Drug Prevention of Paroxysmal Atrial Fibrillation, When and How?

Abstract

Paroxysmal atrial fibrillation is self-limiting since — by definition [1] — attacks stop spontaneously, while only prolonged symptomatic episodes require drug intervention (Table 1). Despite being episodic and self-limiting, paroxysmal atrial fibrillation is a chronic disease: sooner or later after the first clinically significant attack most patients will experience a second one, even while using prophylactic antiarrhythmic drugs [2]. Therefore, drug intervention may at best reduce the number of attacks over time or postpone recurrences. Thus the primary aim of treatment is to improve quality of life rather than to simply suppress the arrhythmia. In this respect patient counseling is highly important. Patients should know that recurrences are a normal phenomenon even when using drugs, and that a breakthrough arrhythmia is not necessarily a sign of drug inefficacy. Consequently, a given drug should be replaced or non-pharmacologic treatment considered only if breakthrough arrhythmias or side effects are not tolerated.