Paroxysmal Atrial Fibrillation: Symptoms and Treatment Options

Atrial fibrillation

In May of this year, during a follow-up visit, I was diagnosed with arrhythmia, specifically paroxysmal atrial fibrillation and flutter.
The doctor recommended proceeding with catheter ablation.
After the follow-up in June, the treatment was adjusted to medication management.
In June and July, I experienced generalized weakness while on medication, which included Rivaroxaban and Bisoprolol taken twice daily.
During periods of restricted activity, my heart rate increased to 110 bpm, with episodes occurring twice a week, accompanied by fatigue.
Climbing stairs and walking caused shortness of breath, loss of appetite, chest pain, and tightness, with chest pain disrupting sleep occurring twice a month.
In August, I took a month off and switched medications to Dronedarone.
After two weeks, I continued to feel fatigued, experienced nausea and vomiting of white foam, and still had shortness of breath when walking or climbing stairs.
I also suffered from headaches, low-grade fever for nearly a week, insomnia occurring twice a week, and persistent chest pain and tightness averaging three times a week.
While riding a bike or during regular rest, I felt weakness in my heart.
Given these symptoms and the electrocardiogram report, I am wondering if it is urgent for the doctor to schedule catheter ablation.
The 24-hour Holter monitor report is as follows:
PREDOMINANT RHYTHM: Sinus with paroxysmal atrial flutter-fibrillation
GENERAL SUMMARY
Total beats: 117,840
HEART RATE SUMMARY
Min: 44 bpm @ 5:22:21
Total Time: 23:53 Hours
Max: 229 bpm @ 20:08:22
Time Analyzed: 23:41 Hours
Mean: 83 bpm
Total Beats: 117,840
SUPRAVENTRICULAR SUMMARY
Single: 1
Pairs: 0
Runs: 0
Longest Run: 0 @ 19:05
Fastest Run: 0 @ 19:05
PAUSES SUMMARY
A total of 39.7% of the time has been labeled as AFL-AF.

DIARY EVENTS: None
COMMENTS:
1.
Sinus rhythm with paroxysmal atrial flutter-fibrillation (AFL-AF burden: 39.7% of the monitoring period), ventricular rate 44-229 bpm with a mean of 83 bpm.

2.
One atrial premature contraction (APC).

3.
No ventricular premature contractions (VPCs).

4.
No pauses longer than 2.0 seconds.

5.
No ST segment deviation greater than 2 mm.

6.
No entries of symptoms were made in the patient diary.

Note: Three Channels (MV5, MV1, Lead III)

Alin, 40~49 year old female. Ask Date: 2023/08/26

Dr. He Dongjin reply Cardiology

Hello, you have nearly 40% atrial fibrillation.
The treatment options include medication management and catheter ablation.
If you are still feeling very uncomfortable with medication alone, it is important to seriously consider undergoing catheter ablation.
Regardless of the approach, the most important thing is your comfort and well-being.
Changhua Hospital cares about you.

Reply Date: 2023/08/26

More Info

Paroxysmal atrial fibrillation (PAF) is a type of arrhythmia characterized by intermittent episodes of rapid and irregular heartbeats. It can lead to various symptoms, including palpitations, fatigue, shortness of breath, chest pain, and even fainting. Understanding the symptoms and treatment options for PAF is crucial for effective management and improving the quality of life for patients.

From your description, it seems that you have been experiencing significant symptoms related to your PAF, including fatigue, shortness of breath, and chest discomfort. These symptoms can be distressing and may indicate that your current treatment regimen is not adequately controlling your condition. The fact that your heart rate has reached 110 beats per minute during periods of inactivity and that you experience episodes of chest pain and shortness of breath while performing daily activities suggests that your arrhythmia may be affecting your overall cardiovascular health.

In terms of treatment options, there are several approaches to managing PAF. The primary goals are to control the heart rate, restore normal rhythm when possible, and prevent complications such as stroke. Here are some common treatment strategies:
1. Medications: Antiarrhythmic drugs are often prescribed to help control the heart rate and rhythm. Common medications include beta-blockers, calcium channel blockers, and anticoagulants to reduce the risk of blood clots. It appears that you have been on various medications, including rhythm control agents like Dronedarone (brand name: Multaq) and anticoagulants. If you are experiencing side effects like fatigue and nausea, it's essential to discuss these with your healthcare provider, as they may need to adjust your medication regimen.

2. Electrical Cardioversion: This procedure involves delivering a controlled electric shock to the heart to restore a normal rhythm. It is typically considered when medications are ineffective or if the patient is symptomatic.

3. Catheter Ablation: This is a more invasive procedure where a catheter is inserted into the heart to destroy the tissue that is causing the abnormal electrical signals. Given that your doctor has suggested this option, it may be worth considering, especially if your symptoms persist despite medication. Catheter ablation can be very effective for PAF and may provide long-term relief from symptoms.

4. Lifestyle Modifications: Making certain lifestyle changes can also help manage PAF. These include avoiding triggers such as excessive alcohol, caffeine, and stress, maintaining a healthy weight, and engaging in regular physical activity. However, it's crucial to consult with your healthcare provider before starting any new exercise regimen, especially given your symptoms.

5. Monitoring and Follow-Up: Regular follow-up appointments and monitoring of your heart rhythm through Holter monitoring or event recorders can help your healthcare team assess the effectiveness of your treatment plan and make necessary adjustments.

Given your current symptoms and the findings from your 24-hour ECG monitoring, it would be advisable to have a thorough discussion with your cardiologist about the potential need for catheter ablation. The burden of atrial flutter-fibrillation (39.7% of the monitoring period) indicates that your heart is frequently in an abnormal rhythm, which can lead to further complications if not addressed.

In conclusion, managing paroxysmal atrial fibrillation requires a comprehensive approach that includes medication, possible procedures like catheter ablation, lifestyle changes, and regular monitoring. It is essential to communicate openly with your healthcare provider about your symptoms and any side effects from medications to ensure that you receive the most effective treatment tailored to your needs.

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