@gloaming I watched the whole video, thanks.

Most of us knew this but these guidelines are definitive on the failure of aspirin to avoid stroke from AF.

I was glad they addressed "lifestyle factors" though it came last and should come first!

I am troubled that a case like mine, and I have no idea how common or uncommon my type of case might be, is not addressed at all. These MD's say that for symptomatic paroxysmal AF ablation in "selected patients (generally younger with few comorbidities).....in whom rhythm control is desired, catheter ablation can be useful as first- line therapy to improve symptoms and reduce progression." (This does leave room for addressing individual cases, with qualifying language.)

I hope this does not mean that ablation is considered after one episode. For that matter, I hope that medication and anticoagulation are not considered after one episode, for all patients. The trouble with guidelines is that the clinician needs to use discretion after discussion with the patient and evaluation of the whole picture. They should not be and are not written with the intent that they be used absolutely and universally- but will doctors use them that way?

I have gone 10 years without daily medication, any anticoagulation, or ablation- with episodes happening generally every year or even every two years. When they do happen my heart rate is near 200 and I land in the ER due to low bp's barrier to treatment. Even the ICU. Yet so far, my AF has not progressed, knock on wood.

My mother had permanent AF and heart failure, and had a stroke when taken off Coumadin for 5 days for a procedure, so I know what can happen. That said, the bleeding episodes she had were concerning- nose bleeds, GI bleeds, and from falls, and she had severe anemia as a result. She also had dementia from the AF and micro bleeds in the brain.

I am grateful that my EP gave me a "pill in the pocket" anticoagulant (as well as PIP diltiazem which I continue to prefer doing with a drip in ER) because once I reach 75 (when my CHADS goes up) there will be more pressure to do an anticoagulant, and I know I am not invulnerable. The video does not mention episodic use of anticoagulants and I wish this targeted use was mentioned.

Again, this video does address "lifestyle factors" which generally means weight, high blood pressure and diabetes. I have none of these risk factors but my CHADS is 2 due to gender and age, soon to be 3. Thanks to a poster on afibbers.org a few years ago, I started drinking low sodium V-8 for potassium. For several reasons I also take magnesium and calcium. I added CoQ10. Identifying triggers has helped a lot: eating and reclining, eating after 6 so closer to bed, reclining after eating, GI gas (simethicone helps) lifting heavy things, and sudden alarms have all been triggers.

One hospital did an echo after my one episode greater than 2 hours (7 hours) to make sure there was no clot- probably not entirely reliable- since I declined anticoagulation. Now, with pill in a pocket, I would have that resource.

Last year I bought "The Afib Cure" by cardiologists Day and Bunch, who posit that progression is not inevitable and that for some, slowing progression or even "curing" afib is possible with hard work. This book also covers medications and ablations and the title is a bit misleading. But it did confirm that some of the things I and others were doing were indeed helpful. I say this with respect for the challenges faced by many for whom this type of thing is not going to work. I am mainly addressing concern for people like myself who are faced with doctors recommending medications and anticoagulation- or even ablation- after one episode when frequency is not yet known.

I have requested monitoring from time to time to make sure I am not having subclinical AF, and the results show no afib in a month. Some flutters, some tachycardia, some bradycardia, basically seconds of each. I have a Kardia and keep the battery active.

Guidelines are like recipes. Over the years, with my health issues, my daughter's and my mother's, I have seen that some doctors use them that way, and some go beyond to individualize after real discussion with the patient. I know doctors have liability concerns and following evidence-based protocols is protective, but they are also protected if they offer and we decline.
I would love to hear a cardiologists say that progression does not always happen. Day and Bunch write that in their book but I have yet to hear it in person, and I don't know if it is true. Time will tell!