Well controlled paroxysmal a-fib.flecainide 100 mg bid and diltiazem 180 er. do paroxysmal afib episodes generally have warning signs or symptoms leading up to the actual occurrence?

There are usually no symptoms of Afib until the dysthymia happens. Even then, it can be asymptomatic if the rate is controlled and there are not a lot of long pauses between the irregular beats. The main issue with going in and out of Afib is the risk of stroke so blood thinners are often used, if tolerated. Good luck!

It sounds like your a fib is well controlled now. In general paroxysmal attacks are triggered by other conditions, fever, dehydration, respiratory infections among others and in no specific order.