Asymptomatic (silent) AFib

My understanding is that AF is an evolving, or a progressive, disorder of the heart. Some tolerate it and are largely unknowing, or asymptomatic, or simply don't want to do anything about it. Many know when they are in AF and it greatly interferes with their peace of mind and with their quality of life. Sleep is impacted, loved ones are nervous because you are agitated and pacing or have that 1000 yard stare, and there's often a feeling of lack of control and of dread. Some are breathless, feel the thumping in the chest wall, and have to belch all the time. It simply sucks for them.

You are fortunate to not have a 'racing heart.' What is your HR during the worst of AF? Most of us have AF between 90 and 140 BPM, and if it's higher it's probably flutter. My information, both orally given by an electrophysiologist and in written form on a precis given to me for recovery at home following a catheter ablation, was that an HR above 100 should not be left untreated after 24 continuous hours. The reason is the heart muscle can become fatigued, but it can also compromise the mitral valve eventually, and it forces the atrium to enlarge...and this causes it to stiffen.

Did they not offer a rationale for letting you remain in AF? Perhaps its because yours is self-controlled and stable, at least for now, and doesn't present a risk to you. AF doesn't kill us, but it can cause problems later that will make our health a challenge. An enlarged left atrium is one of them, as is a prolapsed mitral valve. If it progresses to supraventricular tachycardia, or you develop what is called 'rapid ventricular response', this is a potentially dangerous situation that needs to be addressed right away. But, I take it that it is only your atrium that is contracting chaotically, and there is no apparent ventricular response...it still beats on cue from the SA node.

Again, AF won't kill us. It makes us miserable, anxious, and feeling unwell. But it won't kill us. What your care team SHOULD BE doing is treating you on the basis of quality of life, how it impacts you, how much you'd like to have an ablation or be cardioverted (was that not offered?), your current level of AF (paroxysmal, persistent, or permanent), and on your prognosis. Maybe you need to go further afield and find another more sympathetic EP, hopefully one who is highly sought, very busy, highly experience, and in high demand. Two I am aware of (do not know them) are Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin (he travels to hospitals all over), and Dr. Santangeli at Cleveland Clinic.

Good luck.

That’s a real mystery. My dad’s cardiologist immediately tried to treat my dad’s with meds. When that failed, he had cardioversion, which was successful. I might get at least another opinion.

Have you read the book “Afib Cure” by renowned Electrophysiologists Dr. John Day and Jared Bunch? This book has a thorough explanation of Afib, causes, treatments, and lifestyle changes. This book helped me with my paroxysmal, asymptomatic Afib. I made lots of lifestyle changes.

Best of luck to you in finding the best solution for your Afib.

What Afib doesn't kill. Of course it does. Why do we take blood thinners if it doesn't kill? Think of all those poor people in 3rd world countries that do not have access to anti coagulants.
From the above mentioned book "Afib Cure": Atrial fibrillation strikes one in four American adults. Not only do people suffering from this condition suffer from shortness of breath, fatigue, chest discomfort, decreased ability to exercise and do activities of daily living, arrhythmia, and palpitations, but their risk of a stroke, cognitive decline and dementia, heart failure, or premature death also shoots way up."

I'll repeat myself: AF does NOT kill you. The clot forming here and there, especially in the left atrial appendage, might, and that is why the prescription always includes anti-coagulants. The clot might kill us, but not AF itself. The anti-coagulant isn't prescribed to treat AF. It's prescribed to prevent clot formation. A clot, if it forms (it's only a probability deemed too high for ethical treatment) might migrate to either the brain or the heart, or both. If in the LAD, it means almost certain death, and if in the brain, a stroke.

To help to keep it separated, think of a person who has a Watchman implanted in her LAA, but who still has uncontrolled, perhaps permanent, AF. The AF won't kill her.

This is (obviously) not a diagnosis, but it’s possible you don’t have afib. My Apple Watch also reports that I have a percentage of afib each week, although lower than you as I have topped out at 38%. My cardiologist at Mayo Jacksonville has determined I do not have afib, but I do have premature atrial and ventricular contractions, and he believes the Watch is mistaking PACs and PVCs for afib. I haven’t figured out if there is a way to translate my reported afib percentage to PAC or PVC load, so all I’m able to conclude is the lower that number is the better. Anyway, you might want to discuss this possibility with your doctor.

Thanks for your excellent comments! My HR consistently hovers around 62 but climbs during exercise. Perfectly normal. I’m processing your “going further afield “ comment. Again, I greatly appreciate your excellent response !

Yes, I have the book and read his newsletter! Good book!!

Thanks for this ! I plan to get more info next visit to my cardiologist.

The Apple Watch ECG does at times misinterpret runs of PACs and PVCs as Afib.

A Holter Monitor ordered by your Cardiologist or Cardiac Electrophysiologist to wear for a few days, weeks, or a month, accurately documents your abnormal rhythms and your % PAC and PVC burden. You may ask your doctor to order this test periodically to monitor your progress as you make lifestyle changes discussed in Afib Cure.

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