What is a AF Episode/Attack: I have permanent... - AF Association

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What is a AF Episode/Attack


I have permanent AF and take 10mg Bisoprolol. I read on this forum of quite dramatic AF episodes or attacks, some say they can be painful.

What are these Episodes/Attacks? I have mild palpitations but I’ve never experienced some of the symptoms stated on this forum.

I have side effects from the tablets but my heart is pretty stable with a permanent fibrillation.

25 Replies

Lucky b*gger as one leading EP told another such member.

With paroxysmal AF. the transition from NSR to AF is very distressing and in some poor people can involve fainting. chest pain etc. To be serious these are actually few in general and most of us just feel exhausted, confused and yes terrified when the bag of worms starts up. The problem I think is that with yourself, your body has accepted the AF and it is your norm whereas with paroxysmal it is the constant changes and worry when the next event is going to happen.

Hi Howard, there are three types of AF:

1. Permanent which as the name suggests is there 24/7.

2. Persistent which is again 24/7 but can be stopped with a suitable treatment plan.

3. Paroxysmal which comes and goes often without warning.

Because AF is generally a progressive condition, it’s quite common for paroxysmal to develop into persistent and onto permanent. Provided the AF is controlled with medication and the heart rate is kept below 100 bpm, people with persistent or permanent AF are “arguably” better off because their body adapts to the condition and life goes on although activity levels may be affected.

Paroxysmal is a different kettle of fish because the episodes can vary in length and intensity. I suggest you have a look at the information sheets on the AF Association webpage where you will find far more information.

Emsysy in reply to FlapJack

Spot on Flapjack. I went through all stages and the ironic situation now is that I have felt far better generally with my permanent AF than I ever did at the paroxysmal period. In fact, it is very rare for me to know that I am in AF and only a pulse check confirms the situation. Incidentally, I am on the lowest possible dose of Bisoprolol; 1.25 and this has been the case for the last 7 plus years. Having said this, I do get the very occasional period of lethargy which tends to last for no more than a couple of hours or so.

mrahbar in reply to FlapJack

Do you have to have palpitations to be in Afib?

There are several categories of AF - permanent = you have it all of the time like yourself. Many people don’t even know they are in AF as their body has gotten used to it. Persistent AF = when people are in AF all of the time but the Arrythmia can convert to NSR with elcpectrical or chemical assistance. And Paroxymal or PAF = when most of the time a person is in NSR but suddenly go into AF - often with a very fast rate. Personally I’ve never had a rate over 200 but some forum members have. With rates over 150 you can start to feel very ill, my BP has dropped to unreadable levels (below 60/40) and I’ve spent days in acute cardiac unit because of it and not even been able to sit upright. The difference with PAF is that people eventually convert to NSR without interventions, although many use drugs to speed up the process or to prevent AF starting in the first place.

People vary in their lifestyles and how they cope. Permanent AF rarely have noticeable symptoms and seem to cope much better. I think part of the difference is that when in permanent AF you adapt but in PAF the uncertaintity of if or when or where AF may kick means it can be very, very disruptive and many find they become very anxious. Physical symptoms of anxiety seem to precede AF episodes, certainly it was one of the first things I noticed. I took it as a pre-cursor and to get to a place of safety ASAP - ie somewhere I could sit/lie down.

Hope that explains. Best wishes CD,

TamlaMotown in reply to CDreamer

You've explained that so well CD. I am recently diagnosed with Paroxysmal AF & I was assuming that you were in a permanent state of an AF episode with all the distressing symptoms that entails when you have permanent AF & living in fear of it. So it was good to hear you say that people rarely have noticeable symptoms.

mrahbar in reply to CDreamer


Hello Howard :-) it is good to hear Permanent AF is not too bad for some people. I have Paroxysmal AF so there is a good chance I will end up with Permanent AF one day.

When I first started getting frequent prolonged episodes of P-AF it was horrible, racing heart,too breathless to speak, cold sweat,shaking , horrible sensation in my neck, feeling I was going to faint. It is like the body suddenly deprived of the normal heart function and blood flow goes into shock.

With the help of medication and lifestyle changes, the episodes are not severe or frequent now although I still get the odd bad episode lasting many hours but I have learnt ways to manage my fear and anxiety so cope well with them now.

Hi Howard

I have persistent AF and like you do not suffer attacks although I have had a couple. However, I had noticed that I was getting increasingly breathless, dizzy and exhausted. I noticed some side effects from the drugs and as cardio version did not work had an ablation. Hopefully I will be back to normal and will be able to reduce or even give up some of the drugs. Persistent is insidious and it is easy to not realise how it is increasingly affecting your life. I was putting it down to growing older until it was diagnosed and started to understand it. Good luck.

Thanks for all the replies

I have never been told that I have permanent AF, I was diagnosed with Ischaemic Cardiomyopathy and AF. I assumed it was permanent because the heart will fibrillate 2 or 3 times a minute. I do get quite a few missed beats which takes my breathe away but these are short and I’ve got used to them. I am seeing the doctor next week so I shall ask about permanent AF.

I agree that my body, along with the tablets, have controlled the condition such that it feels normal and has seemed to get better with time.

The reason I asked the question is because I sometimes feel a little guilty saying I have a heart problem when I hear what others go through. I was going to have the heart shock but because the AF is caused by the Cardiomyopathy it probably wouldn’t have any effect. So I haven’t had any surgery or procedures like other people, my condition is managed by the medication.

I still have a fitness that allows me to walk quite a few miles, including hill-walking, but sometimes I don’t have the energy or my muscles protest at any exertion. The lack of energy is annoying because it takes away the will to do anything except sit around and this lack of energy is quite persistent.

But I don’t seem to have episodes or attacks so maybe I am better off.

Bisoprolol 10 mgs seems a large dose for someone in permanent AF and I would be surprised if you didn’t have side effects. I have permanent AF and take 1.25 mgs of Biso to keep exercise related tachycardia in check.

What other meds are you taking? Are you still hill walking?

Howardl in reply to Badger2021


Thanks for your reply

As well as the Bisoprolol, I take 2mg Candesartan, 25mg Eplerenone, 2 x 5mg Apixaban and 40mg Simvastatin. I've taken these for about 4 years. I'm seeing the doctor next week to ask about reducing the Bisoprolol as I am sometimes permanently tired which lasts for days. I do walk but not often I don't have the enthusiasm anymore and I am now quite slow but I don't have a problem with being breathless. After reading the replies maybe I don't have permanant AF, I will have to ask the doctor.

I can't take a lot of Candesartan due to low blood pressure, but if they reduce the Bisoprolol then maybe this will allow me to take more Candasartan. I will suggest this but I think it fall on deaf ears.

mbheart in reply to Howardl

I have permanent AF and I take 10 mg Bisoprolol daily. I have to say I do not have any symptoms at all so I was interested in this thread. I used to ask questions about that but after reading these messages for some months now, I started to realize the difference between the types of AF. I also take 5 mg. Lisinopril each day and Pradaxa 2X a day. The meds don't bother me but I have wondered about reducing the Bisoprolol. Please let us know what the doc says.

Then maybe ask for review by your cardiologist? Low blood pressure (with associated symptoms), lack of energy and low mood could well be related to your medication, rather than your cardiomyopathy.

Howardl in reply to Badger2021

I am almost certain most of it is related to the medication. Cardiologist! I used to have one of them.

You can have permanent Afib or Paroxymal Afib (which comes and goes). I have the latter where the heart beats at around 130 bpm and is irregular. Some people may also become breathless and or dizzy and experience anxiety. The condition is often progressive; whilst I don’t get breathless or dizzy at the moment, I’m very aware that could

change. PAF is, for me at least, anxiety provoking.

I have Paroxymal AF and have had three episodes where I have passed out (in public) and fallen, smashing my face up on two occasions and being hospitalised. My heart rate on these occasions was anywhere from 180-260. Very scary. I have had two Cardioversions and am on 5mg Bisoprolol and Apixaban daily.

In general, since my last Cardioversion, I feel “ok”, just permanently washed out and tired. Also suffer with frequent anxiety attacks.

Awaiting Ablation 🙄

hock217 in reply to Algi996

I have SVT and those were my symptoms. On train after walking 4 or 5 miles thought I was passing out....weak and limp, warm and sweaty. Called my son who met at train stop n had him get me a Cadbury bar...helped but I was dehydrated. Stress test n heart muscle fine. Wore 10 lead cardiac monitor for a month. One morning standing in kitchen got a call asking if I was jogging or exercising. I felt fine. Turns out sometimes I get 120-260 Extra heartbeats. Without hesitation, I scheduled ablation. Just take low dose Sotalol n two baby aspirin. Staying hydrated helps. Now am not active. Balance is off so not bike riding or traveling. Will attend balance workshop this week. It's disconcerting to lose confidence.


Thanks for the reply but are we on the same channel?

Recently diagnosed Paroxysmal, 2 attacks in two months, racing heart, felt very weak, like I might faint, also chest tightness and pressure. Now taking metoprolol 25mg and Coumadin 5 mg. My HR was 130 at the highest, but my resting HR is in 60's-70's.

Have been in NSR for a month, but told it will be back. Very frustrating, in my case in runs in the family (sister), hers was persistent.

Take good care.

Not all AF can be ‘elimInated’, no matter what the treatment and people live with it 24/7 for many, many years. The main risk is stroke - which is why first line treatment is anti-coagulants.

Please go to the AFA website and check out your information - there’s Paroxymal AF, Persitent AF and Permanent AF. No loaded guns involved.

Exactly - 2 ablations, 5 years of drugs, lifestyle changes. Now just had a pacemaker implanted and going for AV node ablation which will leave me pacemaker dependant in a few months.

AF cannot be cured but for some people, not all, it can be eliminated - sometimes for good - more often for a period of time and for others it makes no difference - you live with it. The pacemaker will not stop my AF - but it will prevent it from passing from atria to ventricles and so I am not nearly as symptomatic. I’m noticing the difference after weeks only.

I thought the point of the forum was to respond to the questions as asked. The majority of highly qualified and experienced EP’s say they cannot guarantee to eliminate AF so us poor mortals have got no chance!

Depends upon the Pacemaker - I have a three lead re-synchronisation which will work 100% of the time and it isn’t just for raising HR.

If you want to know all my details I suggest you click on my profile pic and go back and read all of my posts.

Ablation 1 in 2013 Mede things a LOT worse requiring a second performed within 12 weeks which was successful - even though there were complications as my heart stopped and needed resuc. No AF for 3 + years but affects of drugs & ablation exacerbated an underlying condition Myasthenia gravis - Which left me even less functional.

Treatments are purely for QOL but in my case they seriously compromised my QOL and it’s been a very long road back!

Hope it works for you, as a procedure I found it quite fascinating, as was the PM implant as I could not help but see the screen and unlike ablation - no sedation so I wasn’t dozing off all the time.

AF is such a mongrel condition - you really cannot generalise and everyone has a unique experience.

Don’t know what will happen with the AV node ablation as I shouldn’t have sedation at all as again it could exacerbate the Mg. I think they will try with just a local and morphine

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