Persistant, permanent or paroxysmal AF? - AF Association

AF Association
17,460 members20,925 posts

Persistant, permanent or paroxysmal AF?

Can someone please explain the difference between the three?

I am in AF everyday for anything between 2 and 5 hours on average but the occasional 12-24 hours - which category do I fall into?

12 Replies

Hi Sharon. I would say paroxysmal. There is a feeling amongst medics that the term persistent should be dropped as it is confusing. I believe that if AF lasts less than 72 hours and can be converted either by cardioversion or reverts naturally then it should be termed paroxysmal . If it is not possible to restore NSR by chemical or electrical means then it is permanent.


Many thanks Bob.

They won't cardiovert. I am taking bisoprolol and digoxin but still have daily attacks (sometimes 3 a day). Should be seeing EP end of July re ablation but still waiting for confirmation.


How on earth do you manage with that many attacks or are they asymtomatic ?

I'm on Flecanide to keep me in snr which they do pretty much. I was in persistent AF for over a year when I had a cardioversion. I'd been on Flecanide before that,50mgrs twice a day,still am. Please tell us how you get on and hope you get better soon. Terjo


Sharon, The definition for the 3 types is:

Paroxysmal: The faulty electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe. They stop within about a week, but usually in less than

24 hours.

Persistent: The abnormal heart rhythm continues for more than a week. It may stop on its own, or it can be stopped with treatment.

Permanent: The abnormal heart rhythm can't be converted to NSR with treatment.

Both paroxysmal and persistent AF may become more frequent and, over time, result in permanent AF.

As Bob said, The term Persistent is sort of confusing and symptoms really fit into the Paroxysmal category.

Are you still taking the DigoxIn? If so, it doesn't seem to be working for you. you might ask about one of the other meds for Rhythm Control that might work better for you.



Hi Terjo and TheStand

Many thanks for taking the time to respond to my question.

Sounds like I am paroxysmal then!

Terjo; sometimes it is asymptomatic and I only know because I check my heart rate on a pulsometer but mostly I know because my heart rate drops to the low 30s for up to an hour before it starts racing at 130-150. It is the slower heart rate that gives me the most trouble to be honest.

TheStand: Funnily enough I have just had my digoxin levels checked (for the first time) and it is way too low so it has been pointless taking it for the last 3 months! I am now on 187.50 mg and have to have another blood test on Friday. As I am going abroad on Monday I have to phone my GP for the results on Tuesday. However I haven't noticed a difference yet! The hospital also increased my bisoprolol a couple of times, 2.5 to 5 and then to 10 but I really haven't seen any change.

Many thanks


This is all very interesting but I am left wondering if one should always expect paroxysmal AF to become more frequent over time and result in permanent AF, or if medication can keep it under control indefinitely in some cases. I keep reading that we are all different in the way we are affected by AF, and how we respond to all the various drugs and treatments available. Additionally the advice and treatment given by G.Ps and cardiologists seems to vary considerably and this must surely affect the control and/or development of AF. The more I read and try to learn about AF the more questions I need to ask, and I am not sure if that is a good or a bad thing!

1 like


Unfortunately, that is the normal progression for AF. As your heart goes into AF it also develops more electrical pathways which make it easier to happen again. In some that can take many years to happen and others it happens rather quickly. The transition to a permanent AF is not a certainty but it is a very likely outcome. In my case I started about 14 or 14 years ago having maybe 1 attack a year and after 12 years I was having 2 to 3 a week and they got much worse over time, lasting longer and more severe.

As to the drugs... The average is around 3 to 5 years of controlling AF with a drug. During that time the dosage may be increased a few times and then it's normally on to a stronger med. Expecting that you can successfully control AF fr 15 to 20 years using only meds is not very realistic. Also putting off a procedure to try and cure AF only decreases the chances that it will work.

About the GPs and Cardiologists... With a GP, AF was one of thousands of things they covered many years before while they were in school. Unless they have had many AF cases come through and have done much study recently, You may end up knowing more about AF than they do. Also a Cardiologist was trained to handle the mechanical functions of the heart. Not so much the electrical functions. The experts in this are Electrophysiologists (EP), They are cardiologists that have specific training in rhythm problems and are much better equipped to diagnose and treat AF. I trusted a cardiologist for the first 10 years of my AF, just assuming "He is a heart Dr so he knows what he's doing"... I was so wrong. After 10 years of just getting worse and worse I finally went to an EP and began getting treated. My life changed. The EP suggested an ablation in the beginning but I waited almost 2 years before taking his advise. After my ablation, I have now been AF free for about 5 months and am looking forward to many years of not worrying about it.

Don't worry about the questions... Ask away, that's why we are here. Also go to the main AFA site and read everything dealing with AF. The more you know about AF and it's treatments, drugs and procedures, the better this will come out for you.

Hope this helps...



Thank you for all the info. Tim. I am hoping that as I learn more about AF it will give me more control over the treatment I receive and how I deal with each episode and the possible progression of the condition.


Thanks Tim, I suppose I was in permanent AF then for about 18 months by your reckoning trials on many other hypertension meds but each one made me ill, hospitalised on one.

The AF never stopped the pulse rate was controlled with digoxin and 5mg bisoperol twice daily. I asked to be referred to an electrophiysiologist in London who thoroughly examined me, ECCS,scans,pulse etc and put me on flecainide and suggested the cardioversion first (I'd already stopped digoxin as it made me so lethargic I could hardly drag myself around) the Flecanide had no side effects with me but didn't cure the AF . After many more months I had a cardioversion which worked. I still take Flecanide and asprin plus zopiclone , to sleep, I think the Flecanide makes me non sleepy. I've had four AFs ,since the cadioversion ,one in March, another two in May and one in June. The first lasted 18 hours.the second 4 the next 3 and the last one was under 1 hour. I'm not telling anyone else do anything different but I'm just hoping this works for me. I keep quiet lying down or resting comfortably and breathe deeply.

Using the resperate machine has really helped me. They have a website. Hope this helps.



Terjo hi, your post confused me somewhat. If your cardioversion " worked " why the 4 A/F turns ? Sorry to sound so nit-picking but I am down for a cardioversion next week 10th july and I need all the goodnews I can muster.



Hi Charles, it works when it lasts for some time . I was clear of AF for more than 18 months and then had the first AF when they gave me atropine in hospital, when I had a low pulse , it didn't happen in hospital but a few days later when I was visiting London. Since then I've tried to sort out my meds and have started the breathing and I'm in a much calmer mood since finding this forum. Cv doesn't usually last forever but it buys time and is markedly better than having frequent AFs . Good luck and let us know how it goes. Terjo




You may also like...