Does AF always indicate underlying heart disease?

[Amurray77]

I personally don’t think it does. I don’t have any. My heart is absolutely fine and has been checked via Cardiac MRI. I just wanted others opinions. I wonder if this common arrhythmia is a sign of things to come.

[Hidden]

I hope not and believe it doesn't necessarily lead to further problems once stabilized. Re stroke risk I lost enough weight to get off all meds including blood pressure. I really watch my salt intake and have had no congestive heart failure episodes since early in my diagnosis. My BP on my visit 2 weeks ago was 124/70.

I've also been told I have no other cardiac problems. So maybe we will be lucky and have no further heart issues. Take care. irina

[Finvola]

My cardiologist says not (in my case anyway). Natural ageing is a major factor with many people but there has to be a predisposition to AF to start with.

[Hidden in reply to Finvola]

I agree about the predisposition.

Does anyone remember when the terms "type A" and "type B" personalities were used to describe people unofficially? Haven't seen those terms in a while. "A" meant more anxious, perfectionistic, etc. and "B" denoting more laid back people who generally coped better. I'm oversimplifying but for me I was always considered Type A and I would describe most of the people I know with A-fib the same. I guess the key words for me would be anxious, worrywart, excitable.

Any thoughts? I also have 3 friends who are bipolar, have been for years, and are well-managed on medication but they have a-fib.

Maybe certain meds people take for years contribute. I don't know. I do think with a good friend of mine that if he had gotten a good thyroid workup years ago and his hypo was well managed he might have avoided AF. Interesting to consider. I don't have answers-just theories and questions.

Probably too late for us but worth asking doctors to consider these factors for prevention of A-fib down the road for our kids and grandkids.

Just a thought. irina

[Finvola in reply to Hidden]

I think the predisposition to AF can also be genetic - in fact genetic research is where I think and hope the solution to AF will eventually be found. This could bear out your personality theory too and I do remember the type A, type B thing from the 70’s.

The problem is that I could never have been a laid back person - I was always driving, improving!!, getting things done and being impatient. People like that tend to choose high-stress careers too, as I did. But - not all ‘driven’ people get AF - in fact, I wonder how many members of this forum would describe their old selves as calm and collected and yet they still have lone AF?

The poor doctors would have a Herculean task in stress reduction, I think, in a world where hardly anyone is able to exist without a mobile phone to hand in case someone rings to ask where they are - the commonest comment I overhear is ‘I’m in Tesco’s’. Wow! Really? 😀

[Hidden in reply to Finvola]

Spot on. In fact when people tell type A's to calm down, don't get upset it sometimes irritates. Like saying to us when we're trying to lose weight. "Just eat less'" If changing things about our personalty type were that easy we would probably have done it before age 74.

[Janith in reply to Finvola]

I am a typical “type a” ... Very driven, impatient ... very perfectionistic ... everything has to be perfect visually ... high energy ... two afib attacks in three years ... l feel as though it will never happen again?? Please Dear Lord.

[Madscientist16 in reply to Hidden]

I am definitely a "Type A".

[Hidden in reply to Madscientist16]

Welcome to the Type A club. Maybe we should create a sub group: "Type A+". LOL. irina

[BobD Volunteer]

NO! AF often has no reason and can happen in an otherwise healthy heart. In fact it does more often than not,.

[Hidden in reply to BobD]

You might be right too.I guess the answer is no one really knows and when we discover more AF causes new ones pop up. Just happy there are ways to manage it in my lifetime.

[Marina_D in reply to BobD]

This is true Bob,

I'm definitely NOT an anxious person, generally very laid back. Also no heart disease, nor AF with any of my family, immediate and recently historical. I have no other illness either. I am not an athlete so haven't pushed my heart to the limits but I have always been active and kept fit and eaten well, a non smoker (all my life) and drink very little if any alcohol. So basically nothing to predispose or cause AF. However, I have had to deal with some extreme issues in my adult life that would have sent stress levels through the roof. That to me has been my downfall. Even now I find that any emotional issues that arise with family will likely start an episode off.

We are all different! This AF is an unpredictable 'monster' that can rear its head without rhyme nor reason, that's for sure.

[EngMac]

Look at my comment on MartinWillmot below.

[Ianc2]

Just had a letter from my cardiologist telling me my heart repairs were very successful , I feel good and enjoy walking, dancing, etc. Still got a permanent irregular heartbeat though which I will keep forever. Doesn't bother me but it totally trashes electronic blood pressure machines. 240/160 and a purple arm? err no, get the old machine out and pump it up - 140/80. I have been offered another ablation but it will be in an area of the heart that is difficult to get to and has a relatively high risk of complications.

So warfarin for me and 5mg of rampiril for the blood pressure, regular walking, reasonable diet, watch the weight and no booze seems to be the order of the day

[Hidden in reply to Ianc2]

Thank you for mentioning your wild BP readings when not manually pumped,,,,I have them too,along with the purple arm,,! It almost kept me from a hospital discharge cause my pressure was “off the charts” when manual reading said 124/82! It is surprising how many med staffers almost refuse to go looking to find a manual cuff! I had only one memorable bout with afib 4 years ago that gave me a 5 day hospital stay,,,since then,on meds and have ectopics daily but no Afib,,,,I’ve learned to have the flutters and ectopics although I don’t like them,and am thankful the meds seems to be working otherwise,,,and yes,I’m on warfarin too!

[Ianc2 in reply to Hidden]

I got my cardiologist to write into my notes that my BP was only to be taken using the old fashioned pump up method (physgometer?), by the practice nurse , every 6 months.

[MS444]

Sometimes there is an identified underlying cause of AF. Sometimes not. I have one friend who got it without an identified cause. Another who drank heavily for decades (so that is the likely cause), another who was misprescribed thyroid medication for over a decade and is a long distance bike rider (both factors implicated but primarily the thyroid medication - and his prognosis is that ablation has cured him) and me who is an insulin dependant diabetic for 49 years and has suffered from nocturnal hypoglycaemic which I know caused my AF. So this random sample shows 3 out of 4 with an underlying cause.

[willec49]

No. Many people have AF with no underlying heart disease. Many develop it when fairly young. My nuclear imaging stress tests and echo cardiogram showed a normal heart with no structural problems, etc. There is also a kind of AF called "Lone Afib" which refers to AFib with no underlying heart issues and usually in people under 60 years.

[pusillanimous]

In reply to Finvola - there is definitely a familial predisposition , but I hasten to add age related -my father, my three sisters and myself were all diagnosed after the age of 65 - in my case purely by chance as I have symptomless PAV, as many people do.

[Hidden in reply to pusillanimous]

I have 9 cousins and 3 of us so far have afib,,,the others are still young enough that it might not have caught up to them yet,,,,we are 63,61 and 71 in ages,,,just might be in the family!

[Becksagogo]

Thankfully, it was when my AF was diagnosed that they found the other problems with my heart valves. I am probably a Type A person but I did also have radiotherapy as a youngster which may have bought on heart disease later in life. Merry Xmas to you all. Be careful with the overeating and alcohol intake!

[Madscientist16]

The echo I had after my diagnosis showed that my heart was structurally normal in every way. After every other test was completed they blamed the onset of my AF on heredity (my father was diagnosed at 40; I was 51) as I had no other triggers, diabetes, thyroid, etc. However, I was told by my EP that heart enlargement, heart failure or valve issues can also be triggers for AF. I was also told that AF episodes can be hard on the heart and cause enlargement and heart failure. For right now, meds keep my heart in NSR. I eat right and exercise very regularly. I want to keep my heart as healthy as possible.

[smasherda]

At least not for me. I was born with an accessory pathway in the heart (Wolff-Parkinson-White Syndrome) that was diagnosed in 1991 and didn't present until 2003 and since then I have been on a beta-blocker without any further incidents (knock on beta-block ... sorry it rhymes). I live a normal life (exercise, TRY to eat well but still terribly, take my statins, etc.) but if and when I I feel my heart wants to go AFib, I just take an extra dose of my beta-blocker (my EP MD said that was ok*) and I am fine.

* make sure you talk to yours to make sure this is right for you.

[whiteface]

Not for me. I have permanent AF and no symptoms. I live a healthy and active life which includes regular (daily exercise) and I'm not on any medication. Let me know if you would like to know more. Or check out some of my other posts tooo.

[Hidden in reply to whiteface]

Did you mean permanent AF?

[whiteface in reply to Hidden]

Yes. The last time I was in sinus rhythm was just over 4 months ago

[Hidden]

Yes, I had forgotten that from your replies over the last 4 months. I have reread all your posts and replies and several things stand out.

First that when you had paroxysmal AF, your description of it is suggestive of so called Vagal AF. Whilst you had no consequent physical symptoms which is not unusual with vagal AF, you clearly had psychological symptoms. These create a positive feedback loop with AF.

Second you say you have always had a healthy lifestyle. Many would argue that anything more than very moderate exercise, equivalent to a brisk walk does not convey any extra benefit to heart health and that chronic endurance exercise often causes permanent AF in later life. There are of course benefits to psychological health from pursuing an enjoyable, if damaging hobby.

Third, you have a strong family history of ischaemic heart disease. I imagine you have had the usual angiogram. I have CT proven coronary atherosclerosis which is asymptomatic but have opted for high dose statins not to lower my cholesterol, but for their anti inflammatory effect

You have made a strong argument for not taking anticoagulants (AC) in your case. Not many have engaged with you on this. A few things to consider are

1. Your heart scans may have been normal in the past but now you are in permanent AF it may be sensible to have regular scans for as long as you are not taking AC, to see whether your left atrial (LA) volume is increasing. I have no evidence to support my intuitive feeling that this is likely to be an independent risk factor for LA clot formation, but I’m guessing you will prove me wrong (-:

2. A normal echocardiogram does not exclude significant atrial fibrosis, another risk factor.

3. Herd studies aren’t particularly helpful when extrapolated to the individual. And It seems completely illogical that the extra Chads point acquired on your 65th birthday signifies a need for ACs which was not present the previous day.

I think you may be underestimating your 5 year risk of cardioembolic stroke, given your steady progression towards permanent AF. Do you feel you are likely to be particularly susceptible to haemorrhagic complications of an AC?

None of this is intended as criticism, just as a different perspective on some of your more robust views(-: