Interesting Medscape article: 'AF as a stroke cause or innocent bystander? The debate continues.'

[dommydops]

Apologies if someone has posted this already - I couldn't find a previous posting of it - but here's an interesting article available for free on Medscape (people need to register to read it, though:

medscape.com/viewarticle/96...

'AF as a stroke cause or innocent bystander? The debate continues.'

The article surveys results suggesting that, when people with paroxysmal AF go into AF, their stroke risks may go up significantly after some hours, but that the risks may then fall back to normal relatively soon afterwards. If that's right, they say, it might suggest that people with paroxysmal AF should be put on anticoagulants during an attack, and for some time afterwards, but not put on them long term.

[BobD Volunteer]

As Dr Gupta has said before, it may not the the AF but the company it keeps.

[dommydops in reply to BobD]

Yes indeed, that may turn out to be right: the level of uncertainty about the precise nature of the mechanisms linking AF and stroke is interesting, though!

[doodle68]

Hi DD (quote)

Quote...

''The article surveys results suggesting that, when people with paroxysmal AF go into AF, their stroke risks may go up significantly after some hours, but that the risks may then fall back to normal relatively soon afterwards. If that's right, they say, it might suggest that people with paroxysmal AF should be put on anticoagulants during an attack, and for some time afterwards, but not put on them long term.''

I can't be the only person who has regular symptomatic episodes of P-AF of which they are aware but also short episodes of P-AF some lasting just a few moments of which many may not be aware..

I only found out about about these short episodes of slow P-AF by accident when monitoring my Blood Pressure .

I will be sticking to daily anticoagulation.

[dommydops in reply to doodle68]

Fair enough - that's seems sensible (the research in the article is taken by them to suggest that the stroke risk from AF only escalates after some hours in AF, but I wouldn't want to bet everything on that's being right!) I've not had any bouts of AF (that I know of - certainly no prolonged ones) for nearly three years now, and I'm relatively young (AF started at about 40 and I've been on Bisoprolol for years - I'm now 47 - this is one of the few contexts in which I can still describe myself as relatively young 😀...). I've kept off permanent anticoagulation because of the potential for problems from the treatment itself; I'd be delighted if it turns out that I could get by with anticoagulation just during any periods of AF, at least for as long as the attacks stay relatively infrequent. But we'll see how things turn out - there may well be more research conflicting with this stuff soon enough. I've always expected that I'd be on full anticoagulation eventually - I'm very keen to avoid having a stroke!

[saulger in reply to doodle68]

To be honest, I have never experienced short runs of AFib. It seems to develop from skipped beats to full irregularity at up to 120 BPM heart rate, and lasts 3-4 hours.

[dommydops in reply to saulger]

Yes that's how it's always generally been for me, as far as I know, although I've generally had longer bouts of AF than 3-4 hours; typically 6-9 hrs, although once just shy of 48 hrs.

[saulger in reply to dommydops]

When you are in AFib do you have a need to pass water, and do you experience excessive bloating?Many posters on this site reported similar symptoms.

[doodle68 in reply to saulger]

...I understand passing more urine during an episode is caused by the atrial natriuretic peptide mainly from the fibrillating atria, it is quite normal . I make sure I drink some water to stay hydrated during an episode.

[dommydops in reply to saulger]

I don't remember that as a symptom, but it's been quite a long time since I went into AF. Another complicating factor is that it has always come on in response to exercise - running was a particular trigger, but also fairly hard cycling - and I'm probably slightly dehydrated at that point anyway, which might mask those symptoms somewhat.

[doodle68 in reply to saulger]

Hi Saulger how do you know this for sure. My episodes are regular /fast 148bpm and last 12-20 hours roughly every two weeks. They often start with a run of ectopics/missed beats . There is no mistaking I am having an episode because I feel ill.

I had no idea I was also having slow shorter episodes maybe because they are slow I didn't notice and the symptoms were not there . When I say short it can be minutes to a few hours first picked up by accident when asked to record my BP every day for a week. I know it is P-AF my Kardia recorded it as such. I say 'short' a few hours is short for me but enough time for clots to form . I routinely check my BP to keep an eye on it and still record the silent epiodes.

Had I been only taking anticoagulants for 'recognised ' episodes I would have missed the others and been unprotected.

I am sure I can't be alone in having two sorts of P-AF...

[saulger in reply to doodle68]

I can't be sure that I also have slow episodes, but as you say AFIB is unmissable. I too feel ill with a sort of constriction of the chest, and I am adept at taking my pulse as soon as I get the arrhythmia. I also have some of the other symptoms that I mentioned, plus breathlessness and fatigue. Very unpleasant for me.

I bought the WIWE ECG monitor that diagnoses AFib with 98% accuracy (they claim) and the absence of "P" wave in their report confirms AFib.

Like yourself, my episodes are bi-weekly or even weekly of late and last 3-4 hours.

There is a pattern, such as when I carry groceries over a distance or over-train...

Are you planning an ablation or medication?

[doodle68 in reply to saulger]

Hi saulger 🙂 no plans for an ablation for a number of reasons and with the exception of Apixaban (I am CHADS 3) and a small dose of beta blockers I don't take any medication. I recently tried Flecainide , it didn't suit me at all. After almost 5 years of regular episodes I live with my P-AF and pursue a healthy life style.

[saulger in reply to doodle68]

Bravo to you ! I am almost 4 years into my AFib. Virtually forgot about it for months and lately the episodes are becoming more frequent (had one this morning, the fifth this month). I am on low Bisoprolol and no anti-coagulant, CHADS 1 until I am 75, then moves up to 2.I'm keeping a diary and trying to eliminate the triggers by trial and error. May be a fools errand and there is no rhyme or reason why they come and go.

I joined the Wolf Mini Maze Facebook group and there are many good testimonials, and pricey @ $150,000.

All the best. Saul

[Hidden]

My son is 39. Not long ago, while he was to visit us, I asked him to take his BP. Both of us were surprised when the small gauge showed that he was in arrhythmia. He never had any symptoms at all, so I wonder how many people are there with AF and are never going to have remarkable symptoms, to be properly checked and diagnosed.

So, "5 times larger stroke risk" has been calculated with entirely wrong data and to be honest, the correct data about the population "infected" with AF will never be known. What are we talking about...?

[dommydops in reply to Hidden]

That's interesting, and your son can't have been delighted to find that out! I've always wondered about how many people might have undiagnosed AF and whether scientists have any sense of how common that might be.

[Hidden]

It is all the difference between knowing and not knowing. My son is not worried at all, he has no debilitating symptoms, he never knows if he is in AF or not, so he ignores it. The same with me - no worry, no medications, no ablations, no anticoags, no fear. The life goes on...So many people in this world live with cancer, not knowing it at all, until the end.

Maybe 8 years ago, in this Forum, under a different name, I have offered the idea that the diagnosed sufferers with AF may be only the tip of an iceberg. I am still inclined to believe so, with the amount of people with some kind of arrhythmia being very high. My father had it, my mother had it, nearly all my friends have it... Nowadays, teenagers have it... What to say...?

[dommydops in reply to Hidden]

That's interesting. When I do feel myself go into AF it feels unpleasant, and that's definitely affected my response to it a lot. The stroke risk is a more abstract and intellectual factor compared to the immediacy of actually feeling my heart going wrong. It doesn't weigh on me much these days, as it's been quite a time since I went into it properly, always in response to exercise, although my heart wobbled for about 20 seconds in the summer after running up a hill and that was predictably horrid. It would be very interesting to see how many people did turn up with arrhythmia if mass screening were to be done!

[Hidden in reply to dommydops]

Yeah... It would be very interesting to know, but it is very hard to deal with arrhythmia... Many have reported to have been diagnosed by accident, have tried to catch the arrhythmia later, with holter monitor, and it was not a simple task. Arrhythmia come and go, without regularity. The same person switches between different types of arrhythmia, also without regularity. In my country, we say: "You can not catch it neither by the tail, nor by the head!" Is there similar saying in English!?

One is for sure - all arrhythmia count to Dysautonomia. If you look at HealingWell forum, in USA, there is a list of syndromes and disease with unknown cause (many of them chronic), with arrhythmia among them. All of them count to Dysautonomia.

[saulger in reply to Hidden]

We know that it is due to errant nerve impulses, some of which have physical causes.For example, fibrosis of heart tissue: cause or effect?

"Atrial fibrosis is common in atrial fibrillation (AF). Experimental studies have provided convincing evidence that fibrotic transformation of atrial myocardium results in deterioration of atrial conduction, increasing anisotropy of impulse propagation and building of boundaries that promote re-entry in the atrial walls that maybe directly relevant for the mechanisms responsible for maintaining AF."

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

[Hidden in reply to saulger]

Rogue electric impulses are present but, as you mentioned, it is the question are they the cause or the consequence... Also, in medicine, there is often a dilemma are the two different health problems causing each other (e.g. high BP and arrhythmia) or are they present in parallel, as a consequence of the same cause. There are still so many unknown things, since the human body is really complex...

[saulger in reply to Hidden]

Like your good self, I am also trying to live with my AFib drug free and un-anticoagulated, but I've been less successful the last few months.

I was first diagnosed in 2018, but am sure that it was an ongoing problem. I would feel some heart rhythm disturbance after heavy exercise and tried to sleep it off.On the plus side, I believe that my intolerance to high FODMAP foods contribute to episodes and I've cut out a lot of food types.

Wouldn't it wonderful if AFIB were reversible?

All the best to us all.

[Hidden in reply to saulger]

Only now I looked at your profile and realized that we are close neighbors! Spent some wonderful holidays in Greece, the last one in fabulous Parga!

The truth is, that any overexertion leads into trouble with Dysautonomia in general, cardiac arrhythmia being only one of them. Main generator of arrhythmia are physical manipulations with the body, so be very careful with exercising. I have stopped it completely at the age of 60 and wish I have done it earlier. The food has some influence, but not so much as exercise . Coffee and alcohol have also big impact.

I can tell you that I know much more than I am ready to say at the moment and, unfortunately, arrhythmia are impossible to cure. They can be held under control if a person has sufficient knowledge, but the knowledge necessary is enough to write a book. Nobody would consider it to be a good solution - people would like to take a pill and to forget about everything... what I fully understand...

All the best!

[saulger in reply to Hidden]

Yes, over-exercise seems to bring it on for me too, as well as the typical coffee, alcohol, over-eating, stress etc.Exercise has been very important for me. I seem to need it to stay optimistic and relaxed.

Have not been to Parga but loved Lefkada when I spent my honeymoon (divoced) and again, a few years later.

Wishing you continuing NSR and that we can outlast our AFib. Saul