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Atrial fibrillation is a common heart condition that affects nearly 2.7 million people in the United States. AFib is an arrhythmia, or a condition where the heart beats irregularly, too quickly, or too slowly.
There are four main types of AFib: paroxysmal AFib, persistent AFib, long-term AFib, and permanent AFib. Each type is defined by how long AFib symptoms last and their severity. Symptoms of AFib include:
A paroxysm is a sudden episode. Paroxysmal AFib, also known as occasional AFib, occurs when you have symptoms for a brief amount of time. The length of time can range from a few minutes to hours. In some cases, symptoms can last for up to a week. Paroxysmal AFib can also occur repeatedly over time.
Symptoms often resolve on their own, but sometimes you may need to seek treatment. Paroxysmal AFib can progress to persistent AFib.
Cardioversion, a procedure to reset the heart to its normal rhythm, can be used to treat early episodes of AFib and provide relief from symptoms for months or longer. This is a less invasive technique than other available treatment options, which is ideal for people whose AFib has not progressed. However, cardioversion of paroxysmal AFib cannot prevent AFib from progressing over time. It is used as a short-term solution.
Cardioversion can be achieved with drugs (medicated cardioversion) or by using electric paddles that send short, electrical shocks to the heart (electrical cardioversion).
Medications are used to control both the heart’s rate and rhythm. Beta-blockers are a class of drugs used to slow the heart rate. Another treatment called digoxin can also be used to control your resting heart rate, which works by slowing your heart rate and making it easier to pump blood.
Calcium channel blockers can also slow the heart rate, as well as reducing the heart muscle’s strength when contracting.
Anti-arrhythmic drugs are used to control the heart’s electrical signaling to maintain a normal rhythm. Potassium channel blockers work by slowing these electrical signals through the heart. Sodium channel blockers reduce the heart’s ability to conduct electricity.
Persistent AFib is diagnosed when AFib symptoms last longer than one week. This condition is not likely to resolve on its own, and you will need treatment to restore your normal heart rhythm.
Treatments for persistent AFib focus on controlling both the heart rate and rhythm, because these are likely to be a continuing issue that will not go away on its own. Cardioversion can also be used to treat persistent AFib. In many cases, it is also combined with medication to help prevent symptoms from returning.
The medication options for persistent AFib are similar to those sometimes used to treat paroxysmal AFib. Treatments include beta-blockers, digoxin, or calcium channel blockers to regulate the heart rate. Anti-arrhythmic drugs that control the heart’s electrical signaling process, including potassium channel blockers and sodium channel blockers, may also be prescribed.
Read more about medications used to treat AFib.
Catheter ablation may be recommended for some cases of persistent AFib. With catheter ablation, a long, thin tube (known as a catheter) is inserted into the groin and through blood vessels to the heart. The tip of the catheter contains a device that damages the area of the heart responsible for generating the abnormal electrical signals. Scar tissue will form in the area, which helps the heart gain back its normal rhythm.
Long-term persistent AFib occurs when AFib symptoms are continuous and last for 12 months or longer without resolving on their own.
All of the treatments used for persistent AFib are also used for treating long-term persistent AFib. Other surgical options may be pursued in cases where medication and catheter ablation are not effective.
The maze procedure is an open-heart surgery that uses instruments to create lines of scar tissue in the atrium, helping the heart return to its normal rhythm. It has an 80 percent to 90 percent success rate, and its effects last for many years.
Atrioventricular (AV) node ablation can also be performed to treat AFib when the heart rate remains high despite medications. This surgery targets the AV node, which connects the upper and lower chambers of the heart. Scar tissue is formed on the AV node, and a pacemaker is implanted to restore the heart’s rhythm.
Permanent AFib, or chronic AFib, is diagnosed when the normal heart rate cannot be restored even after trying many different treatment options. People with permanent AFib will have it for the rest of their lives. Permanent AFib can be treated with medications to manage the heart rate, help prevent blood clots, and reduce the risk of stroke.
Permanent AFib develops from structural changes to the heart over time in people with AFib that cannot be reversed with surgical treatments. These changes develop in the upper chambers of the heart, known as the atria — the area of the heart responsible for causing AFib. Most treatment options used for persistent and long-term persistent AFib will not work to resolve permanent AFib.
People with permanent AFib may be treated with beta-blockers, calcium channel blockers, or digoxin to help control heart rate. The risk for blood clots and stroke is greatly increased in those with AFib. Blood thinners (anticoagulants) can be used to help reduce this risk in people with all four types of AFib.
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