New member, husband has permanent Afib, what to do?

Two years ago, when getting screened for an upcoming knee surgery, my husband was told that he has Afib. It is permanent, but there are no symptoms. He is 72 years old, medicated for HBP, otherwise healthy, 6'5" 215 lbs, active with the upkeep of our 5 acre place and garden and going fishing. He's been taking Xarelto. His older brother also has Afib, overweight, had a stroke in March and is now considering the Watchman technique. My husband doesn't know what to do, if anything. Life goes along and everything seems OK. He has a cardiologist who doesn't seem particularly concerned. Should we pursue getting the Watchman? Is there more that we should be looking into? Thank you for any advice! Grace

Just to make sure we're on the same page, permanent afib is a choice. It's when you have longstanding persistent afib and you've decided not to attempt to stop it with ablation or drugs. That's a perfectly valid choice many people make, especially those who are asymptomatic. As long as he remains on the Xarelto and his resting heart rate remains under 100, it causes no harm to remain in afib indefinitely.

As for a Watchman, as long as he takes the Xarelto correctly (with a meal) and doesn't forget doses, a Watchman wouldn't do much for him, and insurance might not cover it. His brother's stroke doesn't mean he has a higher risk. I'm going to guess that the brother either wasn't taking an anticoagulant or wasn't reliable about it.

If he wants to speak to a doctor about his options, he needs to find an electrophysiologist (EP), not just a general cardiologist. EPs are cardiologists who have additional training in treating arrhythmias like afib, and they will be much more knowledgeable and up to date than a general cardiologist.

Thank you, Carey, very helpful! It's good to know that remaining in afib indefinitely causes no harm.

One of my biggest concerns has been that afib will weaken his heart over time, and perhaps lead to heart failure.

His heart rate is OK. He's been good about diet - low fat, low salt, mostly vegan (except fish.) Doesn't smoke. He likes his coffee, and a beer before dinner, neither of which seem to bother him. Low stress lifestyle.

It was a shock to learn that he has afib. Looking back, he thinks he may have had it a long time. He remembers an episode from about 20 years ago when he was helping our daughter move, and he got pretty faint and out of breath and had to stop driving for a while. He sometimes feels a bit that way now, but chalks it up to getting older, and it doesn't seem to slow him down much.

Appreciate the suggestion to find an EP if he wants to discuss options.

Grace

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Grace
One of my biggest concerns has been that afib will weaken his heart over time, and perhaps lead to heart failure.

That can happen but it only happens when people have uncontrolled tachycardia for weeks or months at a time. That can and will cause an enlarged heart and eventually heart failure, which is why many/most people with afib take metoprolol, a beta blocker that lowers heart rate. But as long as your husband's resting heart rate remains under 100, he'll be fine. It will not weaken or damage his heart and it won't lead to heart failure.