Hello,
Thank you for your query.

Paroxysmal AF is a condition where the heart rhythm suddenly changes to atrial fibrillation which lasts for a small period of time.

I can see from the details that you have provided that you are 71 years of age and have hypertension, both of which are risk factors for developing AF. You have been treated with radio-frequency ablation and were on flecainide till recently.

Paroxysmal AF is often quite difficult to diagnose and treat. It is good that a definitive diagnosis has been made in your case. Radio-frequency ablation of the foci in the atria responsible for the initiation of AF is considered as the treatment of choice in preventing recurrences of the arrhythmia.

Many a time, the foci are located at the entrance of the pulmonary veins to the left atrium. Isolation of the pulmonary veins with ablation is usually adequate to prevent AF. However, at times, there may be other sites which are responsible. Hence, ablation of these sites after appropriate identification will also help.

Drug treatment to prevent AF has had more limited success. Drugs like amiodarone, flecainide, propafenone, ibutilide are used for acute conversion of AF to sinus rhythm. Drugs like amiodarone, dronedarone, dofetilide, etc have been used to maintain the normal rhythm. However, these are not fool-proof and have significant side effects. Drugs like digoxin, beta blockers and calcium channel blockers have been used to control the rapid ventricular rates during the episode of AF.

Another important aspect of treatment is to prevent the formation of blood clots in the atria and their embolisation to other areas like brain, limbs, kidney, spleen, etc. Hence, oral anticoagulant drugs are used. It is now recognized that paroxysmal AF also has a risk of thrombo-embolism and blood thinning agents are probably needed, unless there is a high risk of bleeding.

There are some specific types of pacemakers used to prevent AF by artifically pacing different sites of the atria. There are also atrial defibrillators which convert AF to normal rhythm by automatically delivering a programmed shock. But these devices are expensive and have other associated problems which limit their efficacy.

Appropriate treatment of hypertension will definitely help in reducing the burden of paroxysmal AF. Also, it might be worthwhile to identify any thyroid related ailments as also, electrolyte imbalances.

I hope this answers your query. Feel free to ask me for any further clarifications that you may require.
With regards,
Dr Raja Sekhar Varma, MD, DM
Consultant Interventional Cardiologist

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