Fast PAF to permanent??

[Gmc54]

Following on from my question yesterday, is there anyone who has gone from fast paroxysmal af to permanent af?

It seems from the replies to my question yesterday that most people who went from paroxysmal af to permanent started off with slow af.

[BobD Volunteer]

I would not agree. Slow AF is quite rare actually. PAF is normally fast and furious .

[Gmc54 in reply to BobD]

Thanks you Bob. I am just wondering if it possible for fast af to become permanent. I only get an episode every 6/8 weeks usually, but they are getting longer each time. I am wondering if fast af can ever become permanent, and if so how do they treat if apart from an ablation - the idea of which frightens the life out of me, in spite of the successes some of our members, including you, have had.

At my surgery there is a gp who ‘specialises’ in heart conditions, but he seems to be very behind the times. The last time I saw him he suggested I went back on Sotolol, which didn’t help during the years I took it. The other doctors at the surgery always refer me to him saying “he is our heart specialist”

I’m just looking for peace of mind. The episodes in themselves don’t frighten mt, but I do worry about what the future holds for me.

[BobD Volunteer in reply to Gmc54]

AF is almost always a progressive condition so the answer to your question is Yes. Ablation is not a cure by the way. Any and All treatment for AF is only ever about improving quality of life (QOL). If you haven't already you need to see an electrophysiologist (EP) as these people really are experts on arrhythmias. Few cardiologists even are so it is unlikely that your GP is qualaified to treat you fully.

That said. many people with permanent AF feel better as the body does get used to one thing all the time and they become asymptomatic. Many people only find out they have AF when they have a stroke or it is discovered during treatment for something else.

So long as you are anticoagulated (if your CHADSVASC score so decrees) and your rate is well controlled there is no eveidence that AF in any way shortens life so it is only comtrolling symptoms that matters.

[Hidden]

Not an answer to your question, but many elderly people with asymptomatic permanent atrial fibrillation are only discovered on routine screening. On questioning they often admit to a history of fluttering of the heart or something similar in the past. This presumably was not usually sufficiently symptomatic for them to have seen the GP.

Arguably it follows they did not have fast paroxysmal AF. I can’t find anything online about this.

So yes I think it would be interesting to hear how long members have had fast PAF before progressing to permanent AF, and whether they remained symptomatic with difficulties with rate control and perhaps needing “pace and ablate”. Equally from more members with permanent AF describing how their AF evolved.

My impression is that permanent AF is yet another condition of the elderly population in the UK that is under researched and inadequately managed.

[BobD Volunteer in reply to Hidden]

I was chatting to Prof Camm a whileback who told me that when he was at medical school AF was considered so common as to be a natural function of age.

[irene75359 in reply to Hidden]

My mother was diagnosed with AF at about 93 and she had no idea. She refused treatment.

[EngMac]

I have read studies that show PAF can turn to permanent AF if the wrong medication is taken. Some medication makes some types of AF worse. Vagal AF is more of a challenge where medications are concerned. If your AF is getting worse after taking medication, you may wish to ask if the medication could be the cause.

[Polski in reply to EngMac]

Thank you - but how do I know I am on the 'wrong' medication, or is it simply by the fact that the AF gets worse. Would the 'right' medication, then, decrease it?

[beardy_chris]

My paroxysmal AF wasn't very fast (say 100 - 120 bpm) but when it became permanent it was at about 90 bpm. Just recently, for diagnostic purposes in hospital, I was taken off my calcium channel blocker (Diltiazem) and my heart was resting at about 120 bpm but up to 160 if I stood up. In my notes, it was stated to be Fast AF.

So, yes, I think fast AF can become permanent and can be brought under control with appropriate drugs (if ablation is not the preferred strategy).

[Gmc54 in reply to beardy_chris]

Thanks Chris, Your reply is quite heartening. (No pun intended!) have you ever been offered, or indeed urged to have an ablation?

[beardy_chris in reply to Gmc54]

I spoke to an EP following a cardioversion that lasted a couple of weeks but didn't really change how I felt much. His advice was not to have an ablation because a) I was relatively asymptomatic, b) I was in permanent AF and ablation is less likely to be successful for patients in permanent AF, and c) there are risks associated with ablation and I probably wouldn't feel much better after an ablation either.

I'm okay with that!

[EricW]

I’m perhaps an unusual case. I was for 20 years or so categorised as slow PAF. About 5 years ago I had a dual chamber pacemaker fitted. Annual checks were all very reassuring until last year when I was told that I had reverted to permanent AF at a rate of 300 bpm. Unlike in the past I have no symptoms. The pulse in my wrist beats at a steady 70 which I’m told is the pacemaker controlling the ventricular beat. The atrials can do their own thing! I’m told that I have had something resembling a spontaneous pace and ablate! Both the pacemaker clinic and my consultant are OK with this situation and I’m feeling fine. Despite being in my mid eighties I’m playing golf, plenty of walking and gardening. I’m due for a cardiac stress test any time soon. That should be interesting. I’m on anticoagulants and aspirin plus calcium channel blockers.

Strange business.

EricW

[MisUse]

I have permanent AF. When first diagnosed I had no idea I had it. Went through phases of it being fast, a number of cardioversions, which worked at first but got to point where it didn't. Discussed ablation and pacemaker, but because of aortic valve leak and narrowing, decided it wouldn't really help. Was on amiodorone for a while which didn't help, but gave me underactive thyroid, thanks. Took me off that and am on Tildiem, digoxin, along with warfarin and diuretic. My AF is now irregular but slow, varies between about 68 and 100, rarely over 100. and don't have to see EP unless I'm concerned. Waiting on valve replacement, so who knows what will happen re AF after that. EP may want to take another look.

[Thomas45]

My AF started off at age of about 48 as fast paroxysmal. Up to about 2 years ago I had only one or two short bouts of fast Paroxysmal a year. Aged 71 I was diagnosed with asymptomatic, persistent AF, which is now permanent. During the 25 years I've had AF I was treated only with medication. The awful Amiodarone for the first 10 months, and then Flecainide, which once I had the right dose vastly reduced episodes. A well-meaning hospital doctor put me on Bisoprolol when my heart had gone haywire during an operation to remove my appendix. He was not to know that 7 weeks later it would trigger urticaria, and a fortnight later send me back to hospital with a "dry" asthma attack. I no longer take any beta-blockers, but still have the urticaria, but not daily, and not so painful. I'm recovering from an asthma attack, but that was not a dry seizing up of the lungs, but an infection which has clogged up my lungs and sinuses. Naturally I take a daily anticoagulant. I've tried Warfarin and Rivaroxaban. Rivaroxaban did not agree with me and I'm happy to be back on Warfarin. I self-test my INR.

[KMRobbo]

Not sure about whether fast paroxysmal AF ever develops to permanent, although mine got progressively worse and more frequent and longer lasting over 2.5 years so I would have thought without the ablation I would have got to longer and longer lasting so eventually it is permanent?

However I can confirm that I was asymptomatic at rest of hr 165 to 190 bpm and I could not tell I had anything.

I only found out I had AF when one I was running right near the end of a run i got a fluttery feeling for maybe 20 or 30 seconds seconds. When I downloaded my gps/ hr from my Garmin i had a spike from 155 ish to 195 ish. It was obvious as it was at the end of the run and was still in my mind. I just thought "strange".

Two months later I got the same fluttery feeling at 9:30 in the evening whilst sat at my computer. I reached for the Garmin plugged into the computer and got a 165 bpm sat down

If i had not wore the Garmin i Would not have known I had AF. The fluttery feeling only lasted 20 or 30 secs then stopped even though the hr stayed high

This lead to my diagnosis