Does anybody know when paroxysmal Afib becomes permanent? I was diagnosed with paroxysmal Afib towards the end of 2022, after I had been fitted with a Linq loop recorder. I was only ever having short episodes lasting up to 8 hours, then on 13th October just gone I started with an episode which is still going on. It is completely wiping me out. I have been confined to my flat because of shortness of breath which is really bad. My gp has been gradually increasing my bisoprolol and I am now at 10mg per day. I don’t know what to do, will I ever go back to sinus rhythm?
Thanks for any help.
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Beatle45
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Definitions seem to vary according to where you are but in general, Paroxysmal comes and goes on it s own. Persistent last longer than seven days and or needs intervention such as cardioversion to return NSR.
Permanent AF is actually just an agreement between patient and doctor that no future attempts to gain NSR are wise or desirable and that henceforth treatment will be limited to rate control (and of course anticoagulation where appropriate).
Hi Beatle, I was diagnosed as persistent AFib just 2 or 3 months after my first diagnosis of paroxysmal Afib. Persistent in this instance meant that the arrhythmia was present 24/7 without a break. For my Afib to be labelled permanent I would need to agree with the medical team that I remain in Afib receiving appropriate medication to reduce symptoms without any further procedures.
As I was very uncomfortable with persistent Afib with symptoms as you describe I decided to explore other options. There was a huge waiting list to see the electrophysiologist (EP) so I booked a private appointment to discuss the pros and cons of cardio version and ablation. Since taking this route I am currently back in NSR but I understand that if Afib returns it will be persistent until I have a touchup ablation or decide to live with it.
Good luck and hope you soon feel more comfortable.
I’ve had 3 cardioversions, first one paid for privately and the others on NHS. And the ablation was on NHS too. Im lucky the EP I saw privately also works for NHS.
Waiting lists were very long after the pandemic which is why I decided to go privately in the first instance. The result of the CV showed it was worth trying an ablation (the cv only kept me in NSR for a week!). The second CV was offered because of the long wait for ablation.
You seem yo be quite lucky with your nhs referrals, perhaps you’re in a part of the country with reasonably low waiting lists. I’ll have to make some enquiries about waiting times here in Portsmouth
I waited 8 months from EP consultation to ablation with sedation.However it took 18 months to get to seeing an EP including a failed cardioversion at 12 months.And I had to fight all the way.At 74 with other comorbidities it was only my previous active life and pushing to keep my QOL.
However the waiting list
For ablation with General Anaesthetic would have added another 12 months to the wait.
Best to have your GP refer you to an EP or cardiologist for further testing. Early intervention is better for success.
As mentioned, a cardioversion to restore NSR and and possibly an antiarrythmic drug to maintain would be a first step. Does GP have you take an anticoagulant ? Also, the increase in Bisoprolol may be causing side effects which should lessen over time.
Being in persistent or permanent afib is not the worst thing if your heart rate is controlled and you are taking anticoagulants. Important to be positive during the journey. (easier said than done).
Bisoprolol may be adding to your breathlessness - do not stop taking it but ask for a referral to an Electriophysiologist (EP) and go through other options with him. This may mean a change of rate control medication and trying cardioversion CV to see if that puts you back into Normal Sinus Rhythm (NSR) and if it does this could signpost the way for you to have an ablation.
Following on from the previous reply, you do not need to see an EP first but you do need to see a cardiologist with a special interest in AF. There is some info missing from your post. If you have had a recorder it suggests you may have seen a cardiologist at some point already. What did they say? Do you know what your heart rate is? If not high (under, say, 110) the bisoprolol could be the culprit for the breathlessness.
Some advice : Do not be fobbed off with ‘It’s an old age thing, most old people live with it quite happily’. No, those are the ones that didn’t know they had AF because they had few symptoms. If you can’t leave the house there can be all sorts of knock on effects in terms of physical and mental health. Your GP needs to get off their ‘chair’ and help you more effectively!
Although I have a recorder fitted and I have a”named” cardiologist I have only spoken to her on the telephone just once, that was before my recorder was fitted . There has never been any discussion about treatment, that has been left to my go.
I'd contact the cardiologists secretary and explain what has happened how long you've been in constant Afib and how it is limiting you, include the breathlessness. And that you would like to be reassessed ASAP. The cardiologist can also refer you to the EP. This is the normal route tbh. It's not on for it to be left to your GP. Beyond their skill set as you are not stable. I'm afraid you will have to be politely pushy.... No one notices the quiet stoic ones am afraid... Lol.
I thought I was persistent too as my last couple of episodes lasted months until I was cardoverted but my EP says otherwise, said my hearts got no fibrosis and is of normal size.
If you’ve got a heart rate above 100 take yourself to A&E, they’ll give you adenosine & amiodarone to try and revert you back to sinus rhythm,
Oh and it’s probably the bisoprolol that’s wiping you out!
I did, the adenosine didn’t work for me but after a few nights in hospital and lots of different meds & treatments I was back in sinus rhythm thanks to the amiodarone.
PS to my reply to Desanthony, if your GP isn’t helpful enough, go out for a walk to a shop where you will need to sit down because you are so breathless. Agree to them calling an ambulance. GPs have to pay for A&E visits ☺️
Tbh I can’t remember where I got that info and I can’t find it now so I may be wrong. But an ambulance callout costs the NHS £269 which would often have been saved if the GP had treated the patient adequately.
I've has proximal afib since 2010. Has an Ablation on 2011 didn't work 12 months later a flutter caused by the Ablation the previous year. I don't care what people say you can control your afib by changing your life style like eating well not eating to late not eating big meals stay away from alcohol don't smoke exercise lightly and when I fall into afib I lie down slow my breathing and take more of the medication like Flecainide. Catheter Ablation is about 35 percent effective. It's not the inside of your heart that they should be burning the problem is on the outside where the nerves are the pulmonary veins are just muscle the nerve are above them. I'll be roasted for saying this I know
You're correct, but I would say that most people in afib have triggers. I do myself and for no reason I can start feeling my heart starting to betray me, but before when I wasn't taking care of myself the attacts were brutal, now not nearly as bad. Everyone is different I understand that. I'm just saying life style modifications have made a huge difference for me. paroxysmal there spelled it correctly.
I think that my A Fib was undiagnosed for years. Never been a smoker and always drank very little. Started off with paroxysmal but long attacks early last year. About once a month. Stopped alcohol, greatly reduced caffeine, lost weight (though BMI wasn’t huge ) took my medication - yet progressed very quickly via persistent to permanent. Antiarrhythmics didn’t work, ablation didn’t work - so now I’m on rate control.
I think there are many like me. Many for whom genetics plays a big part. Im fairly accepting of it - just get tired legs on hills and stairs.
It’s a ‘mongrel condition’ due to it being different for everyone.
If you look at the top of each comment it will give the name of who's replying (including your own name, if it's you) and next to it in fainter letters it will say 'in reply to_____' and give the name of who they/you are replying to. So if you look at my comment you'll see that it says 'in reply to Tut7iFru7i'.
No, they didn't - but I was replying to Tut7iFru7i, which it says at the top of my comment next to my name. I was just having a giggle - I didn't mean for it to turn into this. 😀
I was also having a giggle, Tut7iFru7i responded to the OP Beatle45 instead of the person making the typo Brandue but Tut7iFru7i made a typo also which Hidden responded to and mentioned the OP Beatle45 ’s typo, then Beatle45 responded with “nothing to do with me”
Sorry, I have time on my hands sitting waiting for an AF episode to end.
Bless you. I think that dose of bisoprolol would wipe most people out. I was extremely breathless on even a small dose.Whilst you're waiting on EP you could consider talking to GP re medication options. Alternatively a private cardiology consult (for guidance on meds and poss procedures) would not be too expensive if the wait is long to see one on the NHS.
There are lots of options. Don't suffer in silence.
I agree with everyone who has suggested that you see Cardiologist /EP. That is a high dose of bisoprolol, and it could be making you very tired. It mainly controls the heart rate.
I am on it, having accepted that my AFib is permanent. The clinic recently reduced it from 5mg to 3.75mg - and I definitely feel more lively!
What kind of AF do you have? If it's vagal betablocker are rather counterindicated. Check your symptoms here richardbogle.com/blog/vagal.... I couldn't breathe after one week of 2x 2,5 mg bisoprolol per day. I would look at cardioversion being likely your best 1st option.
I checked your Bio and yes your AF after eating is a major symptom for vagal AF. Also your permanent heavy backpain likely contributes a lot to stress which is another AF trigger. GP is not your best option, sorry for that.
I have vagal afib (and have for over 18 years) and do really well on Bisoprolol, though I admit I am on the lowest dose ( still quite powerful though).
I think the jury is still out on that to be honest, there have been other threads about it, but I don’t think it’s conclusive. Everyone reacts differently.
It's good if they work for you. I do take the smallest possible dose only if I don't see any other option which I truly hope will cease to be a problem after my MiniMaze in Japan.
However, this paper academic.oup.com/europace/a... gives a good summary about the changing perception of betablockers in AF.
Thankyou, yes, I have read the trials that led to this paper too, but the studies/trials again, were quite limited and the people studied did have other ‘things’ going on, including hypertension, which would add to their issues, so I still think the jury is still out I’m afraid.
Good luck with your mini maze, I really hope it works for you 🤞
Thank you for posting that paper - it's really interesting! As someone suffering from PAF who has a low/normal HR and blood pressure this is very relevant to me.
It's just amazing that these medications are doled out like Smarties with - according to this paper - little investigation into long term effects. When I had my first AFib episode I was immediately prescribed Bisoprolol 2.5 mgs which I declined as my normal resting HR is low 50s, sometimes below 45. Had I not known that or been aware what betablockers do I probably would have been barely able to move! I was then given Biso 1.25 mgs to use as a PiP but I've only taken it a couple of times and felt so unwell I had to lie down.
And best wishes for your Mini Maze - I look forward to hearing all about it!
i must write to you on the subject you are suffering from .for years i went in and out of a f.maybe for 2 hrs one time and the next time maybe longer .iwas never on medication .and nievely thought oh well i can handle this if thats all it is.then in 2020 it flipped out but didnt flip back in.i went in to hospital to have a cardioversion but it did,nt work.later in that year end nov , i had a phonecall from bristol heart institute to ask would i be interested to come into a private hospital in bristol called the spire.and have an ablation i jumped at the chance as i could not take a dozen steps without hanging on to the nearest wall chair etc as i was so breathless i went in after knowing that it would take just a day.oh dear !it couldnt be done as i had fluid around my lungs due to heart failure.i was given duiretics and just peed and peed.i felt soo much better after. but my wonerful consultant dr ashley nisbett said you are not going home before we fit a pacemaker.i had it fitted and with meds i feel wonderfuli walk my dogs for 1hr plus and do everything a housewife does i am so blessed.are you being checked frequently?if not ask your doctor and make sure you have a blood pressure machine and use it every day.my meds are duiretics digoxin dabagliflozin and bisoprolol .god bless xx
I'm sure your GP means well but they are not heart specialists. They also are encouraged to stick to cheaper medications like Bisoptolol rather than newer and more expensive drugs such as Nebivolol. As others have suggested, see if you can get a private consult at a local NHS hospital. Prices vary, ours was just £140, but you get a face to face, and in our case NHS appointments for all the pre-cursor tests such as echo cardiograms.
In our case, following the tests, a cardioversion was recommended, and we did have to join the NHS queue for that.
Most importantly, the consultant at face to facecl reviewed the meds and changed them which did help with the breathlessness and lack of energy.
I was diagnosed with permanent AF when my dreaded Apple watch told me and my GP confirmed. However, I am, lucky in that at 65 I work full time and it does not affect me. However, I am on 2.5 mg of Bisoprolol and I am convinced it gives me muscle aches and affects the general dopy level. I do find, however, ( people will yell at me for this comment ) that a lot is in the mind. The more you think of AF the worse it gets. Buy a dog, you spend time walking and talking and less time thinking and sitting.
You've had a lot of replies but have you thought about asking your GP for a referral to be started on an anti-arrhythmic medication such as flecainide?
My now elderly friend, recently turned 90, has had permanent AF for very many years but, unlike you, manages really well with only warfarin. I would guess this is because his heart rate stays relatively normal. He does now have mitral valve leakage, which I have often wondered might have been caused by his AF, but his doctor didn't attribute it to that, only to his advanced age (and his daughter has the same, but without AF - so it might be familial).
You are unfortunate having to deal with such symptoms. From reports here and elsewhere on the internet, it seems that when AF becomes permanent, often the symptoms reduce dramatically and the heart manages well.
I have been in Afib for about 3 days with only a short break inbetween. My BPM has mostly been around 80/90 but l can feel it thumping away and my chest is sore. I was recently put on a course of Doxycycline and l am wondering if this can be related to my ongoing afib. I was also told after a recent scan that l have an enlarged left atrium which is a new to me. I am also having a conflict with my GP regarding my medication. After a discussion with my NHS cardiologist it was agreed that l could increase my medication, which is Sotalol, from 120mg per day to 160mg per day as my GP has no knowledge of this they are not prepared to issue me with the required dosage. Unfortunately my cardiologist has just retired and l cannot get in touch with anyone to confirm this.
See "busby62" post for accepted definitions. You are right now in persistent a fib, but the good news is you're not in long-term persistent.
In general, that means you have about the same chances as anyone else of a successful ablation. Something that should be considered sooner than later, because once you get into long-term persistent territory, a fib becomes a lot more difficult to treat.
Alternatively, you could try a rhythm control strategy with daily anti-rhythmic drugs and cardioversion if necessary.
But whatever you do, you want to make a best effort to get back into normal rhythm before your heart starts to remodel.
Increasing your bisoprolol is probably not gonna do that by itself. And at this point, you should be seeing a well-versed cardiologist or preferably an electrophysiologist (ep). GP's are ill equipped to deal with persistent afib.
Look for Dr Sanjay Gupta’s YouTube page, there’s one where he and HIS tutor are explaining the differences. I noted they’d said those with PAF should be offered an ablation rather than continuous medication.
So, suck if being on meds with dire side effects, I’ve recently spoken to my Consultant who’s finally referred me to a Professor!
All different, my PAF, my cardiologist says, no invasive action at all, unless persistent and by persistent he means persistent, and not the type that goes back to normal rhythm in a day or so. Apixaban and to take 2.5 bisoprolol if an attack is how mine continues to behave itself.
One thing i thing most with AF never mention is alcohol, it is the worst trigger for AF. if I have one, my heart knows abuot it. I like a drink, but stopped 9 months ago, and i truly belive my heart is better for it.
I converted to persistent AF after 2-3 yes of paroxsysmal. This is over a year now so permanent. I take Apixaban & 5mg bisoprolol everyday and I can honestly say that I don’t even notice it. Long May this continue. I don’t think that there’s any timetable for conversion. Each person is different.
Trust in your cardiologist, every case is different. I have paroxsysmal AF diagnosed 8 months ago, since then had two episodes, so Cardio says no intervention on his patients unless permanent AF which i agree with too.
My husband has permanent AF he has heart failure and COPD too, he was taken in as H.R. was high and would not come down, had the shock treatment twice, and it worked, now he is on Apixaban and an alternative to Bisoprolol and it has never increased again since, his h.r. is on an even keel all the time, well he has enough problems with h.failure and COPD so at least one thing working for him. For myself, i am on Apixaban only and if i get another attack of AF i am to take 2.5 mg of bisoprolol (pill in the pocket method). I never drink alcohol and this is a no-no, it is the worst thing to bring on anyones AF. and I want to live I am 76 now and never had any heart issues ever until now.
So my advice is stay off invasive procedures unless your cardio says its the best for you. There is no definite that parasysmal will turn to permanent, no rules at all.
Hi Beatle45. I must say I was staggered by all the different replies, and varying aspects of the way folk are having AFib. I'm on Flecainide (100 twice a day, with the option of another 200 if necessary, along with a blood thinner and low dose betablocker (1.25) forgot the name. I've noticed that I get 'stomach flutters, bloating and nausea' often within 20 minutes of eaten (often after 7.0pm meal) and was amazed to see this can relate to AFib episodes. Recently started going to Gym/Swimming, now have a smartwatch and surprised to see that my pulse rate went up over 110bpm just on the 'lowest level' on the cycling machine - for 5 mins. I've been told by cardiologist not to have an upper pulse rate of over 110. Even more amazed to read my heart rate was over 120 from Swimming gently. Which is disturbing, as I'm encouraged to ''carry on exercising'' (which I've been enjoying). Like you I've been wondering the difference between Paroximal AF, and Permanent AF. The descriptions given by another member was really information. One of the frustrating things is daily 'fatigue', even more after exercising; get to 2.0 in the afternoon, and I need to sleep (not just a 20 minute nap, more like 2-3 hours); if I fight my way through and plod on, by teatime I'm wilting, and frequently have an AF episode after I've eaten. I wake frequently during the night, and have even had an Episode starting a 3 a.m. which woke me up.
This 'condition' is more confusing and complicated than I had realised, and as many people have already said 'different for each person'. Perhaps I just have to learn to live with it, deal with it when it happens, and keep taking the meds, and trying to improve my fitness and modify my lifestyle (reducing stress is difficult as my husband now has early Alzheimers Dementia, and it's getting more difficult each day to deal with, and exhausting (I'm 76, he's 71). However, I recognise that things could be much worse, that there are others dealing with far worse conditions, and try to 'accept' what we have to deal with, but this can be difficult at times.
I do hope things improve for you, and you get some help from you GP or consultant. Good Luck -)
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