36 Year Old Healthy Male Paroxysmal Afib

I am 36 active male who was diagnosed first time yesterday with PAF at the emergency department during an afib episode where they converted it back to normal rhythm using electro conversion. This was the first time it was caught on EKG although I have experienced it before but only about twice a year and have always let it convert on its own on avg of 10 - 12 hours.

My question is with all of the stroke risk calculators I am usually a 0 and so I am torn on whether I should take something like Warfarin or consider Ablation surgery given this or if I would even be a candidate. I exercise daily and relatively fit as well so I would prefer to just live life as is and go in to the ER when an episode happens.

Is this a high risk decision where it is very infrequent when it happens or should I consider drugs or surgery still? I am so confused all of the sites and forums I have been reading are typically people older with other issues compounded with afib so that makes it harder.

Any help would be so appreciated!

thanks,

Ryan

31 Replies

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  • Hi, Ryan! Welcome! I have found this community to be wonderful, and hope that you will find the support by those of us who also are on the same path.

    I can't really speak for your situation, but wondered if you remember your age when the episodes with AF first began? I am older than you, and I have found that as I have aged the number of episodes and trips to the emergency room have increased.

    I opted to treat medically, because my cardiologist and I both felt comfortable going forward that way. I tend to be pretty conservative in my approach to my personal health issues. I think for some, a surgical approach is not an option for one reason or another, and others treating with meds isn't an option.

    One of the first things I did after my diagnosis was to go for a second opinion. Not because I didn't like my doctors or didn't believe the diagnosis, but simply to have another educated and experienced mind review my case. It was very helpful to me as I have moved forward.

    Other than AF I am a very healthy person. My lab test results are always spot on. I eat well and exercise daily. As I have aged, I have noticed that the episodes are happening more frequently, and are beginning to interfere with my day to day living. Somewhat similar to how life was before my diagnosis and treatment.

    I'm so sorry that I can't be more help to you, but there are many here who have had experience along the spectrum of treatment options.

    Best wishes to you! ~ Kel

  • Thanks Kel,

    I would say about 10 years ago so like age 25 when they started, and I have had probably 7 or so episodes in my life total. Its tough to find many people in their 30's with this which I find odd and a bit worriesome to be honest.

    With surgery I read you still should or might have have to still take meds? Also that surgery has not proven to reduce risk of stroke not sure how that is if it has stopped the afib episodes?

    Is this true? Do some people have surgery and never experience it again?

  • To answer that question I had three ablations before my AF was stopped six year ago with no AF related meds since and worth it all.

    The risk of stroke remains because of changes in the inside surface of the atria can still cause blood to eddy which might allow clots to form. At the moment as I said in my other reply,guidelines suggest that just having AF with no other risk factors doesn't necessarily mean you should be on anti-coagulation but there are medics who consider that anticoagulation should be given to AF patients regardless of any risk factors. The targets are moving all the time and what is fact this year may not be next. Stay abreast of all the latest news and move with the time is my advice.

    Bob

  • Hmm, as far as surgery outcomes go, I can't really speak to that since I have not had surgery. When my cardiologist presented the surgical treatment option to me, he did say that I would need to be on meds to continue to reduce my stroke risk since I have had a TIA. I'm hoping that some of the others that have had experience with surgery will be able to give you some more insight by sharing their stories with you.

    I was very young (at least in my opinion, lol) when my first episode took me into the emergency room. I can't really remember exactly how old I was, but I was definitely in my early 30s. Unfortunately, the AF diagnosis was not made because my heart converted on its own before an ECG reading could be made. So, I was misdiagnosed (in my opinion) as an anxiety attack (which from what I have been told have similar symptoms), and I was encouraged to seek treatment for generalized anxiety (as the "panic attacks" seemed to have no rhyme or reason to when they would occur). I was assessed by a mental health professional, prescribed anti-anxiety meds, and a referral to a counselor.

    But, as time went by the "panic attacks" increased, and I found the anti-anxiety meds to be less effective or not effective at all. It wasn't until I needed to be admitted to the hospital for another simple medical procedure that the AF was finally detected on the ECG strip. I recall alerting the nurse that I was having another one of my "anxiety attacks" and asked if she could ask my doctor to authorize meds to help. It was only after she looked at the monitor I was hooked up to that she said, "this is not a panic attack. Something is happening with your heart." And so, the diagnostic process began which finally nailed the AF. In some ways I was relieved to know that what I had been experiencing was not anxiety. Not because I wasn't willing to treat anxiety, but because at least I had an understanding as to why the treatment for my anxiety wasn't working. I know it might sound strange because being diagnosed with a serious heart condition is not something anyone would want, but I finally had an answer. ~ Kel

  • Hi Ryan and from the term EKG I assume you are in USA? Here in England we call ablation a procedure not surgery but it is always an option you should never discount. AF is always a progressive condition and how quickly that happens is the great variable. People who exercise excessively as in endurance athletes etc are prime candidates for AF at younger ages but for sure the greatest number of members here will probably be 60+.

    With a Chads score or 0 then you shouldn't worry too much about warfarin ---IF IT REALLY IS 0! Many people don't realise that for example high blood pressure counts even if you are controlled. The mere fact that you had it means the score counts.

    It sounds at the moment as if your AF s relatively mild with infrequent events so provided that you manage the situation well then why change anything just yet. BUT! Should events become more frequent or life changing then I would definitely consider ablation over a life time of taking drugs. Many people don't bother going to ER (A and E in UK) once they have been diagnosed and have drugs to control their AF either rate or rhythm control so it may seem excessive to go to ER for cardioversion every time.

    Read all you can from the main website about the subject and ask any specific questions here.

    Bob

  • Hi Ryan, more and more endurance athletes are now being diagnosed with Atrial Fibration and Arythmia which in short is an irregular heartbeat. Cardiologists and Electrophysiologists don't know why this is the case as there are often no other underlying cause for the athlete.

    AF can effect people in many different ways from not being symptomatic to being disabled by the condition. Athletes pick up on it quickly because they are familiar with their heart rate.

    Treatments range from living with it to medication and/or ablation

    I had an an ablation on the 9 July and so far so good touch wood but I know I won't be able to red line it anymore. To ablate means to cause not to exist which is blocking the rogue electrical impulses within the heart.

    Eighth placed Tour de France finisher Haimar Zubeldia, disclosed that he sat out for three months in 2012 for persistent atrial fibrillation.

    It’s not known what kind of procedure he had, if any but I suspect he had an ablation .

    This story has many important messages for endurance athletes... he stayed out of major competition for three months. In other words, he rested, so that his body and heart could heal. Secondly, and perhaps even more striking, is how well his body reacted to prolonged rest. The man misses almost half of his pre-Tour preparation in 2012, yet he finishes in the top-ten then and again in 2014. The human body performs better with adequate recovery and it is important to listen to it. AF is not a an end to being active but it does require attention and sometimes treatment, but it often ends up well. You may not be able to ride like a Tour cyclist, but you will ride or run or swim again and possibly compete altho I am not sure I will be riding the TdF or topping a marathon podium in the near future!

  • Thanks for that Elbows. Seen you mention red lining a couple of times on posts. I'd be interested to know what you consider your red line to be, or how close you would want to get to it, compared to your last know max bpm ?

  • Does max BPM even matter if you are not having an episode at all? I would think unless you are in afib for those like me with intermittent episodes the bpm would be fine to push? No?

  • Your right Ryan, and we have athletes who have come out the other side of AF to win Olympic Gold Medals.

  • Hi Ryan. Except, like me, my AF is triggered by excercise. I've been fortunate enough to be in NSR since my last attack but hesitant to push my heart rate now.

  • In reply to Runski, redlining for me has been when I have collapsed in a heap at the finish of a race, pushing myself to the limit and hyper ventilating from the effort. This was after a sustained effort at my max which had been determined by my coach from a ramp test. I must add this was when my racing came down to a sprint and it is always best to race within your limits otherwise the effort will mean you will blow and start going backwards. I don't see myself sustaining that effort again because I don't compete at that level anymore and I am trying to grow old gracefully!

  • I thought so. I used to do a lot of interval training when I was a much younger but couldn't see myself ever getting to that state of oxygen debt now with of without AF. If I can get back to moving at respectable pace again I'd be happy. No sprinting to the line!

  • Wow awesome replies everyone, thank you so much for taking the time to help out someone new with this dx.

    I am in Canada and it is a procedure I guess but not easy to get in and could take years to have it done, the health care is very slow in Canada for some surgeries or procedures which can be frustrating. Even to get in to see the Cardiologist or a Electrophysicist can take 6mths to 1 year for the first visit!

    The stroke calculator I used which shows me as 0 is the following preventaf-strokecrisis.org/... and I am in otherwise perfect health with this happening only 1 time or 2 per year on average over the last 10 years or so since I was 25.

    Anyway I know everyone is different and treatments vary that is the risk in reading so many other cases because there are a lot of other variables which can change the treatment plan drastically. None the less I workout everyday and play hockey 3 times a week where I do push myself to the max and I must admit it really is frustrating that I have to have this in my mind everytime I want to exert myself physically :(

    Ugh...

  • Hi Ryan

    I've always had a CHADS/CHADSVASC score of zero but my heart rhythm specialist put me on Aspirin 10 years ago and changed that to Warfarin about 3 years ago.

    But I have a history of pretty well round the clock AF/arrhythmias, so different from you. My condition is controlled now and I have no arrhythmias, but still on Warfarin I assume for life. And the underlying condition is still there.

    If I were in your situation, what I'd probably do is discuss it with the cardio, and if you have any feelings one way or other (anti-coag or not), then tell him/her because that may sway the advice?

    Koll

    PS. Forgot to say, I probably started AF in my early 40's, maybe earlier. Nearly 65 now so will get a score of 1 on my birthday. I shall go out and celebrate !

  • Hi Ryan. Sorry to hear you are one of us. I was about 43 when I first felt my heart was not behaving and I wasn't really troubled with it much over the next 20 years - just isolated episodes. It has been more problematic in the last four years but I have had two ablations and feel relatively on top of it for the time being.

  • Hi Ryan. I was in my 40s when A.F. started and it was infrequent. That has dramatically changed over the years( I am now 58) so now I am on medication and waiting for an ablation. However it is not all doom and gloom . I think I am generally much healthier than would otherwise have been as I have worked hard to clean up my act! Being.g diagnosed so early means you will be in the medical system and will be looked after( hopefully) so will be unlikely to have a stroke. There are many people with the condition who have no idea and are undiagnosed. They are the biggest worry. This forum is fab. There are quite a few younger people that use it. Lovely to have you here.x

  • HI Ryan

    I'm not about to comment on your specific case but let me tell you my story.

    Diagnosed as PAF at about 46. Life long athlete, not overweight or other medical history. On sotolol, but not Wafarin or other blood thinners. All is well for about 10 years before I have my first stroke. Fortunately, the signs were not serious or persistent. The various doctors referred to it as a TIA (Transient Ischemic Attack) and stroke. In any case, they were talking about a cerebrovascular accident probably due to a clot from the fibrillating atria. They all said, WE WERE NOT EXPECTING THAT AT YOUR AGE. Advised to go onto Aspirin, 3 years later, more full blown stroke. Finally put onto Wafarin, now taking Eliquis.

    All I am saying is, be careful. There probably is no black/white answer to your treatment, it is all about risk management. However, as I understand it, your risk of stroke (which could be minor or catastrophic) is now increased. Talk to your doctors, and preferably an AF specialist, then decide how to proceed.

    Cheers

    Ian

  • Salutary tale that Ian. Sorry you had to find out that way, but hopefully in UK at least knowledge is increasing and your case should be more and more rare.

    Take care.

    Bob

  • Robboian's tale should be a lesson to all who believe that a low CHADs score means you don't need anticoagulants. All of us with AF, irrespective of age, frequency of episodes or other health issues are, without the protection of an anticoagulant, at least 5 times more likely to have a stroke than someone with a similar profile to ourselves but without AF. Taking anticoagulants should be one of the first considerations, the default position, unless there are good reasons why you can't take them. AF diagnosis is not a trigger to 'think about' anticoagulants. It's the signal to start - as soon as possible.

  • Hi Ryan, welcome to the club! I was first diagnosed in my 50s but looking back, I'm sure I had an episode of A Fib or A flutter when I was pregnant, age 20... Running around trying to find my mother's precious pooch which had absconded, at seven months pregnant, is probably enough to do it for anyone! I suggest the best thing is to read up absolutely everything you can on the condition (the AFA website is a great place to start). You will find all sorts of ideas about what you should and shouldn't do but in the end, it is for you to decide which is the best way forward. Others have more experience than me with medical matters so I won't muddy the waters! But take care and stay well.

    Lis

  • Hi Ryan,

    Just by being here you've made one bloke feel better! I thought I was young at 43.

    This place is really good for I formation and support. I thought I was going to die when I arrived here a year ago. No, still alive and kicking!

  • Hi Ryan,

    You have certainly come to the right place for information and advice. When I first got diagnosed two years ago aged 41 I was devastated. I knew nothing about AF and thought my days of competing in my various activities were over. Thanks mainly to this site and reading plenty on the internet I know now our condition is manageable. It's taken two years to come to this conclusion, as I didn't want to except it. I convinced myself I would get better and wouldn't need an ablation or didn't have to take an Anti Coagulant. As my AF has progressed and if you read the stories on this forum, it does tend to, I am open to anything that will give me a better quality of life.

    One piece of advice I would offer is AF tends to affect people differently. You will see quotes like "AF is a mongrel condition" and this is true. What one person may be affected by others may not have the same issue. Triggers tend to be different from person to person. Some people have other underlying conditions that may exacerbate their AF. I guess what I saying is read the advice on this forum and make your own mind up. I like you have a CHADS2 score of 0 and I choose not to take an Anti-Coagulant at the moment as my hobbies end up with me battered and bruised as it is, but not taking an AC is my choice. I'm fully aware of the statistics and the risk is mine. However, the scoring process is there for a reason and I will go with the medical specialists advice until something else changes. I eat very healthy and I understand the signs for TIA's etc, so keep an eye on everything. I'm opting to go for an ablation, at 43 and still very active I believe having an ablation will prolong my fitness and let me continue for years to come.

    There is a Canadian triathlete called Ron Allen who at 69 is still competing. Just before he turned 60 he was diagnosed with AF and his Doctor advised him to take up golf. He said "I'm not old enough for golf" and after successful procedures competed in the Ironman in Hawaii.

    Jason

  • I'm taking part in "the jelly man" in Japan....... Iron man is too hardcore for me

  • Iam 54 chads score 0, i do not take anti coagulants. I was diagnosed about 5 years ago but had infrequent episodes before that, always thought they were anxiety. have you tried flecainide to end your episodes? I am on that now as i would others be in AF most of the time. Now it has progressed to this stage I have just about decided to have an ablation.

  • Hahaha japholic hilarious! :-D :-D

  • Hi folks....

    I'm 31, and had paf since I was 18. I am sure it is adrenergic and vagal af.It is so frustrating, and I am literally scared to exercise , because of the potential onset Of palpitations and then af.

    I'm 6,1 and around 11 stone, so not in bad shape considering but one day that will change if I keep this sedatory lifestyle up.

    Considering ablation if the options open to me, I also don't take A.C or beta blockers.

    All the best to you all

  • Go for ablation get you're life back. We never get away with it because in some of us it does return until we end up on that table. I dodged it for 10 years and it got me in the end!

  • I'm 25 and I have PAF I got an ablation last week. It's odd that I'm so young with this condition and I don't have any heart problems I'm healthy as a horse. It's funny how I heard one of the guy joke in the procedure room that I had the most normal atria that they've seen. Which made me wonder why the hell do I have Afib? I've did research and I found out antibiotics use can be a cause of afib with people with normal hearts.

  • Its frustrating isn't it, when I was first (correctly) diagnosed they did an ultrasound of my heart and told me "You have a perfectly normal, healthy heart"

    I cant help wondering why then do I have AF?

  • Likewise japonica, had the echo and artery scans, and was told its all normal.

    Very frustrating condition

  • Likewise japonica, had the echo and artery scans, and was told its all normal.

    Very frustrating condition

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