Are there different types of Atrial Fibrillation?
Put simply – yes! Early on in the disease Atrial Fibrillation (AF) can be paroxysmal, which means it can come and go without warning, and you may go for long periods of time between episodes.
When AF first occurs, early episodes may be brief and cause very mild symptoms and it is not uncommon at this stage for some people not to know they have it. However, stroke risk is the same whether AF is persistent or paroxysmal.
There are different categories of AF and these describe the progression of the disease from occasional episodes through to the complete absence of a normal heart rhythm. These categories are:
Paroxysmal AF
AF may be intermittent – the irregular heart rhythm can come and go without warning and you may go for long periods of time between episodes. Episodes stop without treatment, usually within 48 hours and, because they are often brief with only mild symptoms, paroxysmal AF can often go undetected in many people.
Persistent AF
AF episodes lasting longer than seven days or requiring treatment in order to cease.
Longstanding Persistent AF
Continuous AF of more than one year duration.
Permanent AF
When the presence of the arrhythmia is accepted by the patient and doctor and no further attempts are made to return the heart to normal rhythm.
Treatment options
You should talk to your doctor about which treatment option is best for you. Many factors can influence which treatment will best suit you, but the good news is that there are more treatments available now than even before.
Blood Thinners
Patients with AF are commonly prescribed blood thinners to reduce the likelihood of stroke by preventing the formation of clots. There are two different types of blood thinners, which act in different ways:
Anticoagulants
These help to block specific chemical reactions in your body that are responsible for blood clotting. Blocking these reactions means a blood clot takes longer to form and this helps to prevent a stroke.
Heparin and warfarin are types of anticoagulants. Apixaban, dabigatran and rivaroxaban are new anticoagulants, known as novel oral anticoagulants (NOACs), for stroke prevention in non-valvular AF.
Anti-platelet therapy
Platelets (very small blood cells) clump together during blood clotting. Anti-platelet medicines help to prevent this clumping, thus preventing blood clot formation and helping to prevent a stroke. Aspirin, clopidogrel, ticagrelor and prasugrel are all examples of anti-platelet medicines.
In general, anticoagulants are recommended over anti-platelets to prevent AF-related stroke. For the majority of AF patients the benefit of taking an anticoagulant therapy outweighs the risk of a bleed. You should talk to your doctor about which treatment option is best for you.
Medicines for rate and rhythm control
Often the symptoms of AF can be reduced by using medications to slow the heart down (rate control). Sometimes medications may be given to try and:
- convert the abnormal rhythm associated with AF to normal sinus rhythm, or
- to improve the chances of electrical conversion (see below), or
- to prevent episodes of AF if episodes are intermittent (rhythm control)
Often patients taking these medications still need to take blood thinners, and this should always be clarified with your prescribing doctors.
Some people experience severe and frequent episodes of AF which affect their quality of life and do not resolve with medication. Others may suffer unpleasant side effects from their AF medications. In some of these situations non-drug treatments may be an option. These treatments include:
Cardioversion for patients with persistent AF
In this procedure an electric current is delivered through special gel pads positioned on the chest, which may help the heartbeat revert to a normal regular rhythm. Many people undergoing this procedure may also need blood thinners for a limited time before and after the procedure.
Cardiac ablation
In this procedure a catheter (a long thin wire) is passed into the heart chambers via a large blood vessel at the top of the leg or arm. Radio waves emitted from the tip of the catheter destroy (or ablate) small areas of the heart tissue that may be triggering the abnormal heartbeats in AF.
These interventions are not 100% successful. It is essential that you speak to your doctor to determine which treatment is best for you and the risks and benefits associated with treatment.
