New to AF. Advice welcome.

Hi all

I'm brand new on this forum and I'm glad to have found it.

Here's my story: I'm a 49-year-old Frenchman who was diagnosed with persistent AF in February.

I'm asymptomatic and the AF was discovered accidentally during a completely unrelated procedure. I was immediately put on Eliquis and told to see a cardiologist as soon as possible.

The cardiologist checked my heart to confirm the diagnosis. My heart is structurally normal, no anomaly whatsoever. The blood work was normal.
He put me on Amiodarone and I saw him again two weeks later. The AF was still there, so he said we should give the medication time.

I saw the him again yesterday, no change. He seemed to hesitate a bit (I thought maybe he was pondering giving the med even more time), but he said a cardioversion should be attempted quite quickly. It's scheduled on July 3.

I've been pathologically anxious and depressed for years due to a combination of factors: OCD, PTSD following an abusive relation, solo fatherhood resulting from coercive reproduction... My abusive wife died in 2011 from cancer, one year after my mother (cancer as well). In 2024, my father died (of...yes, cancer!) and I was let go of a company after 25 years).

I'm not exactly surprised by the diagnosis. What's surprising is that I had no major health issue before.

The faliure of Amiodarone has dealt me a serious blow. I've seen so many people follow the correct pathway only to die in the end. It's hard not to think I'm next in line.

I've done a bit of reseach and I don't believe in the cardioversion all that much. It will probably work but only for a short time. It doesn't seem to solve the problem. I guess the cardiologist is following the standard pathway from least invasive to most invasive (ablation).

I guess that my question is 'How much hope is warranted here, if any?" After decades of an unforgiving life, AF is pretty much the last straw. I walk a lot, I lost 20kg in 5 years, autonomy is crucial to me. I really can't picture myself with a decaying heart.

For now, I can only wait for the cardioversion. The cardiologist doesn't seem to find my particular situation serious but maybe I'm not reading him well.

Anyway, that's pretty much it. If anyone has tips or advice, I'll be happy to take it.

I wish everyone well on their journey.

Hi Torvic, welcome to the forume.

Actually, your doctor is following pretty sound reasoning. Like most antiarrhythmics, amiodarone is better at preventing afib than it is at stopping it. What's also true is that it becomes more effective over time the longer you take it. So his reasoning of waiting a while and then cardioverting makes perfect sense. The cardioversion will almost certainly stop the afib, and then the amiodarone is already on-board to prevent it from recurring. I would definitely agree to the cardioversion.

However, you say you're asymptomatic. That means that one of your options is taking Eliquis and nothing else if your heart rate remains under 100 bpm when you're in afib. If it goes over 100 then you can add a beta blocker and still do the same thing. In other words, just living with afib indefinitely instead of trying to stop it. People who choose this route are said to be in permanent afib and millions of people choose it. I know several people who are in permanent afib and they bike, run, lift weights, etc. They just pay no attention to their afib. So that's one option you can consider.

Carey, does this advice mean you discount the opinion of those who say Afib will continue to get worse if not treated? I seem to remember something about it being important to get Afib corrected, if possible, within six months of diagnosis of persistent Afib.

I found that recommendation is hard to achieve with the pace of medical appointments.

Hi Torvic,

I concur with Carey's post.

If you get to the point of considering an ablation, the team in Bordeaux is excellent. However, Pierre Jais, who spent most of his career there as a leading researcher, and has done excelleent work for a number of our members recently moved to the American Hospital of Paris. [www.american-hospital.org] If Bordeaux if better for you than Paris, there are excellent members of Jais' team I can get information on. {edit} This is who I was thinking of Meleze Hocini MD PhD: [www.afsymposium.com]



Edited 1 time(s). Last edit at 06/24/2026 01:18AM by GeorgeN.

Quote
nonthumper
Carey, does this advice mean you discount the opinion of those who say Afib will continue to get worse if not treated? I seem to remember something about it being important to get Afib corrected, if possible, within six months of diagnosis of persistent Afib.

I don't discount the fact that afib is a progressive disease, but it can't get worse than persistent afib. That's where the progression stops. So that advice to treat early applies more to people with paroxysmal afib who are symptomatic. Those people shouldn't delay because persistent afib is more difficult to treat than paroxysmal, so you don't want to delay and let it become persistent.

But if you don't care if it's persistent because you're asymptomatic? Then it's a different story. There's no reason to rush to treat it because it won't get worse than persistent and it won't shorten your lifespan as long as you control rate and stroke risk.

I guess that my question is 'How much hope is warranted here, if any?" After decades of an unforgiving life, AF is pretty much the last straw. I walk a lot, I lost 20kg in 5 years, autonomy is crucial to me. I really can't picture myself with a decaying heart.

I would say you should have a lot of hope and the statistics support it, not to mention stories here and elsewhere. Theyou re should be no reason why shouldn't be able to live a normal life with Afib, both in terms of lifespan and even quality of life.

Just understand that most here and on other health forums are in the small minority where treatments don't work as well. The vast majority, get treated and go on with their life.

To your situation specifically, I'm surprised your cardiologist is taking such an agressive approach given you're asymptomtic. Did you see a general cardiologist or an electrophysiologist (EP)? You should be seeing an EP who is a cardiologist with xtra training in arrythmia's like Afib.

I'm assuming asymptomatic means your heart rate is also normal. In cases like these, no treatment -- be it medications or ablation -- are often the best treatment. The exception being anticoagulation, if your risk score is high enough.

So again, don't treat this like a death sentence, but rather as something that could end up being quite benign. The next step might be to get a second opinion from an EP.

Jim



Edited 1 time(s). Last edit at 06/24/2026 12:16PM by mjamesone.

Torvic, I am sorry to learn of your challenging life and all it has heaped on you, especially in such a short span of time. Now, you are experiencing the nasty side-effects.

I hope that, in spite of the AF, you can give yourself full marks for having attempted to manage your life's quality by losing weight, increasing cardio and muscular-skeletal fitness, and taking other steps to deal with your arrhythmia. You deserve credit for honouring your body the way you have. Even joining here and placing your case before us is, hopefully, a win for you.

Cardioversions work in some cases. Not all. I am a four-time-failure. But I have read of accounts of people being in long-standing persistent AF and agreeing to try one cardioversion. It worked! So, it is worth at least one shot...er, schock.

Amiodarone, in my one-time experience, requires a hefty loading dose for about a week. Twice the 'maintenance' dose, which typically runs 400 mg per day, perhaps less per doctor's instructions. As Carey said, it takes time to 'load up', although it converted me to normal sinus over night on the first dose. It is a toxic drug and the patient should be closely monitored during the early weeks to ensure their eyes, lungs, and kidneys are not suffering from the exposure.

What is your typical heart rate when in AF? I suppose it is salutary in a way that you are asymptomatic because many/most know when they are in AF....and it's not the least bit fun. I am one such person. You can have an HR of less than 100 and be asymptomatic, and you can have flutter and be asymptomatic. Happened to a friend of mine. Or, like me, your HR climbs to between 140 and 180 and you feel awful....and anxious as a result. When the rate runs much higher than about 100 beats per minute, it means the ventricles are getting signal to keep up, and it is called 'rapid ventricular response.' This is when you need more aggressive treatment, and perhaps why amiodarone was prescribed for you...don't know.

As the others have suggested, the very best electrophysiologists know how to ablate hearts with complex arrhythmias. They may not always be able to stop all fibrillation, but they can at least reduce the extent of it, its duration, and also slow its progression somewhat. Your formal diagnosis of 'persistent' AF means you have at least two walls affected in your left atrium, probably three or more. The best EPs will find your foci or rotors and be able to ablate them.

Hi everyone

First of all, thanks for taking the time to read me and answer me. I appreciate this very much.

I say I am asymptomatic because, without being diagnosed, I never would have suspected anything was wrong. My HR is typically around 70-75, sometimes less (at full rest). I've never noticed shortness of breath or heart racing.

That's why it's so puzzling.

I don't know if the cardiologist's approach is the right one (based on what I've read, at least he doesn't seem to be a lunatic). He did, however, say that it wouldn't be wise for my heart to stay arrhythmic too long. In his words, "Right now you're fine but at some point your heart will start to hate it". He also said that ablation wasn't necessarily recommended for asymptomatic patients. Honestly, I have zero desire to have ablation surgery unless it's completely needed.
The cardiologist also said he felt very confident that the cardioversion would reset my rhythm. In any cases, the procedure is in 9 days, so I guess I'll know pretty soon what the next step is.

If this condition doesn't make my heart degenerate and is manageable with meds, that's fine by me.
I don't know if asymptomatic patients call for a different type of treatment. What's sure is that Amiodarone didn't help. The cardiologist mentioned switching to a different drug (flecainide) after the cardioversion.

None of this is in my control for now, unfortunately.



Edited 1 time(s). Last edit at 06/24/2026 04:06PM by Torvic.

Torvic,
I have been on Flecainide for 4 or 5 years and found it very helpful. (I have paroxymal afib). After 2 ablations and a Watchman implant, my heart is performing well on a small amount of flecaininde and Metroprolol, a beta blocker.

I honor you too, for looking out for yourself. Keep giving yourself afirming self-talk. / So glad you found this forum. It's a gold mine.

My understanding, perhaps erroneously, is that AF is almost always a progressive disorder for the heavy majority. It may be a quick progression, it may take years to move through stages. But, if AF runs uncontrolled for long, it leads to structural damage and morphological changes in the heart and in its substrate that are very potentially deleterious. So, you want AF very closely monitored and controlled. How you do that is up to you.

And this is irrespective of how AF makes you feel, if you're symptomatic or not. If it runs, it can affect the heart in ways that are impossible to reverse.

Ablation is now considered to be the gold standard of care for AF. It has a more positive and robust history, and I have seen just this week that the evidence for PFA being better than AF in terms of needing touch-ups or repeats is accumulating rather nicely. An ablation is palliative care....meaning it's an attempt to prevent further deterioration in the patient's heart. Ablations do a better job over time and across patients, even across practitioners, than do the drugs most of the time.