Long Term Living with A-Fib

[DPM67]

At the age of 45, I was recently diagnosed with A-fib. I have no symptoms (was discovered while taking a simple life insurance physical exam -- didn't even know I had it) and am in good health otherwise. My cardiologist put me on daily Aspirin and then said "see you next year" after some blood work and checking for some other underlying reasons (which were not found). He stated I probably have Lone A-Fib caused or exacerbated by stress (which I've had a ton of the last 3 years).

My question is this: Should I just resign to having this condition for the rest of my life and wait for symptoms to start showing up? All that I've read indicate if it can be treated early, there's a chance of curing it but letting it go can re-train the Atrium to never beat correctly again. I'm not certain if it makes sense to just to ignore (relatively ignore) the condition, take my aspirin daily, get my exercise, watch my cholesterol, etc and wait for symptoms to arise.

Second part of the question: Is there any data that would support that someone can live a very long life (30+ years) with A-Fib with little or no symptoms ever arising? As stated I'm in good shape, play ice hockey once a week, walk frequently, golf, etc. but I have a hard time thinking I should just check in with my cardiologist once a year unless something starts to happen. Just seems odd to me to let this continue as there are so many bad things that seem to happen if the condition were to continue for 10-20-30+ years.

[RVVq]

I am sorry to hear that you already have permanent Afib. It is rather rare to have it at such slow rates thought, however it is a good sign. As the other poster mention, the ablation technology is advancing fairly rapidly and we are slowly learning how to ablate permanent Afib with better results. If you are interested in getting an ablation you should look into contacting Dr. Sanjiv Narayan in San Diego. His team has recently developed a new system for determining the optimal ablation targets for Afib patients (FIRM Ablation) and they have had tremendous success so far. After their FIRM ablation 84% of patients were free of AF after 2 year follow-up and most patients in that study had permanent or persistent AF. If you really want to treat your condition than that might be your best option (currently). You can research his work on Google Scholar. Good luck and good health!

[DPM67]

I appreciate both comments so far. I can certainly appreciate the points that are made by both of you and you both can be somewhat correct in what you have said.

To clarify the first commenter, I do actually have permanent A-Fib already. It doesn't come in "episodes" as some/most describe. I have it all of the time -- although with virtually no other symptoms (At rest heart rate is still under 70 as it has been my entire life). Yes, I realize I'm probably very lucky about that part.

I'm an Engineer by trade so I understand the statistics are lacking and the long term questions I seek are probably not there because of the constant changing (and hopefully improving) techniques to address this. There are also a lack of long term subjects to study I would assume.

I also understand that in a lot of medical cases, if it's not broken to the point of issue, why try to fix something with a procedure that carries a greater risk that what you are diagnosed with...if that is indeed true. I was told the risk of stroke is 5 times higher than normal with A-fib. Seems to put one in a category that has high risk already. So these ablation techniques carry a risk and may or may not be fully effective, but is that higher than the risk of stroke by doing nothing?

Yesterday, I found this very interesting link to risk of stroke that explains the actual numbers behind "risk" so that one can see the additional risk of stroke with this condition and other influencing factors.

http://www.ninds.nih.gov/disorders/stroke/preventing_stroke.htm

What this shows is that if I have AF and a 115 Systolic BP and no other risk factors, the 10 year probability of stroke is 5%, that is really no different than a person who is 55-59 years of age with no condition (5.9%). I found this a bit more comforting to realize that although I'm 45 and not 55, that I'm really not much higher in risk than a normal 55-59 year old male. On top of that, with a aspirin a day, I would think that would reduce my risk somewhat, although the stats don't address that.

All in all, I realize that I'm going to have to deal with this chronic disease.  It's not going anywhere as it's already permanent. My initial frustration was the "wait and see" response to see if I get any worse and do relatively nothing with virtually no discussion on what the risks actually are. It's completely an unknown how long I've had it or when it developed at this point. Worst case, I could have had this for up to 9 years already (when I received my latest EKG that was normal). Hence my question about living with this for many 20+ years. Sounds to me like that may be more common than I initially thought, but I've still seen no stats for long term life expectancy (maybe because the risk isn't significant but who knows).

However, looking at the risk chart presented on the Government website, I see the risk is still relatively low with AF and only AF and that makes me feel a bit better about the "wait and see" approach that I've been given by my cardiologist.

Thanks again for both your input. It is appreciated!

[denalidon]

I agree with most of the points raised, but not about the long term results of ablations.  This data has not been adequately standardized and has not been followed in randomized tests for long periods of time (beyond 5 years).  The field is changing constantly and continues to improve as medical technology advances, especially in the minimally invasive thoracic ablation techniques.  I would not resign myself to a lifetime of AFib........there are obviously increased mortality/stroke risks not to mention the constancy of the mental burden of dealing with all the baggage.  Assessment of your particular circumstances by not only a good cardiologist but also a really good electrophysiologist is important.  There are many good AFib websites out there to get a good initial background education on this subject.  Don't give up on this condition being, at the very least, being made very manageable if not cured in our lifetimes.  

[RVVq]

Atrial fibrillation is a chronic disease. You have no choice but to let it continue, as there is currently no cure for this condition. Ablation does not really cure this condition, despite what some doctors say, but rather slows down the progression of the disease. Atrial fibrillation always recurs in the ablated patients, usually within the first 5 years after the ablation. Furthermore, A-fib ablation is a fairly risky procedure with
approximately 5-8 % risk of serious complications, including strokes, heart attacks and damage to a pulmonary veins and other blood vessels. Therefore ablation is only indicated for patients that have unbearable symptoms associated with A-fib and have failed one or more anti-arrhythmic medication. If you are completely asymptomatic then the potential risks associated with the procedure would greatly outweigh its potential benefits.

So to answer your first question, currently you have no choice but to resign to having this condition for the rest of your life. You can try to slow down the progression of the disease with pills and possibly an ablation, however the risk of the above mentioned treatment options might outweigh the potential benefits that they provide.

Second part of the question: You can live a very long life with A-fib. However, it is a progressive disease that will over time damage and stretch out your heart, in addition to greatly increasing your risk of a stroke. The rate of disease progression varies greatly from from person to person, as some people advance to permanent A-fib in the first years after the diagnosis, meanwhile others have lone A-fib for decades. There no algorithms to predict how aggressive the disease will be in a specific individual.

Chances are if you are asymptomatic, you will remain asymptomatic for the rest of your life. Maybe once you will transition into permanent A-fib, it will be more difficult for you to exercise. So you can consider yourself VERY lucky, as most young people with A-fib have horribly debilitating symptoms and very poor quality of life.