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What Is Paroxysmal Atrial Fibrillation?

Written by Christine Case-Lo | Published on July 8, 2013
Medically Reviewed by George T. Krucik, MD, MBA on July 8, 2013

Atrial fibrillation (AFib) occurs when the atria (upper chambers of the heart) lose their normal rhythm and beat chaotically.

Skipping a Beat

Chest pain? Lightheadedness? Heart palpitations? Can’t catch your breath?

You may be experiencing paroxysmal atrial fibrillation. Atrial fibrillation (AF or AFib) occurs when the atria (upper chambers of the heart) lose their normal rhythm and beat chaotically.

When this happens, blood isn’t flowing through the heart and body efficiently. This inefficient flow can cause blood to pool inside the atria, increasing the risk of blood clots.

Who Gets Atrial Fibrillation?

According to data from the Journal of the American Medical Association (JAMA), over 2.3 million people in the United States have some type of AFib. Estimates vary widely due to the difficulty of diagnosing different types: 25 to 62 percent of those with AFib have paroxysmal AFib.

AFib occurs more often in elderly people, and the older you are, the more likely you are to have it. Younger people are more likely to have paroxysmal AFib, as opposed to other types. Those with heart disease, thyroid problems, high blood pressure or sleep apnea are at greater risk.


Some people may experience a single episode of AFib. However, people with permanent damage to their hearts experience constant, or chronic AFib.

Paroxysmal AFib is an episode of uncoordinated movement of the atria that occurs occasionally and then stops. Episodes can last from minutes to days before stopping and returning to normal “sinus” rhythm.

Persistent AFib doesn’t stop without treatment, but normal rhythm can be achieved with medication or electric shock treatment.

Chronic or permanent AFib can’t be changed back to normal rhythm, even with medication or electrical shock.

Other Causes

In addition to damage to the heart from heart disease or high blood pressure, medications and other factors can cause paroxysmal AFib, including:

  • binge drinking (4 to 5 drinks within 2 hours)
  • stimulant medications and drugs (ex. methylphenidate, pseudoephridrine, cocaine)
  • nicotine
  • caffeine
  • low potassium (electrolyte imbalance)
  • stress (especially due to illness or surgery)
  • viral infections
  • heart or heart valve defects
  • overactive thyroid


Symptoms of paroxysmal AFib include lightheadedness, weakness, pounding heart, and chest pain. However, further complications also may occur.

Stroke and embolism are the most serious. Blood pooling inside the heart can coagulate and form clots. Those clots can travel to the brain, causing a stroke. They can also lodge in the lungs, the gut, and other sensitive areas, blocking blood flow and starving tissue.

If AFib persists over a long period without treatment, the heart may no longer effectively push blood and oxygen throughout the body. This could potentially result in heart failure.


Treatment for AFib involves resetting the heart’s rhythm and preventing blood clots.

Normal heart rate can return with paroxysmal AFib. Therefore, doctors may try to reset normal rhythm with medications or cardioversion (electrical shock).

Your doctor may suggest an anti-arrhythmic medication like amiodarone (Cordarone) or propafenone (Rythmol) even when normal rhythm has returned. They also may prescribe beta-blockers to control blood pressure.

If you experience another episode of AFib, blood-thinning medications like warfarin (Coumadin) may be prescribed to prevent blood clots.

Progression from Paroxysmal to Permanent

After the first episode of AFib, another may occur. A study published in QJM: An International Journal of Medicine suggests that 70 percent of patients with paroxysmal AFib experience another episode within one year. Furthermore, 90 percent of patients have another episode within four years.

More than 25 percent of people with paroxysmal AFib will go on to develop persistent or chronic atrial fibrillation. Most of these cases experience heart disease as well. Rheumatic valve disease, hypertension, and coronary artery disease all factor in to developing chronic AFib.

According to the American Heart Association (AHA), if your episodes of paroxysmal AFib last longer than two days, you’re more likely to develop chronic AFib.

Living with Paroxysmal Atrial Fibrillation

Staying healthy is key to living a normal, active life with AFib. Treating underlying conditions like high blood pressure, thyroid disease, and obesity can help reduce risk factors for an AFib episode.

Avoid stimulants like caffeine and nicotine, and excessive alcohol consumption to prevent additional paroxysmal AFib symptoms. Lifestyle changes like establishing an exercise routine and reducing stress help as well.

Talk to your doctor and schedule regular checkups.

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