How Do Stages of Atrial Fibrillation Affect Treatment?

In this video segment, we are going to understand why AFib stages are crucial to understanding why some treatments don't work as well in later stages of AFib?

In this post I will be discussing stages of atrial fibrillation, and why it's important in the management of your atrial fibrillation. Learn here why it matters in your care if you have paroxysmal atrial fibrillation or persistent atrial fibrillation versus permanent atrial fibrillation.

When I first meet a patient who has developed atrial fibrillation they tell me a very common story that they got episodes of atrial fibrillation that previously were short and infrequent. Sometimes people would go several years without developing any episodes of atrial fibrillation, but as time went on they developed more frequent episodes, and those episodes started lasting longer and becoming more severe. The natural progression of atrial fibrillation is that at some point people will get an episode of atrial fibrillation and it just stays and it doesn't want to go away.

Let's talk about the stages of atrial fibrillation and how it can affect the management of a patient with atrial fibrillation:

The first stage is called paroxysmal or intermittent episodes of atrial fibrillation.

These are episodes that come and go and typically last seven days or less. In this stage a patient is in normal rhythm the majority of the time.

The next stage is called persistent atrial fibrillation.

In persistent atrial fibrillation you have continuous AFib that lasts more than seven days.  Long standing persistent AFib is when you're in continuous atrial fibrillation that last longer than one year.

Lastly there is permanent atrial fibrillation.

Permanent atrial fibrillation is a clinical diagnosis where a decision has been made by both the patient and the doctor to no longer try to restore normal sinus rhythm by any means, which can include either medications or ablation procedures.

Why are these stages so important?

As people progress in stages of atrial fibrillation, when you go from paroxysmal to persistent and then longstanding persistent, your heart inherently changes and becomes more used to being in atrial fibrillation. As you get more episodes and progress further down in stages the upper chambers of your heart become more stretched and dilated. In addition a patient also gets more scar tissue inside of the atrium where the AFib comes from in a process called fibrosis. Even down at the cellular connections of the heart it inherently changes as you develop more atrial fibrillation, even microscopic electrical channels of the heart change the longer someone has atrial fibrillation. All of these make it more difficult in order to try to maintain or return to normal rhythm as atrial fibrillation progresses.

The progression of AFib is the inherent answer of a question that I get sometimes of, “why didn't this procedure work, or why didn't this medication work?” This is because not everybody's atrial fibrillation is the same. As the disease progresses it becomes harder and harder to maintain normal rhythm. Like in any medical condition, the earlier you catch it, the earlier you're treated, the better your success rate can be whether that is with medications or with ablation procedures.

These stages are why I frequently recommend patient to get early consultation with an Electrophysiologist. An Electrophysiologist, like myself, is an expert in heart rhythm disorders such as atrial fibrillation. During the earlier stages of atrial fibrillation, like paroxysmal atrial fibrillation, you will have more treatment options as well as a better success rate from any procedure or medication.

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