Paroxysmal atrial fibrillation

### What you need to know A 75 year old man with a history of hypertension, type 2 diabetes, obesity, gout, and stage 2 chronic kidney disease presents to the emergency department with sudden onset of diplopia, left sided hemiparesis, hemisensory loss, dysarthria, and ataxic gait. He reports a 12 month history of intermittent palpitations associated with fatigue, but previous investigations with 12 lead electrocardiograms (ECGs) and 24 hour Holter monitors have been normal. On arrival at the emergency department, he has an ECG which shows he is in sinus rhythm. Magnetic resonance imaging of his brain shows multifocal emboli involving the right middle cerebral artery territory, midbrain, and the cerebellum. Bilateral carotid doppler ultrasound shows no haemodynamically significant carotid stenoses. A review of his inpatient telemetry reveals several episodes of paroxysmal atrial fibrillation, and he is given apixaban for anticoagulation before he is discharged to a rehabilitation unit. Atrial fibrillation is the most commonly encountered cardiac arrhythmia in clinical practice (box 1).7 Paroxysmal atrial fibrillation (PAF) is intermittent episodes of atrial fibrillation that terminate within seven days either spontaneously or with intervention.8 This excludes atrial fibrillation that is triggered by transient causes such as sepsis, cardiac surgery, pulmonary embolism, pericarditis, or other reversible causes. Box 1 ### How common is atrial fibrillation?RETURN TO TEXT