (palpitations or other symptoms from our last email), but some might not. It can be unpredictable – you could feel perfectly fine one moment and then suddenly notice your heart racing the next.
- Persistent AF: In persistent AF, the abnormal rhythm doesn’t self-correct. If your heart goes into AF, it will stay in AF until something is done to stop it. That “something” might be a medical intervention, like medications or an electrical cardioversion (a controlled electric shock to restore normal rhythm). The cutoff doctors use is that if an AF episode lasts longer than seven days (or if it’s shorter but requires intervention to stop), we call it persistent AF. Some people live in persistent AF for weeks or months until treatment is attempted. During that time, the heart is continuously beating irregularly. Many folks with persistent AF get used to the sensation over time, but it can still cause symptoms and risks as we discussed.
- Permanent AF (or Long-standing Persistent AF): This is when AF has been present for a long while and a decision is made not to try to restore normal rhythm anymore. In other words, the heart is in AF continuously and both the patient and doctor accept that this is the new baseline. Instead of trying to eliminate the AF, the focus shifts to controlling the heart rate and preventing strokes (because maintaining normal rhythm proved too difficult or not possible in that case). The term “long-standing persistent AF” is often used if AF has lasted over a year and rhythm control hasn’t been successful. “Permanent” means you and your healthcare team have agreed to manage it without further attempts at getting rid of AF itself. It doesn’t necessarily mean it can never be changed, but for now, it’s being left as is.
Why do these distinctions matter? They guide treatment strategy. For example, someone with paroxysmal AF might be a great candidate for certain medications or an early catheter ablation to nip it in the bud, whereas someone with permanent AF might skip those attempts and focus on rate control and stroke prevention. Persistent AF often prompts more aggressive efforts to restore normal rhythm (within weeks or months of onset, cardioversion or ablation can be considered). Also, some therapies (like a certain procedure or surgical approach) might be recommended more strongly for persistent AF than paroxysmal.
In summary, knowing your AF type gives context to what you’re experiencing and what approach your doctors might take. It’s a bit like knowing whether a fire is a bunch of sporadic sparks versus a steady flame – it influences how we try to put it out.
Next email, we’ll delve into treatment: specifically, medications used for AF – both to control your heart rate and to try restoring a normal rhythm. We’ll also touch on the importance of these approaches for different AF types.
