Questions

Hi

I was diagnosed with Afib 6 years ago. I am 70 years old. At the time my Dr took me off a beta blocker and
gave me Eliquis. I went to a cardiologist and he said I have a type more considered to be a nuisance that anything else.
I worry about my health a lot. I don't really understand how bad this is. It seems like I have nothing to really worry about
but I do anyway. I have no symptoms. A friend of mine had an ablation but the cardio says they don't do that for this form.
I trust my dr's but then doubt creeps in. Does anyone else have something similar?
Any comments/suggestions?
Thanks
Don

Hi Don, welcome to the forum.

Do you know if you're constantly in afib or does it come and go? Since you're asymptomatic I know it may be difficult to be sure, but has your cardio ever used the word "persistent?" I'm guessing the type of afib the cardio refers to is what's known as longstanding persistent afib. That means you're constantly in afib as opposed to experiencing it in episodes that come and go. The longstanding part just means you've been that way longer than one year.

Your cardio is a little wrong about it being the the type they don't do ablations for. They can and they do, but the success rates are lower than for paroxysmal afib (the kind that comes and goes). However, very highly experienced electrophysiologists (EPs) have good success rates.

That said, since you're asymptomatic, if you take your Eliquis religiously and your resting heart rate remains under 100, then there aren't many good arguments for seeking an ablation. You will live just as long and be just as healthy as someone without afib as long as you maintain the Eliquis and the heart rate remains under 100. So your cardio is right that it's kind of just a nuisance.

Lots and lots of people here have persistent afib. You're always welcome to ask questions but the short answer is you'll be fine and you can trust your doctor.

There are two types of AF: valvular and non-valvular. It's progression is in stages: paroxysmal (comes and goes on its own)l persistent, long-standing persistent, and finally permanent, with each being intuitively easy to understand.

AF is AF. AF begets AF. You don't want to be in AF if you don't really have to. Not for long. The problem is that it IS a progressive electrical disorder. The speed of progression varies between individuals, and some individuals know when they're in AF while others have no sensations; they're 'asymptomatic.' Good for them, but also bad for them. They may find themselves feeling quite secure and well, not realizing that their fibrillating heart is edging towards permanent AF and the attendant problems that may/often happen. We're talking about mitral valve prolapse, collagen deposition in the substrate, fibrosis, atrial AND ventricular enlargement (their walls ticken and them become 'muscle-bound'), or eventual heart failure. None of this is a sure thing, nor is it likely to happen inside of two or three years. But, it COULD happen inside of 4 -6 years.

Your typical HR is above 100 BPM when you are in AF, meaning your ventricle responds in sympathy: rapid ventricular response (RVR). While a rate of 100 or so isn't really a problem for the atrium, it isn't great long term for the ventricle(s). In fact, when I had my first ablation the instruction leaflet said to get to my ER if my AF returned and it remained above 100 BPM for more than 24 hours.

Carey wisely asks you for more information and clarification. What type of AF do you have? What did your cardiologist say in defense of you just living with it and treating the stroke risk with apixaban? Not that we think he's mistaken, but without some information it's hard for those of us who have had successful ablations and are free of AF years later to just nod and shake hands on the way out. It's true, the more advanced forms of AF are much harder to ablate, but in the right hands, someone with experience treating complex cases, it can be done. And again, you should not be in AF long if you needn't be, if some kind of intervention would have you in AF only a few minutes a week at most. AF begets AF. The longer you are in it, the more it persists.

And if you really are in AF most/much of the time, your risk of a stroke from clots dislodging from the left atrial appendage (LAA) is about rive times (X5) what your average person not in AF would face. Any conscientious EP or cardio will strongly urge you to use apixaban, rivaroxaban, or dabigatran, whichevr your system won't respond poorly to.

Hi
My Cardio says it is persistent. My problem is the meds. I was on Eliquis for a year and I had bleeding in my intestine. Very low hemoglobin (47) and a lot of transfusions in a hospital during covid. Not fun. They cauterized it and told me to stop Eliquis but my Cardi said I should try 1/2 a pill. I started bleeding again. Cauterized again. Same spot.

My issue is my Cardio keeps mentioning going back on Eliquis but my Gastro Dr says no. I feel trapped. Aren't they supposed to tell me what to do?
Don

Ah, okay, this adds a new wrinkle. Yeah, you shouldn't be bleeding in the intestines but that's a whole lot less dangerous than a stroke, and being in persistent afib at 70 means your stroke risk isn't trivial. And an ablation isn't going to get you away from the Eliquis anytime soon, if ever. So that makes you a perfect candidate for a Watchman device. You're exactly the sort of person it was made for.

Is your cardio an electrophysiologist? If not, then you need to book a consultation with one, and pick one who does Watchman implants. It's an easy 30-minute procedure and you'll be up and about a few hours later feeling perfectly fine. After a couple of months when they're sure it's implanted correctly, it will allow you to stop the Eliquis forever.