The AFIB Report

Your premier information resource for atrial fibrillation


Number 105
December 2010/January 2011
10th Year

Almost 15 years ago Professor Michael D. Ezekowitz, MD of the Veterans Administration made the statement “patients with lone atrial fibrillation are not at higher risk for thromboembolism than the general population and can be managed without anticoagulation or anti-platelet therapy”. This statement was supported by Rodney Falk, MD of Boston University and by Dr. Stephen L. Kopecky of the Mayo Clinic who in 1987 reported that lone atrial fibrillation patients have an exceptionally low risk of stroke and that this risk varies little whether the fibrillation is paroxysmal or permanent.

Despite the overwhelming evidence that special stroke prevention measures are unnecessary for lone afibbers with no risk factors for stroke (hypertension, diabetes, congestive heart failure, age over 75 years, and previous stroke/TIA), and no evidence to the contrary, guidelines for the management of AF maintained the recommendation that lone afibbers with no risk factors for stroke should be on aspirin or warfarin for life.

The just-released 2010 European Guidelines for the Management of Atrial Fibrillation finally bring some common sense to this subject with the following two statements:

  • In low-risk patients with no stroke risk factors (essentially lone afibbers below the age of 65 years with a CHADS2 score of 0) no anti-thrombotic therapy is the preferred option.
  • Patients below the age of 60 years with no evidence of cardiovascular disease (lone afibbers) have a very low risk of stroke estimated at 1.3% over 15 years (cumulative).

It would seem to me that if the risk of stroke for a 60-year-old lone afibber is 1.3% over the next 15 years, then the risk for a 70-year-old lone afibber must also be exceptionally low.

In summary, lone afibbers with no stroke risk factors are best off avoiding aspirin and warfarin as the risks of taking these drugs on a regular basis outweighs the benefits.

This year-end issue contains a thorough evaluation of these new European guidelines, as well as summaries dealing with factors affecting AF recurrence, AF and quality of life, diabetes and risk of AF, age versus ablation efficacy and risk, and much more.

If you have not already done so, I encourage you to take a look at my new AFIB JOURNEYS section. Here you will find the personal stories of afibbers who have dealt with their afib challenges in many different ways – some through successful surgical interventions, others through supplementation or dietary changes – to name just a few. There is a great deal to be learnt from the experiences of your fellow afibbers!

Wishing you good health and lots of NSR,


My favourite Supplements

The AFIB Report