The Types of Afib and What It Means For Your Care

March 25, 2024

Man in striped shirt gripping chest with both hands

As you undoubtedly know by navigating our website, atrial fibrillation of Afib is a very concerning condition that affects millions of adults around the United States and is increasing in prevalence with the commensurate increase in excess weight and metabolic disease. Concerningly, because many patients do not understand the progression of the condition, some do not seek care early enough and may progress to a more severe stage of Afib. This progression is not necessarily linear. For some, it may occur within months, while others may take years. Ultimately, however, it becomes more challenging to treat as Afib progresses. In this article, we will talk about the various stages of Afib and the success of treatments once a patient has crossed each threshold.

Paroxysmal Afib

Paroxysmal or occasional Afib says it all in the name. These episodes come and go with no rhyme or reason. Some patients may experience episodes every few weeks, while others may have only one yearly. The intensity of these episodes will also vary dramatically, though typically, they do worsen and become more frequent as the condition progresses. Paroxysmal is defined as an Afib episode that lasts less than one week and stops naturally or with treatment.

During this stage of Afib, the well-selected patient will have a greater than 70% chance of correcting their condition the first time using a minimally invasive and very safe treatment modality known as cardiac catheter ablation, where we destroy heart tissue causing errant electrical firings using heat or cold therapy. A second catheter ablation can increase success rates above 80%.

New technology, known as electroporation and commonly referred to as Pulsed Field Ablation, has just hit EP labs and has similar results.

Persistent Afib

The persistent form of Afib is diagnosed when the heart rhythm issues last for more than a week. The body may not self-regulate at this point, and treatment is typically necessary to return the heart to regular rate and rhythm. Treatment may include cardioversion or cardiac catheter ablation.

At this stage, patients will have, on average, a lower chance of fully solving their Afib or may need multiple catheter ablations to get the relief that they need. The success rate of a primary catheter ablation will drop to about 50%.

Long-Term Persistent Atrial Fibrillation

Undertreated or untreated atrial fibrillation can soon become a long-term problem, and this is where the abnormal heart rhythm issue has persisted for over one year. Once again, the degree to which Afib is bothersome or debilitating will vary between patients, but typically, at this stage, patients are experiencing ongoing heart palpitations and may be chronically tired and unable to perform routine exercise or other activities that would otherwise strengthen their hearts. This is very concerning because treatment modalities become very unreliable.

Permanent Afib

Occasionally, there is nothing more we can practically do to fight Afib. At this point, we will have tried all the medical and procedural therapies in our armamentarium, but success simply cannot be achieved. Now, long-term management of symptoms will be the primary concern rather than continuing to perform procedural options. The longer-term risk of congestive heart failure is ever present, and patients must be aware of potential consequences.

The bottom line

While Afib itself is not necessarily a dangerous condition, unless you have an underlying cardiovascular issue, it can quickly spiral into a circumstance in which medical and procedural treatments are unreliable or ultimately no longer effective. This is why electrophysiologists emphasize education about this concern that many do not even realize exists.

Further, we encourage patients to visit a qualified electrophysiologist in addition to their cardiologist because we have advanced diagnostic equipment that allows us to diagnose even the most occasional of episodes – those that are often missed using traditional EKG testing.

If you are experiencing non-emergent palpitations and have not received an appropriate diagnosis, speak to a qualified electrophysiologist to learn more and understand the treatment options while they are still effective.