New ESC Guidelines Recommend Abandoning Term "Lone AF"

I found this interesting. Don't know exactly what to make of it.

The latest guidelines from European Society of Cardiology say:

"Lone AF [is] a historical descriptor. Increasing knowledge about the pathophysiology of AF shows that in every patient a cause is present. Hence, this term is potentially confusing and should be abandoned."

It's in Section 6.1 at this link: [academic.oup.com]

There are a lot of other interesting things in there as well.

We removed most instances of the word "lone" from this site a couple of years ago for this reason. You'll still find it here and there, but once the site redesign is complete you won't find it anywhere. The original meaning of the term "lone afib" was afib with no concurrent heart disease, but the consensus now is that the presence of afib is itself a form of heart disease known as atrial myopathy, so there's really no such thing as lone afib.

Wait so there is a cause? I was told there was no cause for me. 29 now diagnosed at 27. Normal weight eat and exercise welll. Structurally normal
Heart and don’t drink alcohol or consume caffeine

Yes, there's a cause, but no one knows exactly what that cause is. Fibrosis probably plays a big role, but then you get the question of why there's fibrosis, and that can have multiple causes. So for now the generic term atrial myopathy is used.

Loan AF (in my mind at least) means you have no other health conditions other than afib.

Well, I do know the cause of my AF, I went Hyper Thyroid (graves disease) then had my thyroid nuked, was ok for a few years then took a higher dose of my thyroid med. because I was tried. Bad thing to do as I went hyper from it and got my first episode of AF. it affected my heart but does that mean that I had something wrong with my heart to begin with, I don't think so. I am in my 80s and still do not take any heart meds, but I now am in permanent AF, it doesn't affect me very much, I take Xerlato and Synthroid,

Happy holiday weekend Elizabeth! ... at 80 yrs old and doing otherwise fine, I suggest to just enjoy the ride and appreciate the great good fortune of your overall good health! I see no need for you to worry much at all about specific descriptors such as 'lone AFIB' or 'atrial myopathy' at this point in your AFIB history ... especially if you have decided there is not much motivation to do anything more than your so far very successful management of your condition over the years. It seems you have also shared your mother's enviable AFIB genetics and history as well! Kudos to you and your mother!

Cheers!
Shannon

Here is a discussion (referenced from the ESC document) [www.onlinejacc.org]

Abstract
The historical origin of the term “lone atrial fibrillation” (AF) predates by 60 years our current understanding of the pathophysiology of AF, the multitude of known etiologies for AF, and our ability to image and diagnose heart disease. The term was meant to indicate AF in patients for whom subsequent investigations could not demonstrate heart disease, but for many practitioners has become synonymous with “idiopathic AF.” As the list of heart diseases has expanded and diagnostic techniques have improved, the prevalence of lone AF has fallen. The legacy of the intervening years is that definitions of lone AF in the literature are inconsistent so that studies of lone AF are not comparable. Guidelines provide a vague definition of lone AF but do not provide direction about how much or what kind of imaging and other testing are necessary to exclude heart disease. There has been an explosion in the understanding of the pathophysiology of AF in the last 20 years in particular. Nevertheless, there are no apparently unique mechanisms for AF in patients categorized as having lone AF. In addition, the term “lone AF” is not invariably useful in making treatment decisions, and other tools for doing so have been more thoroughly and carefully validated. It is, therefore, recommended that use of the term “lone AF” be avoided.

Here is a graph from the paper: [www.onlinejacc.org]

There are a number of comorbidities listed that sometimes have been excluded from the definition of Lone Afib.

My philosophy from the beginning of my afib journey is to eliminate any of these from my life that I have any control over.

Thank you Carey for the explanation and info about site too.

Like Colindo, I too think of "lone" AF as AF without cardiovascular comorbidities. And to me that still seems like an important distinction (whatever term for it is used). I keep coming across the claim that people with AF without CV comorbidities have same stroke risk as general non-AF population... That it is the CV comorbidities that increase the stroke risk.

Like this recent study concluding: "In this large cohort of participants with AF without cardiovascular comorbidities, we found that AF itself, without cardiovascular comorbidities, did not confer increased risk of stroke."

[www.ahajournals.org]

So it seems to me it's still important to distinguish "Lone AF" from AF with CV comorbidities.

"So it seems to me it's still important to distinguish "Lone AF" from AF with CV comorbidities".

I completely agree PoetKim.

There have been some studies showing Atrial Flow is preserved while in AFIB if the the rate is controlled, and the ejection fraction is good, as the force of the ventricles contracting press up against the Atria, still creating flow. I want to research this more, and will try to get an TEE done during one of my upcoming episodes to measure this on myself.

Shannon:

Thank you for your kind words, I wish you and your wife a happy weekend as well. I also was fortunate in having a very good Holistic doctor (Dr. B.) and also a good EP, my BP was usually high in the doctors office, my EP had me wear a monitor which would check my BP every few hours for 24 hours and based on that reading he did not prescribe any BP meds for me. Other docs that I have seen over the years wanted to prescribe BP meds right away. Also, Dr. B. said did not believe in the low BP readings that older people are supposed to have, he said that when you are older your arteries become stiffer and the pressure will be higher to pump the blood, so with a couple of good docs. I didn't go the route that so many older people are put on. I also started on some supplements in my early 20s, especially the B vitamins, which I am sure has helped me, this too was due to the knowledge of a great brother.

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The Anti-Fib
"So it seems to me it's still important to distinguish "Lone AF" from AF with CV comorbidities".

I completely agree PoetKim.

There have been some studies showing Atrial Flow is preserved while in AFIB if the the rate is controlled, and the ejection fraction is good, as the force of the ventricles contracting press up against the Atria, still creating flow. I want to research this more, and will try to get an TEE done during one of my upcoming episodes to measure this on myself.

Does a lower than usual BP while in AFib shows a weak EF ?
I'm asking because before my first ablation procedure (PVI), each AFib event was associated with a lower BP and physical weakness.
Now, while in Afib, there's no such sensation. I've just discomfort (irregular HR and the feeling that my stomach is pushing upwards), my BP is in the normal range and I can behave as usual, just caring to move up and down (standing up, sitting down, leaning formard...) slowly. Does it show my EF is not much affected?

"Does a lower than usual BP while in AFib shows a weak EF ?"

I am not aware of, or have ever seen anything written about low BP associated with low EF, but I have never looked into it.
My own BP is lower during AFIB, but that is due to the rate control medication I take, Bystolic/Diltiazem, (these drugs are used to lower BP).

Has your medication you take during episodes changed post Ablation?

If all AF is ‘a form of heart disease’, then in my case that heart disease - whatever it is - was handed down to me by my mother (1 of 3 sisters all with history of AF). I think it’s a genetic quirk - as in poor electrolyte handling/channelopathy - that surfaces (in my family case) by mid-30s. Maybe the correct way in my case is that my genetics give me the predisposition to develop a particular kind of heart disease. By the way, no fibrosis (low voltage areas) in my atria according to Prof Jais when he ablated my at that time 57 year old heart 2 years ago at Bordeaux. I must say I did like the comforting term of lone AF but do understand the timbre of this thread.

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Pompon
Does a lower than usual BP while in AFib shows a weak EF ?

No, BP and EF aren't closely related until you get to the extremes. A dangerously low EF will also produce a dangerously low BP, but you can easily have a low EF and hypertension at the same time. BP is usually influenced more by blood volume and vascular resistance than EF. If you want to know your EF, you need an echocardiogram.

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The Anti-Fib

I am not aware of, or have ever seen anything written about low BP associated with low EF, but I have never looked into it.
My own BP is lower during AFIB, but that is due to the rate control medication I take, Bystolic/Diltiazem, (these drugs are used to lower BP).

Has your medication you take during episodes changed post Ablation?

This was the usual effect of AFib before taking meds (2 episodes) and while taking meds (propafenone, sotalol - both useless): AFib starting abruptly (no ectopic as warning), BP falling around 85/50 (i.o. 110/70), great weakness.
Those heavy symptoms while in AFib became a thing of the past after my ablations. Drugs have no effect on my AFib, but just adverse effects while in NSR. I don't take rhythm drugs or BB any more.

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Carey
No, BP and EF aren't closely related until you get to the extremes. A dangerously low EF will also produce a dangerously low BP, but you can easily have a low EF and hypertension at the same time. BP is usually influenced more by blood volume and vascular resistance than EF. If you want to know your EF, you need an echocardiogram.

OK. I guess my EF was likely lower than usual back then, while in AFib.
It's likely not the case any more now, but it'd be hard to know, since my short episodes have nearly no chance to show up while in my cardiologist's office.

Well, you do lose the "atrial kick" during AF, and I've heard that estimated to be as high as 15% of your cardiac output. But I'm a bit skeptical of that number. I've lost most of my atrial kick and I never really noticed a difference in cardio capacity. I'm pretty sure I would notice such a drop if it were real.

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Carey
Well, you do lose the "atrial kick" during AF, and I've heard that estimated to be as high as 15% of your cardiac output. But I'm a bit skeptical of that number. I've lost most of my atrial kick and I never really noticed a difference in cardio capacity. I'm pretty sure I would notice such a drop if it were real.

I haven't exercised in afib for ~16 years, however I do remember that my heart rate was significantly higher during afib for the same exertion. In fact, on my very first episode, I put on a heart rate monitor, walked down to my basement and back up. My heart rate went to 148 coming up the stairs. I was very fit and normally my heart rate would have been in the 70's, 80 max to go up the stairs. My resting AF heart rate was low ~70's. A week or two later, I was talking a walk with a monitor on, to see what I could do. I was walking in the city and had to run to avoid getting hit crossing a street. My HR went to 235, then that converted me to NSR. During my 2 1/2 month episode a couple months later, I continued to exercise. I did not want to push my heart rate > 180, so would limit it to 160 and my exercise capacity at that rate was certainly diminished.

But how much of your diminished capacity was loss of atrial kick and how much was due to the irregular, uncoordinated heart beat of being in AF? Without question my cardio capacity was also diminished during AF episodes, but I've been in NSR for three years and I know from two TEEs that my atrial kick is virtually gone now due to extensive ablation work. Nevertheless, I can climb hills at the same speed and with the same heart rate as I could before any ablation work. I've worn a heart rate monitor for years during bike rides and recorded it with an exercise app, so I've got hard data and I just can't see any real consequence of the loss of atrial kick. I don't doubt it's a real thing, but I doubt it actually affects cardiac output as much as some sources claim.

Can it be related to heart chambers enlargement?
It's said that endurance athletes may have larger heart chambers. Does this mean they can have higher than average atrial kick?