Understanding the Stages of Atrial Fibrillation (Afib)

If you have researched Atrial Fibrillation or Afib, you’ll know that it is a progressive condition that, if left untreated or under-managed, can progress, often quickly, in severity. Atrial fibrillation often begins as occasional, or as electrophysiologists call it, paroxysmal. Left untreated, it can eventually become permanent; however, there are stages in between. Here, we will discuss the four stages of atrial fibrillation, as well as what they mean to the patient and what treatment options are available at each stage.

It’s worth understanding that early detection and treatment are best to ensure a positive outcome, as is the case with most other conditions and diseases. The longer the patient waits for treatment, the less likely they will have a satisfactory result.

The Stages Defined

Paroxysmal Afib

Paroxysmal Afib can be thought of as fleeting episodes that do not last more than a week. There is no defined timeframe or frequency at which these episodes occur. For some, the episodes may occur weekly, while for others, they may occur only once or twice a year. There is no way to know exactly when the next episode will occur and no patient traits to help us predict their onset or severity. However, obese patients and those with cardiovascular issues will generally have more intense and frequent episodes. The intensity of each of the episodes may also vary. Some episodes may feel like a little flutter, while others may feel like a heart attack. In fact, many patients end up in the emergency room, thinking they’ve had a heart attack after their first significant Afib episode.

Paroxysmal Afib can be treated with anti-arrhythmic medication, and patients with high stroke risk, as delineated by the CHA2DS2VASc score, may also be put on anticoagulants. Paroxysmal Afib can also be treated with cardiac catheter ablation as a first-line option, including heat-based RF ablation or cold-based cryoablation.

Persistent Afib

Persistent Afib involves symptoms of Afib that continue for over a week and cannot be managed or eliminated without intervention like antiarrhythmic medication, cardioversion, or catheter ablation. Persistent Afib is usually preceded by months or even years of paroxysmal Afib.

Persistent, Afib is typically treated with cardiac catheter ablation using either heat or cold to destroy improperly functioning heart tissue. While most ablations focus on pulmonary vein isolation for paroxysmal Afib, the treatment area may be more diffuse at this stage. Results are unpredictable, and treatment success is somewhat lower than when treating paroxysmal Afib.

Long-standing Persistent Afib

Long-standing, persistent Afib can be considered a somewhat treatment-resistant stage of the condition that lasts more than a year. Multiple treatment modalities may be tried with varying success. Often, treatment is unsuccessful, and while symptoms may improve, the likelihood of eliminating Afib is relatively low.

Permanent Afib

Finally, permanent Afib is more of a decision stage than a condition. It is a situation in which the patient and electrophysiologist have decided and understood that there is no possibility of further treating Afib. This circumstance often arises because the patient did not identify and seek treatment for their Afib appropriately. Many patients with permanent Afib experience a higher level of fatigue because their heart is overworked. These patients are also at the highest risk for congestive heart failure due to the excess strain placed on the heart.

Understanding the types of Afib above is critically important in educating patients that while Afib itself is rarely life-threatening, the consequences can be significant. In a society that is gaining a substantial amount of weight, collectively, the risks of developing Afib are increasing. Unfortunately, many patients do not understand Afib, nor do they know how to identify it. As we’ve mentioned elsewhere, despite having EKGs that may show a normal heartbeat, a patient may still be experiencing Afib, which can eventually progress to more severe cardiovascular disease.

We encourage any patient experiencing the symptoms of Afib to contact an electrophysiologist like Dr. Tordini to understand more about their diagnosis and treatment options. It’s also important to remember that Afib shares many symptoms with heart attack and other cardiovascular disease, so if you believe you’re having a heart attack or medical emergency, do not delay dialing 911 or getting to your nearest emergency room.

Dr. Tordini is a part of Florida Medical Clinic Orlando Health