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AF Association
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Paroxysmal or permanent?

Hi everyone....First of all I would like to thank everyone who replied to my question about how long they had been on warfarin...very informative and I am now going to start taking it after refusing anticoagulants for the 3 years since diagnosis of AF. (I know that a lot of you will think I have been stupid for refusing it).

Secondly can I ask when AF becomes permanent? During the past 3 years I would occasionally experience episodes of AF probably monthly which lasted about 3-4 hours with a range of 50-100 BPM. During the past week these episodes have become daily usually in the evening but also had an episode yesterday morning. I keep reading posts about cardioversion and ablation but as I never see a cardiologist this is never discussed. As a lot of you seem to have a vast knowledge on the subject of AF could you please answer the following questions:

Am I now in permanent AF?

At what point is one offered a cardioversion?

At what point is one offered an ablation?

I am female 69 and take 2.5m bisoprolol and resting heart rate is usually in 50's.....is there an alternative/better medication for these now daily episodes? Thank you.

7 Replies

Wow, why have you never seen a cardiologist or better still an Electrophysiologist (EP)?

The treatments for AF are good and improving all the times

Hard to answer your question as to when it becomes permanent but note the difference between permanent and persistent - both you will be in AF all the time but persistent means you can still be converted into NSR - permanent means that will not be possible. Sounds like you are well on the way to AF taking control so I if I were you, I would be pursuing treatment for cardioversion to NSR as soon as possible as the sooner treated the more successful the long term prognosis for NSR,

Having said that, many people on this site will be in permanent AF but still live fulfilling and active lives.

Best wishes CD


PS - I don't think anyone has the right to call you or anyone else an idiot for not taking anticoagulants - I did for a long time.

The decision to do this is always a benefit v risk assessment and a very personal one but sounds sensible to now be on them if you are experiencing daily episodes.


I agree with CDreamer

I suggest you try and get a referral to an EP as they will then be able to discuss cardioversion and/or ablation (I have had both in the past 3 months). Only a specialist can advise in each particular case. We are all different.

I have been taking Bisoprolol for many years together with Flecainide. It has never been discussed for me to be only on Bisoprolol.

I repeat we are all different and I suggest you see an EP sooner rather than later.



From what you have said I suspect you are still in paroxysmal AF. However you could already have flipped to persistent because you can still get events when in persistent AF which makes you feel worse for a number of hours or even days. The only way to tell is whether your pulse is regular for some or most if the time. Best way is with a holter monitor or Kardia.

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Mine changed from paroxysmal to persistent (24/7) very quickly. Say over a period of a few months. I was under a lot of stress at the time which no doubt didn't help.

I find it amazing you have never seen a cardio or especially and EP. That's like having toothache and not going to a dentist. I've never had any success from any other source, so would really recommend seeing a specialist, an EP, not just a "normal" cardio.

My EP put me on some drugs, after trying a few with mixed results, that sorted my then persistent AF and stopped it completely. I remained on those drugs for 2-3 years but then had an ablation to get off them because of the side-effects. The ablation worked 100% for about 8-9 years.

I'm on anticoagulants for life even with a CHADS score of 0 which went up to 1 when I reached 65.




I would say you are not yet in persistent af (based on your description).

If you are reverting to NSR spontaneously then i dont think a cardioversion is going to be useful to you.

My ep asked me immediately if i would prefer drugs or ablation as a first line of treatment. I opted for ablation. I was on bisoprolol for about six months while i waited for ablation. This done in November 2013 and af free since then. So depends on circumstances, your ep and you. I was having almost daily episodes lasting 6 hours ish

I am on no meds except apixaban. I was on warfarin but decided to move to noac as for me easier to manage and probably safer.?

Goid luck 🍀


I quickly responded before.

If you are not in AF then they won't do a cardioversion!!! There's no point as you are in NSR. If you are in persistent AF or actually in AF paroxysmally then there is. If in persistent the key is to see if you can be returned to NSR because that determines treatment options.

As for going from paroxysmal to persistent to permanent they is I understand no fixed or appropriate time or duration or symptoms. It can be weeks or many years. For some the first time they are diagnosed with AF they are already in permanent!!!

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