Each form calls for a specific treatment
Atrial fibrillation (AFib) is broadly defined as an irregular heartbeat, but that won’t tell the whole story. In fact, there are distinct forms of AFib, and your management plan will depend on which form you suffer from. Your prognosis could depend on that detail, too.
So, what differentiates the three forms of AFib? Two key factors are duration and frequency: that is, how long each AFib episode lasts, and what sort of intervention it takes to stop it.
Paroxysmal AFib: when problems come and go
Do you get short stretches of palpitations? Perhaps you notice that your heart skips a beat now and then, but you can’t determine a pattern. Episodes that have a clear start and stopping point qualify as paroxysmal AFib: when abnormal electrical signals and a fast heart rate begin out of the blue and stop just as suddenly, without any treatment on your part.
Paroxysmal AFib is often traced to the pulmonary veins in the left upper chamber of the heart, and tends to bring more noticeable symptoms than other types of AFib (this might be due to the fact that consistent symptoms become normal and unremarkable). Sometimes the symptoms last for minutes, sometimes they can last for days; a principle feature of this type of AFib is that it’s unpredictable.
Persistent AFib: when irregularities remain, unless you intervene
When your AFib goes on for more than a week, and keeps going until you treat it with mediation or a surgical procedure, it’s known as persistent AFib. Cardioversion is often used to bring the heart rate and rhythm back to normal. This treatment can either come in a chemical form (administered through an IV) or, using paddles, your heart is electrically shocked to return a normal heart beat.
Persistent AFib symptoms are similar to paroxysmal AFib: heart palpitations, racing heartbeat, dizziness, fatigue, weakness, and breathlessness, among other discomforts. Symptoms can become more frequent as the disease progresses, but some people won’t notice symptoms at all. When symptoms are very difficult to control, catheter ablation can be a good option: this surgical procedure cauterizes certain electrical pathways in the heart tissue to get the signals back on track, and it can be extremely effective.
Long-standing persistent AFib: when heart rhythm can’t be corrected
When AFib continues for over a year, and doesn’t go away with treatment, it’s considered long-standing persistent AFib (formerly known as permanent AFib). It can be much more difficult to manage this advanced form of AFib – medication, cardioversion, and catheter ablation often won’t solve the problem.
Obviously, this permanent form of AFib can be tough to handle. You may feel symptoms constantly and, knowing that there’s no cure in sight, your worry and stress can build up to unhealthy levels. Continuous AFib can also leave you anxious and fatigued, and that can really diminish your quality of life.
The source can determine the type
AFib is often a symptom of another medical disorder, so figuring out that underlying cause can help you understand which form of AFib you have – and where it might be going.
Structural defect. One common cause of AFib is heart valve problems. Both main types of valve disorders – heart valve regurgitation and heart valve stenosis – can cause the heart muscle to enlarge, and that can lead to AFib. Your chances of developing persistent AFib are greater if you also suffer from a heart valve disorder.
Secondary AFib. Many seemingly unrelated conditions can lead to heart arrhythmias. When another condition is found to be causing your AFib, it’s known as secondary AFib. Secondary causes can include everything from heart attack and other heart issues to sleep apnea and alcohol abuse.
This is the most common type of AFib in the US, and it’s often tied to problems that arise with aging and poor lifestyle choices. On the bright side, treating the underlying disorder can often reduce or eliminate secondary AFib.
Lone AFib. When no cause can be found for your AFib, it’s known as lone AFib. This might mean that it’s really secondary AFib with a cause that’s yet to be uncovered, or it could happen independent of any other medical issues. As AFib research continues, more sources are uncovered and fewer lone AFib diagnoses are given, but it’s still a significant issue.
Lone AFib can be especially hard to treat. In many cases, doctors will start with minimally-invasive techniques like medication, and gradually work through more invasive methods until the rhythm irregularity is brought under control.
Postoperative AFib. It’s not uncommon for AFib to reoccur following cardiac surgery. Many things can happen during the operation to trigger the irregular heart beat, and certain factors can play a role in your chances of developing postoperative AFib, including fluid and electrolyte shifts, pre-existing COPD, age, and gender.
Unfortunately, this type of AFib can complicate recovery and increase the possibility of stroke and other complications. The good news is the medical community is focusing more on this type of AFib and has introduced new guidelines to help doctors prevent and treat it more effectively.
The better you understand your AFib, the better you can control it
AFib is a progressive disease: your paroxysmal AFib could very likely turn into persistent or eventually permanent AFib. The key is to get it under control as soon as possible to improve your outlook, and to do that you’ll need to observe your symptoms closely and communicate openly and often with your doctor.
You might not be able to eradicate a heart rhythm disorder on your own, but knowledge is power. The more you know about how your symptoms respond, and how your condition is defined, the better you can protect your heart in the years to come.