Paroxysmal atrial fibrillation

Abstract

There has been a tendency to treat paroxysmal atrial fibrillation (PAF) in a similar way to sustained AF, but treatment objectives may be very different. We discuss current definitions, epidemiology, pathophysiology and natural history of PAF, and review evidence for its treatment and management. PAF comprises between 25% and 62% of cases of AF, with similar underlying causes to those in sustained AF. The main objective of management is prevention of paroxysms and long-term maintenance of sinus rhythm, and Class 1c drugs are highly effective, although beta-blockers are useful alternatives. If patients have severe coronary artery disease or poor ventricular function, amiodarone is probably the drug of choice. Although randomized controlled trials of thromboprophylaxis in patients with paroxysmal AF per se are lacking, the approach to patients with paroxysmal AF should be similar to that in patients with sustained AF, with warfarin for 'high risk' patients and aspirin for those at 'low risk'. Non-pharmacological therapeutic options, including pacemakers, electrophysiological techniques and the implantable atrial defibrillator, show great promise. Despite paroxysmal AF being a common condition, management strategies are limited by evidence from small randomized trials, with inconsistencies over the definition of the arrhythmia and the inclusion of only symptomatic subjects. Evidence for antithrombotic therapy is also based on epidemiological studies and subgroup analyses of the large randomized trials.

Prevalence of Paroxysmal Atrial Fibrillation Depending on the Regression of Left Ventricular Hypertrophy in Arterial Hypertension

“…The therapy of paroxysmal atrial fibrillation is one of the great challenges in the treatment of rhythm disturbances. However, treatment of this arrhythmia by drugs, by radiofrequency ablation, or by implantation of antiarrhythmic devices is currently not enough (3). The data of this study indicate that antihypertensive treatment and its resultant reduction of left ventricular muscle mass and left atrial diameter could lead to a decrease in the phases of paroxysmal atrial fibrillation.…”

“…In 25-62% of cases of atrial fibrillation the arrhythmia occurs as a paroxysmal atrial fibrillation (2,3). In the majority of cases, the underlying causes of nonrheumatic atrial fibrillation are arterial hypertension and coronary heart disease (4).…”

“…The treatment of this arrhythmia is important because of its high rate of complications. The prevalence of ischemic stroke in patients with nonrheumatic atrial fibrillation and hypertension or coronary heart disease is reported to be up to 2.0-5.6% (3,5). The therapy consists of either antiarrhythmic therapy or causal therapy of the underlying disease and additional anticoagulation (6).…”

Implications of CHA₂DS₂-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

“…Paroxysmal AF was defined as intermittent episodes of AF interposed with an episode of normal sinus rhythm [14]. In addition, TTE was conducted in all but 78 patients who were uncooperative or presented with an acute medical condition.…”

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke

“…Holter monitorization (HM) and other monitorization methods are used to detect PAF in stroke patients (7). The PAF detection rate is reported to be 2%-25% (8,9,10,11,12,13).…”