I still feel quite confused about paroxysmal/persistent/permanent. Diagnosed 3 years ago with paroxysmal and up until 3 or 4 weeks ago I would have an episode maybe once or twice a month and it lasted 2-3 hours. Over the past 3 weeks these episodes have become daily and can last 6-7 hours. I am conscious of my heart beat and my fitbit indicates that my hr is bouncing between 58 and 90 BPM. I take 2.5mg bisoprolol daily but am now taking another 2.5 mg when the episodes occurs which is usually ear!y evening. Does anyone else have these daily episodes and am I still in the 'paroxysmal ' category? I have never see a cardiologist since diagnosis.

9 Replies

  • Yes, you are still paroxysmal.

    Persistent is there all the time but can you can be returned to normal rhythm by something like a cardioversion, even if it only lasts a short time.

    Permanent resists the intervention of a cardioversion.

    Under 90 BPM doesn't sound too bad, but there are various ways forward that could stop you having AF on a daily basis.

    Ideally you should see an EP - electrophysiologist - with whom you could discuss the ways forward that might be helpful.

    Have you had an echocardiogram or a long term ECG - 24 or 48 hours or 7 days?

    I think you started taking warfarin not long ago.

  • Thanks for clarifying this I always considered myself to be permanent as I was always in AF, but cardioversion worked even if it was only for two weeks. I'm now persistent....

  • You are still paroxysmal if you return to NSR without intervention. Under UK NICE guide lines you should see a specialist if your GP has not managed you condition adequately within one month so you do need to see a cardiologist who deals with arrhythmias fairly soon. Start banging desks if I were you. In addition to looking into your stroke risk you should be having an echocardiogram to check that there are no physical/mechanical problems with your heart. (AF is electrical.)

    AF is sadly almost always progressive but yours does seem to be moving rather quickly.


  • Thank you for your replies. I am having to wait to begin my warfarin as gp suspects that I might have an ulcer in my oesophagus which could bleed. I have a hiatus hernia which causes bad acid reflux and take Omeprazole. Can't begin warfarin until after my endoscopy on 29th December. Mentioned seeing an EP to GP who said they only refer if AF is permanent which seems to go against info. which I have read on this site. I honestly find this site far more helpful than the NHS.

    Do you think that I should increase my bisoprolol to 5 mg in the morning instead of taking 2.5 in the morning and then another 2.5 when AF kicks in? Do some people take 5mg ?

    Definitely plan to pay to see EP.

  • Your GP is WRONG! There is no point in seeing an EP when it may be too late for effective treatment.

  • Refer your GP to NICE Guidelines and tell him to stop prevaricating. In this game you need to fight your corner.

  • Bob, what is actually meant by intervention......does it mean without medication such as flecanide or without a cardioversion?


  • My understanding is either John. Flecainide is used for chemical cardioversion after all.

  • thanks Bob....have sent you an email....

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