Dr John's 12th "Fact"

[Beancounter]

For those who have not seen it I shall not link to it as the website is well known and linked widely in this forum, but instead I shall post it in it's entirety.

"If your AF heart rate is not excessive, it’s unlikely that you will develop heart failure. Likewise, if you have none of the 5 risks for stroke, or you take blood-thinning drugs, AF is unlikely to cause a stroke. In these cases, you don’t have to take an AF-rhythm drug(s) or have an ablation. You can live with AF. You might not be as good as you were, but you will continue to be."

OK this roughly speaking sums up where I am and what my Cardio has told me, I am in permament AF but without a severely raised heart rate (generally around 75-85), or BP generally 120/80-90 ish. I have none of the 5 risks for stroke, and I take warfarin, although the Cardio did say I could come off if I wish, and I preferred to stay on, as like Tim, stroke scares the heck out of me.

However this then does not really make sense if we believe the A Fib is a progressive disease.

So for example StopAfib.org publishes this article

stopafib.org/progresses.cfm

and if I may quote just one line from it

"The longer you have afib, or the more persistent it becomes, the harder it is to treat."

And it's not as though this website is alone.

There is "Afib begets Afib", "The progressive nature of Atrial Fibrilation", and many many other sites which state quite categorically A Fib is a progressive disease.

So which is correct? or are they both correct?, Is Dr John really saying that A Fib is progressive but that if you have almost no symptons, then the risk of treatement is worse that the risk of waiting and treating it IF and when the A Fib gets worse?

I am confused, and of course nervous, I am not even seeing my cardio for another six months now, and yet I am truly worried what damage may be occuring without it being treated.

Any opinions out there?

[TheStand]

Ian,

Very good points and some interesting thoughts in there. Although there is some flaw in his conclusions.

First his statement that "If your AF heart rate is not excessive, it’s unlikely that you will develop heart failure." He is basically correct. I agree that if you have AF, then the lower heart rate is better for you. That is like saying if you have cancer but is a non lethal form then you're ok? I would still want to do all that I can to get rid of it. With AF being an irregular heartbeat reducing the pumping effectiveness of the heart, even if it is not a "Critical" problem over time the lack (or reduced amount) of oxygen being supplied to the cells would have to have an affect. And a muscle was not meant to be overused and somewhat stressed continually. And just the word "unlikely" is a problem. I have 5 grandbabies now and twins on the way so I want to be around for them as long as possible (they are so fun to play with) so I would not be assured by the unlikely chances ad will do what I can to increase my chances of sticking around.

Next... "if you have none of the 5 risks for stroke, or you take blood-thinning drugs, AF is unlikely to cause a stroke." No matter what the level, the irregular beat will always increase you chances of developing a clot. Even for those of us who are on "well controlled" anticoagulants, still have that risk, although greatly reduced. There are a few ways to look at this. With Paroxysmal AF, the greatest risk of developing a clot is during an attack when the heart is not pumping correctly. With Permanent AF the heart is not pumping correctly "all of the time". The advantage to Permanent AF is that the heart will not start pumping correctly after an attack (because the attack never stops) so this sort of decreases the chances that the developed clot will be pushed out into the system. I don't know the exact math but logically being in a risk situation 24 hours a day/7 days a week would increase my risk of developing a clot over someone with Paroxysmal AF. In his statement using the words "you take blood-thinning drugs" conveys the idea that you are no longer at risk. I know that is not what he meant to put across. Even on anticoagulants you are still at a higher risk of stroke than a person who does not have AF, but less that if you were not taking a blood thinner. And then to finish off that part he again says "unlikely" to cause a stroke. I just don't like that word when it's used concerning my lifespan.

"In these cases, you don’t have to take an AF-rhythm drug(s) or have an ablation." Again he is 100% correct. You don't have to do either of these. Taking Rhythm control drugs is never a perfect choice due to the side effects that all meds have. But a balanced decision on benefits VS risks. Will this drug lower my risks, or improve my quality of life more than the risks if I don't take it? The same can be said on ablation. The same choice needs to be made. IMO anything that can be done to improve my quality of life and lower my risks for stroke is worth a try, but even that has limits. Look at the stats for Amiodarone. To me that is the last choice and it would have to be "There is nothing else to try" before I would even consider it.

"You can live with AF"

Yes, you can live with AF and I know many who do. But that risk VS benefit thing again asks the question... What is the benefit of living with a condition that is increasing my chances of stroke and heart problems?

"You might not be as good as you were, but you will continue to be." Is that a guarantee in writing? I would love for someone to guarantee me that I will continue to be. Even those without AF don't get that promise.

------------------------------

"The longer you have afib, or the more persistent it becomes, the harder it is to treat."

And it's not as though this website is alone.

There is "Afib begets Afib", "The progressive nature of Atrial Fibrilation", and many many other sites which state quite categorically A Fib is a progressive disease.

So which is correct? or are they both correct?, Is Dr John really saying that A Fib is progressive but that if you have almost no symptoms, then the risk of treatment is worse that the risk of waiting and treating it IF and when the A Fib gets worse?

---------------------------------

First I never have liked that phrase Afib begets Afib... It just doesn't sound right but it's idea is sound. I liked the way it was explained to me by my EP. "The more Afib happens causes the heart to learn how to slip into Afib easier and eventually can make it easier for it to just stay there." A simple way of stating a complicated medical process that I wouldn't have understood at the time.

And Which is correct??? I would have to go with His own statement "The longer you have afib, or the more persistent it becomes, the harder it is to treat." . Which sort of answers you last question about the risk of waiting. I think, with all that has been learned about AF in the recent past, the question of "IF" has just about gone away and has been replaced with the "When".

I just can't agree with the idea of "Just live with it". At the very least (dealing with permanent AF) slowing down the heart using rate control meds will take some stress off of the heart and will decrease the chances of problems down road and increase the lifespan of that muscle. And another minimum is to decrease the risk of stroke using anticoagulants. But why continue to live with it instead of trying to eliminate it.

Wow Ian, you really caused me to think about this one.....Thanks

Tim

[tk11]

Hi Ian,

As you know I am fairly new to all this only about a year with drugs and advice changing regularly, I have just been put onto Amiodarone you mention above...more info please.

Tina

[TheStand]

Hi Tina,I mentioned Amiodarone in my response to Ian's post. Amiodarone is possibly the best of the Rhythm Control drugs. Most experienced Drs will use it on a short term basis because it almost always works to return and keep the patient in NSR.

Here is a statement from Drugs com. "Amiodarone is for use only in life-threatening situations. This medication has the potential to cause side effects that could be fatal, and you will receive your first few doses in a hospital setting."

Reported studies gave many problems with extended usage including the Liver, Kidneys, Vision, Nervous system, lungs and many other serious complications. Most EP's will only give Amiodarone to patients as a last resort with all other meds being tried and usually after surgical procedures tried and failed.

Short term usage is normally OK with a few exceptions But long term usage in not normally done.

If you have any other questions Tina, Don't hesitate to ask.

Tim

[reevo]

Hi Beancounter,

My own opinion is that Dr.John is broadly correct. My reading and research has led me to a similar conclusion. Here are just 2 reasons why :

1. Prior to ablation procedures being introduced in the late 90's, the Mayo Clinic followed a/fib sufferers, both those on the then existing medication and those who chose to refuse medication - surprisingly, their mortality age was virtually identical with the average non a/fib population. Scare tactics by some doctors lead to increased stress on the patients and reluctant compliance to powerful drugs.

2. Mr Schilling ( EP ), during a talk he gave at heart rhythm conference at the Birmingham a few years ago stunned the audience, of which i was one, by telling us that the risk of stroke in most patients those with a/fib has been exaggerated and the risk is only very slightly above general risk in middle aged/older patients. This obviously does not apply to a small percentage of patients with other heart related conditions alongside their a/fib, and those do need to take anticoagulants even with the risks attached. His talk is probably available as mp3 or transcript if your interested.

Once again this shows the importance of doing your own research, as the opinions of consultants and EP's vary considerably.

Good luck