He is entirely consistent in logic and in his learning and experience. Honestly!

You have a history of periodic, if short-lived, arrhythmia. It comes and goes without any control on your part. It may even have happened last night while you slept. Any time you're in arrhythmia, you have an increased risk of a stroke. If it's atrial fibrillation, your risk of a stroke is about five times what it would be if you were perfectly healthy....and young. I don't know if you understand why the risk is so high, but it lies in the shape and placement of what is called the left atrial appendage (LAA). It's a shallow cave or grotto high on the extreme left side of the left atrium where blood flow is rather poor at the best of times. When fibrillating, it's much poorer, so poor that slow blood can become a bit stale and want to clot. If the clot(s) become dislodge, and travel to the heart itself, or to the brain, it can cause serious problems, like stroke in the brain. Or an infarct in the heart. Or thromboembolic problems in the lungs. You don't want the clots at all, and the anticoagulant you are taking helps with that. The Flecainide controls your heart rhythm, and that may be necessary or not. If you can convince your cardiologist to go off it for a trail, you may find that you really don't need it. Or, that you do because you begin to get the odd run of AF again.

So why does he say if you go off the meds that you should have a loop recorder? Because of the nature of paroxysmal AF. You may not be sufficiently symptomatic to actually know when it happens, especially during sleep or other activities where your mind is 'busy.'

And, why does he say there's no point to having an implanted recorder if I'm' going to stay on the meds? That's his point....every procedure carries risk, and if you don't want the recorder, and would rather stay on meds because you like what they do for you, then skip the recorder! Stay on the meds because you're being well-treated by them. IOW, choose one or the other. If the recorder is implanted, and you're off the meds, but the recorder picks up the odd blip at times, don't you still need the meds? I would say so, and apparently he/she thinks so as well.

Is it safe to come off the meds? Only a Holter monitor worn for a few weeks or a loop recorder can help you to know that. If a record goes on for some time with no episodes then you can go off the meds. Or, if the recorder does show some runs of AF, you can always start on the Eliquis again.

Is it dangerous to have AF and NOT be on a DOAC (direct-acting oral anticoagulant) like apixaban, rivaroxaban, or dabigatran? Yes, but the latest findings suggest that it's not that critical in the first 20-48 hours. The loop recorder would pick it up, your monitoring agency would text you or call you, and you'd pop the first DOAC pill right away (because you'd always have a small emergency supply, even one tablet in your wallet/purse).

To sum up, you are of the mind that your current medication protects you from AF. It's working. But you haven't had any episodes lately. You'd rather discontinue the drugs, but your cardiologist says you should have a loop recorder to monitor your rhythm 24/7 for at least a year or more, but that it would be safe to go off apixaban at least...for now. This is reasonable and sensible. Without the monitor function, you may still have enough AF, unbeknownst to you, and therefor be at risk of a stroke if you are NOT on a DOAC. Best to have the implant, be monitored, and if you're apparently free of AF, even if only due to the flecainide, then why continue to the DOAC? *

*There is some research suggesting that the danger of dislodged clots from the LAA extends for months for some patients. That is why we have the Watchman. That is why we have some patients stay on apixaban or whatever it is for life, especially if they have other comorbidities that make discontinuing it almost criminal to suggest. But, if your Watchman checks out at the six month mark, usually with a TEE (trans-esophageal echocardiogram), then your risk of a stroke, even with your heart in AF, is very much less than the five times I mentioned earlier.