Paroxysmal Atrial Fibrillation: Symptoms, Diagnosis, and Management

Paroxysmal Atrial Fibrillation

Dear Dr.
Lin:
Previously, I experienced discomfort near my chest after exercising, so I went to the hospital for a check-up.
Initially, I visited a municipal teaching hospital, where I was prescribed Concor and Earlet after the first consultation and scheduled for a 24-hour Holter monitor test.
The results showed no significant symptoms.
However, I later experienced various abnormal sensations around my chest and heart for a week, so I consulted my family doctor at a clinic.
I found that my heart rate was somewhat elevated, stabilizing around 100 beats per minute.
My doctor advised me to return for further evaluation, but my 24-hour Holter monitor test showed no abnormalities [the test was done without discontinuing medication], as the doctor did not specifically instruct me to stop taking the medication.
Following my clinic doctor's recommendation, I switched to another hospital.
On the day of my visit, I first underwent a resting electrocardiogram (ECG), followed by a consultation.
After the consultation, the doctor performed a chest X-ray to rule out any acute conditions and confirmed there was no pneumothorax.
Three days later, I had an echocardiogram and coagulation tests, and the doctor reported everything was normal, with no signs of pulmonary embolism or other acute conditions.
When I inquired about my heart rate issue, the physician suggested it might be related to my level of physical activity, as my heart rate was not irregular.
However, I was puzzled because I was using a blood pressure monitor that measures atrial fibrillation, and on May 21, it suddenly issued a warning.
I immediately took another measurement, and the warning did not appear again, leading me to believe it was an error.
The day before, I had insomnia, and when I woke up the next day around 10 AM, I took an extra measurement [because my heart rate was unusually slow, but I didn't think much of it since the eye pressure-lowering topical medication contains a beta-blocker].
The second measurement showed a heart rate of 90 beats per minute, and then the atrial fibrillation warning appeared again.
I took another measurement immediately, and the warning did not reappear.
To gather more information before my appointment, I measured my heart rate hourly, and in the afternoon, the warning appeared again, this time with a heart rate dropping to 60 beats per minute.
[Question 1] Does Concor, a medication that slows the heart rate, affect the results of a 24-hour Holter monitor test? If so, should I retest?
[Question 2] Paroxysmal atrial fibrillation can last from a few seconds to several minutes, but can such brief episodes be detected? I noticed that the warnings occurred more frequently in the days following the initial alert.
[Question 3] What is the impact of very brief paroxysmal atrial fibrillation on health? If it is detected but is transient and resolves quickly, how should it be managed?
[Question 4] I am preparing for a follow-up appointment; how can I best communicate with my doctor?
Thank you.

Li Guanting, 20~29 year old female. Ask Date: 2016/05/22

Dr. Lin Jixiong reply Cardiology

Hello,
1.
Concor may affect heart rate and rhythm, which could potentially influence the results of a 24-hour Holter monitor.

2.
Very brief episodes of atrial fibrillation may not be detected during the examination.

3.
If arrhythmia resolves within a very short period, it is advisable to discuss this with a cardiologist.
When consulting with the physician, you should clearly describe the frequency of the episodes, how long the symptoms last, and how the related symptoms manifest.

Dr.
Lin Chi-Hsiung

Reply Date: 2016/05/22

More Info

Understanding Paroxysmal Atrial Fibrillation (PAF) is crucial for managing symptoms and ensuring proper diagnosis and treatment. Let's address your questions one by one, providing clarity on the implications of your symptoms, medications, and the nature of atrial fibrillation.

Question 1: Does Concor affect the 24-hour ECG measurement results? Should I retest?
Concor, which contains bisoprolol, is a beta-blocker that slows down the heart rate. This medication can indeed influence the results of a 24-hour Holter monitor (ECG) by reducing the heart rate and potentially masking episodes of tachycardia or arrhythmias. If you were experiencing symptoms of palpitations or irregular heartbeats while on this medication, it might be beneficial to discuss with your doctor the possibility of retesting without the medication. However, it is essential to do this under medical supervision, as stopping beta-blockers abruptly can lead to rebound tachycardia or other complications.

Question 2: Can extremely brief episodes of paroxysmal atrial fibrillation be detected?
Paroxysmal atrial fibrillation can indeed be challenging to capture, especially if episodes are short-lived. Standard Holter monitoring may not always detect very brief episodes, particularly if they occur infrequently. However, if you have a device that can monitor your heart rhythm continuously, such as a smartwatch or an event monitor, this may provide more data on your heart's activity. If you suspect that you're experiencing these brief episodes, it’s worth discussing with your healthcare provider the option of longer-term monitoring or using an implantable loop recorder, which can capture arrhythmias over extended periods.

Question 3: What are the health implications of extremely short paroxysmal atrial fibrillation episodes? How should they be managed?
While brief episodes of atrial fibrillation may not pose an immediate risk, they can still be concerning, especially if they are symptomatic. The health implications depend on the frequency and duration of these episodes, as well as any underlying heart conditions. If you experience symptoms such as palpitations, dizziness, or fatigue during these episodes, it is essential to report this to your doctor. Management may involve lifestyle modifications, medication adjustments, or further diagnostic testing to assess your risk of stroke or other complications associated with atrial fibrillation.

Question 4: How should I communicate with my doctor during my next visit?
When preparing for your next appointment, it’s helpful to be organized and clear about your concerns. Here are some tips for effective communication:
1. Document Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any associated activities or medications. This information can help your doctor understand your condition better.

2. List Questions: Write down your questions in advance, including those about the effects of your medications, the nature of your symptoms, and the need for further testing.

3. Be Honest: Share any concerns you have about your health, including anxiety about your symptoms or the potential for atrial fibrillation.

4. Discuss Monitoring Options: Ask about the possibility of extended monitoring or alternative diagnostic tests if you believe your current testing may not capture your symptoms accurately.

5. Follow-Up Plan: Ensure you understand the next steps, whether that involves medication adjustments, lifestyle changes, or further testing.

In conclusion, understanding paroxysmal atrial fibrillation involves recognizing its symptoms, the impact of medications like Concor, and the importance of effective communication with your healthcare provider. By being proactive in your health management and discussing your concerns openly, you can work collaboratively with your doctor to find the best approach for your situation.

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