If you are fit and healthy -- how dangerous is AF? Maybe not as much as we've been led to believe...

[whiteface]

When I was first diagnosed with AF in 1988 at 30 years of age there was utter consternation as I was extremely fit. AF had then only been seen in unfit people (smokers, overweight etc.). Unsurprisingly these people die early because of a range of factors and they also have a higher incidence of stroke. So the question is does AF actually increase risk once you remove all these other factors. The technical jargon is "co-morbidity". I am aware of one study that was done which actually stripped out all the other factors so see if AF (single variable) affected life-span.

Here is the conclusion

"Overall survival of the 76 patients with lone atrial fibrillation was 92% and 68% at 15 and 30 years, respectively, similar to 86% and 57% survival for the age- and sex-matched Minnesota population. Observed survival free of heart failure was slightly worse than expected (P=0.051). Risk for stroke or transient ischemic attack was similar to the expected population risk during the initial 25 years of follow-up but increased thereafter (P=0.004), although CIs were wide. All patients who had a cerebrovascular event had developed > or = 1 risk factor for thromboembolism."

So you'll see NO increase in stroke risk for 25 year and longer life (actually statistically not significant, but hey let's celebrate)

The study is here ncbi.nlm.nih.gov/pubmed/175... or try searching for the title "Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study"

It was done in 2007 so there may be more up to date research but I haven't seen it. Have you?

[Luludean]

O , it is good to read a positive message !!!

It looks sensible and thorough. Sometimes I think we could read too much pessimistic information and just worry ourselves to death.

Only snag is that often a pre existing heart problem stets off the AF .

But , we have to face a these things and get on in the most resilient way we can . A sense of humour and trust in one's cardiologist are the two best medications.

[BobD Volunteer]

I have always told newbies that AF won't kill them it just feel that way. The problem is that ignoring it can lead to major cardiac issues such as heart failure. My take has always been that treated AF i e controlling rate does not present a life shortening problem. In fact one leading EP said here that AF is not the stroke risk, it is the company it keeps hence the CHADSVASC system to asses anticoagulant need.

The problem comes when younger fit athletic people, who are actually prime candidates for AF as we know,carry on regardless. There have been some public disasters especially at marathon events for example which suggest that AF can kill you if you are stupid and try to ignore it. I agree that for most of us it is a problem to be endured but we should not discount the dangers.

[whiteface in reply to BobD]

My dad died aged 63 of heart attack, my dad's mother died aged 63 of heart attack. My Mum's dad died aged 65 of heart attack. It was a massive worry to me as I'm 60. Have I got <3 years to live?

So this was the first question I asked the 3 cardiologists I have seen. I've also spoken extensively to my brother about it who is a GP of 40 years and I am now reading the book on the Haywire Heart.

ALL 3 doctors have told me that there is NO connection between AF and heart failure. My dad had exercise-induced angina, my grandma was an heavily overweight diabetic and my grampa a smoker. That is fundamentally what killed them. You have to understand the company it keeps to be able to decide IF there is a risk or not.

I was told NOT to take flecanide as it was more likely to cause a problem.

My heart has been checked over using an echocardiogram -- it works perfectly -- nothing enlarged. So despite 40 years of endurance activity it looks just normal. And during bouts of AF there is no change in BPM it is just irregular and no symptoms. I have reduced the amount of exercise I take and have reduced the severity of that exercise. That seems sensible. So don't misunderstand me -- I'm not being cavalier.

BUT I am also finding huge prejudice that "AF is unhealthy" and you have to medicate whereas this study says lone AF is healthy and for some of us a least medication is bad.

So, if AF makes you feel unwell then you will probably chose to do something about it. BUT if you are a fit and healthy feeling athlete with "silent AF" .... Well IMHO that's up to you -- but personally I haven't seen any data so far to say that AF on it's own is a problem.

[secondtry in reply to whiteface]

Very interesting, I am just going for a second opinion on taking Flecainide, may I ask what sort of problems were mentioned when you took advice and did they apply to healthy person in their 60's with no co-morbidities?

[whiteface in reply to secondtry]

I think the key factors were 1) I don't have any "symptoms" (This point seems to be quite difficult for people on this forum to grasp/accept. My heart beats at the same rate -- just irregularly. I found out it was AF not quite by accident but you'll get the point.) I believe that was the crucial factor. 2) I had had several bouts and they typically self reverted within 48 to 72 hours. So they said "go home and let nature run it's course". That was around 7 years ago now and since they episodes have become more regular. 3) I was then in my early 50s with no co-morbidities and with a fit and healthy lifestyle (and I'd ALWAYS been fit and healthy -- that seems to be important too).

Separately there is my own view and there are two aspects to that which I'll share in the hope they help you make an informed choice. 1) It is my view that all medicine carry some form of risk or side effect. So I always want to know what that is. In this case I didn't need to find out as the medical profession told me not to take it. 2) I looked at the Flecainide molecule (I am a Chemist) and its formula is C17H20F6N2O3. I'm not inspired by anything with fluorine in it... Take a look on Wikipedia?

Importantly for many people Flecainide is clearlu VERY helpful if not crucial to their life.

Finally I know myself better than any doctor who is doing his or her best with only limited information about me. So I always make my own choice and use my doctors as a critical source of information to help me with that.

I hope this helps.

[secondtry in reply to whiteface]

Many thanks whiteface, we are certainly on the same page re the doctor strategy. I will check out Flourine. I thought 4 years ago, when the Flecainide started (as had 9 AF episodes a month), and still do that there will be a price to pay for taking it but it was my best option (my choice not the 3 medics I consulted). I needed to stop the AF dead and buy some time to correct lifestyle issues which are not done overnight. I am currently on the last L/S issue sleep and then all being well I can look to wean very slowly off the Flec in 2019...eternal optimist that I am!

[whiteface in reply to secondtry]

Best wishes with it all. And relax and enjoy life. (For most of us it is helpful to realise that you could have got something much worse!

[Hidden in reply to whiteface]

Do you see any advantage taking a statin with your family history? On the matter of lone AF this is interesting

ncbi.nlm.nih.gov/pmc/articl...

[jedimasterlincoln]

Bob has hit the nail on the head once again.

I don't think I've ever been under any illusion that AF was going to kill me, but when uncontrolled ignored or untreated it can cause problems you could do without.

It starts being scary and ends up being a mundane irritating annoyance and an obstacle to most people.

[azriverrat]

Mine was not controlled until the fifth ablation. Meds had also stopped working. Afib uncontrolled can lead to chf. But if you can control it sure you won't die.

It is not always as simple as hey I have an issue. See an EP. Get an anticoagulant and some nice arrhythmia pill and on your merry way. For awhile mine was controlled with 480mg a day of sotolal and another I forget how high dose of metoprolol. It was controlled until a tia. I also felt like a walking zombie but it was just afib and flutter.

[Coco51]

Thanks for a nice positive post! A small study but encouraging. But in fairness I was always told that AF is not a dangerous arrhythmia. One cardiologist even told me his old auntie had lived happily with AF for 30 years into her 90s. I guess my problem was that I didn't believe it!

Like you I usually have a slow heartbeat, normally around 45bpm. With AF it settled around 90bpm but would shoot up to 150 with mild exercise which I found uncomfortable and distressing, feeling faint and short of breath and spooked by the irregularity (so not symptom free). The EP said this is because the heart is beating less efficiently and delivering up to 20 % less oxygen. Also the blood can pool in the left atrial appendage and cause clots even in otherwise healthy people. My heart is fine according to an echocardiogram, but AF still felt bad. Maybe with an athlete's super strong heart this doesn't happen... too late for me to test that out now!

Anyway Flecainide (I was told) is for symptom control -so optional (but for me it did make the rhythm more regular). More important is rate control and anticoagulation where appropriate and acceptable.

I'd absolutely agree that there's no point in taking any drug if you feel things are under control and manageable without. It's your body and your life!

[Hidden]

Thanks-always good to see the bright side.