Anyone with occasional Afib NOT on a blood thinner?

Check Steve Ryan a-fib.com. He recommends St. Stephen Sinatra natural anticoagulants.

Because of gi bleeding I cannot take blood thinners for my a fin, just metoprolol 50 mg 4 times a day. Its worked well for several years, no issues

The benefits of blood thinner depend on the risk factors of stroke;
higher the risks more the benefits
there are some scoring systems how to assess the risks. The most commonly used scoring systems are
CHADS2 score or CHADSVASC sore
always call your cardiologist to make any decision
good article for afib.
mdtodate.com/atrial-fibrillation

@claresmayo, I recommend calling Mayo Clinic directly to ask about their approach to Roemheld syndrome or gastrocardiac syndrome. While the term or diagnosis isn't widely used anymore, the association between heart and gut is known. As you likely know, Mayo Clinic uses a multi-specialty and multi-disciplinary approach, meaning that you receive care from a team of clinicians focused on you and your needs.

Here are the contact numbers should you wish to inquire further: http://mayocl.in/1mtmR63

Clare, what gastric events trigger your a-fib?

I identified GI issues as my main trigger for afib, years ago. I don't eat after 5pm. I don't recline after eating. I avoid being full. In bed, I only lie on my left side. If I have gas in my GI system, I take simethicone. These measures have helped tremendously. I don't care what they call it! Maybe I have Roemheld syndrome or maybe not. To me it makes sense mechanically, that the GI system could trigger the heart. (GERD also can cause shortness of breath: the GI system is close to both lungs and heart.)

Stunned to read this about Mayo as I've been desperate to coordinate specialists in ophthalmology (retinal expertise) and cardiology (arrhythmia specialist) - to no avail.

My issue is I've been forced to take blood thinners for frequent but asymptomatic AFib (to avoid stroke, duh)

However, I was diagnosed in Nov. with wet macular degeneration, and my instant reservations about how Xarelto (any blood thinners) would further endanger my eyesight.

Just a quick overview of my unfortunate eye condition...Leakage of blood and toxic fluids from tiny abnormal capillaries growing into my retina, cause eventual blindness at an uncertain rate.

Patients can slow this process by injections of a so-called antiVEGF compound into the eye, but blindness is still inevitable.

My own research confirmed my immediate fear that taking blood thinners would hastens this evolution.

I wanted the coordinated consult to help me arrive at a decision about alternatives to Xarelto (*Watchman " heart procedure"?). That would be based on a cost/benefit evaluation looking at my particular risk markers in terms of cardiac risk of stroke, blindness caused by retinal leakage (including blood), and overall health to evaluate my suitability for the Watchman procedure?

I too thought they had a multidisciplinary approach which would be just what I needed. They told me I would just have to schedule appointments separately with two specialists! Is there another way to reach a pertinent office to arrange a cross-disciplinary consultative approach?

@realitytest, I can see where there may be some confusion. Your first appointment will be made with the specialist related to your primary concern. Upon consultation, that specialist will arrange for related appointment(s) with other disciplines and/or departments as required for your care.

Are you currently a Mayo Clinic patient?

No. After calling (and failing) to try to make a coordinated appt between the two specialities, I gave up.

Ages ago (over 30 years) I did go to the Mayo clinic about a mysterious illness and they did as you just described. I was assigned a "primary" doctor (cardiologist - they heard a slight murmur) and he sent me to a few other specialities.

I thought it was just great, even though he didn't arrive at a diagnosis, and was hoping it would be the same. Maybe if I just showed up, I'd get similar treatment!

@realitytest that is a terrible predicament. What is your CHADS2 or CHAD2VASC2 score? https://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk One includes female and over 65 as a factor, and one does not use gender and includes over 75. The former seems to be the latest system.

Basically with your current situation, it seems you are choosing between stroke and blindness.

Is your current MD at Mayo? If not then maybe you could start with eye doc at Mayo. Then move on to cardiology asap after that, with the records and recommendations from the eye doc. (This could be from a doc outside of Mayo too). It sounds like a Watchman is your best bet.

One of my best friends is going through a new diagnosis of macular degeneration. It is really tough and scary. That said I guess, to be blunt, I would choose blindness over stroke. So I wondered how high your risk is for stroke. It's also tough when afib is asymptomatic and I assume you have worn monitors. Would ablation help?

Thanks for writing! Yes, that's about how I saw it at first (choose blindness or stroke).

However, we are speaking of probabilities and in that regard we are all different. I.e., taking anti-coagulants "only" increases the likelihood - not certainty - of leakage into the retinas. Furthermore, the risk of strokes caused by AFib are "only" about 5 % without treatment and what's more that is only the figure without antVEGF treatment.

Besides that fine tuning of ones situation, there is a range of risk even with the same scores per the CHAD2VASC2 (just a broad prediction for a large demographic). My CHAD2VASC2 score is about 2 at present based on age (76) and 3, adding a point for my gender, female.

I don't have high blood pressure, though (yet!), nor am I overweight nor do I smoke. I also exercise regularly (mostly in a gym) . There are SO many variables, though, to do with depression, abnormal sleep, and hereditary factors (we three siblings have a severe inherited lipid disorder aggravated by lifestyle factors - one, younger, has already succumbed to a CV event two years ago .)

One example, even though I've managed to reduce my lipid profile to fairly normal results per lab, that's only part of the picture. For instance, for all I know I have plaque build-up in my aorta and other key anatomic parts from all the years when I left my lipids untreated - very elevated since from mid-20s. So complicated!

Why I want advice about the desirability of the Watchman, to be based on a careful cardiological analysis of my total risk factors based on more than lab numbers (for example, calcium and stress tests - possible also an arteriogram.

It doesn't help that I've only met a single retinologist so far (they are VERY back-booked) who's even thought of the risk to my eyes of taking blood thinners! (It's highly specialized research.) Apart from my preferences, Cardiac interventional specialists (doctors who perform the Watchman - not risk-free) need to justify the procedure to an approval board. They need to present medical reasons a blood thinner - otherwise, the most desirable treatment for AFIB - is unsuitable for any given patient.

And there are other considerations for a cardiological surgeon to weigh. Whereas the CHAD score raises the stroke risk score significantly by age, its also true that:
with age, FALL RISK is greatly increased. With that, so is the risk of hemorrhagic stroke. (Some doctors discontinue blood thinners because of age, and 15% of all strokes (all ages) are hemorrhagic stroke. If someone taking an anticoagulant has a hemorrhagic stroke, they can only survive if the anticoagulant effect is blocked by special agents (depends on ones hospital being able to give a accurate differential diagnostic lickety split - and having the proper agents on hand. For the record, my local rural hospital is NOT the best equipped nor are our doctors the best, by any means.)

The only consolation in trying to make the best medical decision (too bad wet macular degeneration is incurable!),
is that many strokes lead to blindness anyhow.

Might as well flip a coin! 🙁

Such a mess.