Asymptomatic A fib, and use of a monitor watch and starting eliquis

Hi I wear a FitBit Sense

After ablation almost four years ago I wore a heart monitor for 30 days. As a result, my cardiologist said there was no need for Eliquis. Off all meds. Had a great cardiac surgeon who repaired mitral valve, did ablation, and LAAC. Perhaps you can wear monitor right now. I don’t like the loop recorder as it is not monitored in real time, so I refused it. Fine as wine. Going on 82. PS. Read "The AFIB Cure".
Regards,
Sagan

I started Eliquis about two years ago (dumped Lisinopril). My EF went from 49 to 55 percent. I have a Fitbit and an Apple Watch. Both alert me when I’m in AFib. I am asymptomatic also. I rarely have any sense that I’m in AFib and have been exercising during occurrences without any physical issues. Heart attack at 48. Now 76 and no other serious, heart-related issues since. I’ve always seen my meds as proactive rather than reactive.

Like you I am/was asymptomatic with Afib. I may have had Afib episodes before I was first diagnosed, but not knowing the symptoms didn't know I was in Afib. The first time Afib was detected was in December 2024 during a workup for cataract surgery. I went on Eliquis the day that I was first diagnosed with Afib and remain on Eliquis today. I Had a Pulse Field Ablation done in May 2025 and was Afib free until about a month ago. Now I understand the feelings in my body when I go in and out of Afib. Eliquis or any other blood thinner medication is recommended for 2 (or maybe more) reasons. One is related to Afib and the possibility of a clot forming because of the why that left atria beats out of sync with the ventricle. The other is related to age. After age 75 a Eliquis is recommended due to the increased chance of stroke due to a blood clot regardless of if it is related to Afib.

You can check and see if you need a blood thinner at this website:
https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk
I do not wear any kind of watch to monitor my heart rate, but I do check my heart rate once or twice a day using a Cardio Mobile device. Which BTW is a recommended device by my cardiologist.

My situation is a mirror of what you described. I have a Fitbit Plus that I use to monitor my "condition". In 5+ years it has yet to record an event. I did set it up to alert me of increased heart rate of greater than 100 bpm for at least 10 minutes when it believes I am at rest. I've received 2 of those over the same 5 year period. What does it mean, good question. For some of us the constant monitoring brings many more questions than answers.

As an arrhythmia patient myself, I offer some thoughts/observations:

a. I have worn four Samsung Galaxy watches, with the Version 4 and newer able to measure blood pressure (if you're going to bother self-monitoring for arrhythmia, you'd be well-advised to add this one other measure to your daily habit). None of them detect AF unless I enable the ECG app and hold a fingertip from the opposite hand against the main control button. I don't know if the newest version has a battery that can run a continuous sampling, but battery drain on watches is a problem and will be for the foreseeable future...especially as you add continuous sampling). The watches also must be enabled, not defaulted, to allow periodic monitoring during sleep. I don't know about the others, FitBit, Apple, Garmin....;

b. A person already wary, already somewhat aroused by sensations and symptoms, of their arrhythmia, can soon become obsessed or over-stimulated by a wearable that's constantly hectoring their owners about things going on inside them. You'll end up throwing the watch into the nearest stream or flushing it in anger or frustration...especially if you are having arrhythmia and it's doing its job for you....alerting you;

c. The single greatest risk from AF is a dislodged clot from the left atrial appendage. This can be after three minutes of AF or three hours, or three days. You won't know it until it's too late. That is why few EPs will agree to a PIP approach to taking a DOAC...it's going to be too late for too many if the clot forms in a few minutes and then gets washed out of the LAA and into the blood flow up the aorta. If it gets to the lungs, the heart, or to the brain, it's bad news. A person should go on a DOAC immediately they/their cardiologist knows that AF is at play, even paroxysmally. They should not cease taking the DOAC until they have demonstrably gone months without recurrent AF....AND....ideally....had a confirmatory TEE showing no leakage from a sealed LAA.

So, I won't discourage a wearable, providing you use it wisely and tolerantly. If its output becomes an imposing, or an impossible, burden on you, what will you do? I spent hours upon hours glancing at my watch, flat on my back on a gurney until my wife one time demanded I take off the watch and hand it to her. I eventually had an ablation and wondered why I had waited as long as I did. It was our vaunted Canadian medical system that takes so long, but that's another story.

@gloaming There are lots of good points in your post, and I wholeheartedly agree with the thoughts that a person can become obsessed with the wearable monitoring devices, to constantly looking for or living in trepidation that another "event", whatever it may be, will occur. While it's not a bad idea to be aware that such events are occurring, and documentation of these events to send to a healthcare provider can certainly be useful, I can't think it's helpful to be so obsessed with heart rhythm, rate or other "readings" to the point where other normal life activities are compromised or excluded altogether.

I do understand the compulsion of doing that, however. I was that way with the bradycardia I experienced for at least two years before I got the pacemaker. I had a Garmin heart rate watch and was constantly checking my heart rate, looking at the graphs, and wrapping myself in knots about it, either in denial, hoping it would improve, checking it again and again. I had episodes of atrial tachycardia as well, but I didn't pay as much attention to those- thinking these were "just" SVT and not significant ( the EP I was referred to after two years of this informed me differently, but we were on the way to solutions by then).

Once I got the pacemaker, however, I decided I was finished with the constant heart rate monitoring. I took off the watch, and decided that it didn't matter any longer what my minute to minute heart rate was, that it was where it should be for the activity in which I was engaging. I certainly felt better, and I'd check the heart rate periodically, mostly just for the joy of seeing it in the 70's, 80's or wherever it should be with the activity. I have to say this was a freeing experience for me to lose that compulsion.

I feel for the most part the same way about the paroxysmal A-fib/flutter that has become a part of my life now. Fortunately most of the time it's short lived, so even if it's symptomatic it lasts generally less than one minute. I've had a couple of Kardia mobiles on hand, mostly just for curiosity to see if what I was feeling might be A-fib, and while they worked, they did call it A-fib. I don't really need these devices, as I have been diagnosed with A-fib already and the documentation has been provided to my cardiologists many times over, thanks to my pacemaker monitor they know exactly when and how long my arrhythmias last, and the A-fib is fairly well controlled with metoprolol (heart rate) and I take Eliquis. I know that makes it easier not to worry about when and how long these arrhythmias are occurring.

I am AFib asymptomatic. I was on Eliquis 5mg twice daily and did very well with it. I had a ablation and watchman implant recently and doing great and off the Eliquis., just a baby (81mg) daily.

Has anyone had or considered having their left atrial appendage closed. Interesting procedure. I discussed with my cardiologist, but he didn’t think I was a good candidate.

@stryker66 This is commonly done in some cases, and it is done via the AtriClip or the Maze procedure and its more recent variants such as the Mini-Maze.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6652788/
https://my.clevelandclinic.org/health/treatments/17086-heart-surgery-for-atrial-fibrillation-maze