PAF to permanent AF

[Mgal]

I was diagnosed with PAF some 10 years ago and for most of this time AF episodes have been brief and infrequent. In some cases only every few years and never lasting more than a few hours. However recently episodes have been more frequent and my latest ‘attack’ has now been going for 3 weeks. I take warfarin, flecainide and diltiazem which, I’m sure, has kept me under control! Has my AF become permanent and what happens next?

[BobD Volunteer]

Just to be clear Permanent AF just means that you and your medical team agree that no further attempts to obtain NSR are appropriate.

Remember that any and all treatment is only for quality of life (QOL) so provided that rate is well controlled and you are anticoagulated where appropriate then all is good.

It may be that you are not prepared to accept that situation in which case a cardioversion may be tried to see if NSR can be obtained and for how long. That could signpost future treatments but best discuss that with your EP.

[Omniscient1]

The questions you need to ask yourself is , are you in trauma at the moment? Is the current 3week-so -far attack as bad as the early ones? Are you symptomatic or asymptomatic.I presented to my GP with permanent, asymptomatic AF. The only symptom is the ridiculous non-NSR heart rhythm.

My cardiologist decided very early on (but to be fair probably quite a while into my condition) that intervention was unlikely to succeed. Hence no intervention, despite me shaking the tree every now and again.

If you're not in any trauma, discomfort, etc at the moment, then you may have arrived at the other side of this, but like me, not in NSR.

Gary

[Mgal in reply to Omniscient1]

thanks for all comments - I think on balance I’m well off compared to some. HR about 60-70 and very mild palpitations - almost asymptomatic. I’m seeing my cardiologist next week - he offered my a CV some time ago but by the time I had turned up for the appointment I had reverted to NSR. I am not convinced about ablations and my cardiologist is not in favour so looks as if I’ll just get used to it. QoL not suffering - I can still play 18 holes of golf - just curious!

[Ossie7]

Hi Mgal, whenever I go into AF it’s classed as ‘ persistent ‘ as it lasts longer than a week , as Bob says permanent is when the AF is deemed not possible or advisable to try to convert to sinus rhythm by whatever means . So it will depend on how are you are feeling and how symptomatic the AF is as to how it is managed . I am very unwell in persistent AF and have poor QOL as I can barely walk and get chest pain etc . You will need to get referred back to cardiologist for further management if it is causing distress , reduced quality of life etc .

[Buffafly in reply to Ossie7]

And asap because the longer you are in AF the harder it gets to return to NSR.

[Ossie7 in reply to Buffafly]

totally agree, I had to go private cate in the end to get my first cardioversion ( and second !) x

[Lilypocket]

As you were in PAfib until this episode an RF ablation might be of interest as it can be effective in cases such as yours.My posts look grim but now my heart has healed after my ablation, I have been off all meds for over 2 months. Keeping my 🤞.

If your general health permits, your cardiologist feels it could help you and you are symptomatic and would like to try something else if the meds have stopped working as well it may be worth having a chat about an ablation.

Take care.