Hello: I am a 61 year old male in generally good health except for idiopathic paroxysmal atrial fibrillation.I am being treated with daily Monocor and 325 mg ASA. I was diagnosed in 1984,and I get about 1-2 attacks a month.Most times it auto-converts to sinus rhythm in about 12 to 36 hours.
On those occasions when it doesn’t resolve on its own,my cardiologist has given me a prescription for Flecainide (300mg) to take as required.
The reason I am writing you is that when my attacks begin,they are often quite debilitating,(I have fainted going to the bathroom in the night on a couple of occasions),but after a period of 12 hours or so,they become almost asymptomatic,with the only indication being a thready pulse.I am at that point capable of brisk walking, for example,without difficulty.
So my question is: Am I at risk of clot formation when the arrhythmia is largely asymptomatic? As I write this,I am experiencing an episode which began on Thursday last,and seemed to revert to sinus rhythm last night(Saturday),but has since reoccurred asymptomatically as a thready pulse,and I have taken the Flecanide.
I would (and plan to) discuss this with my cardiologist,but living in Canada with it’s socialized medicine,it is very difficult to get to speak with him.Sorry to be so long winded!
I don’t think your treatment is adequate. I am also concerned about the risk of clot formation and stroke. Your AF is very symptomatic, and thus cannot be followed with the present regimen alone; you should consider an ablation.
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Hope this helps,
I am an internal medicine resident who follows this blog. I agree with the above; people with atrial fibrillation are recommended to have medication to block the formation of clots, even when the atrial fibrillation comes and goes. And most people don’t feel it when they get atrial fibrillation–the ability to feel this rhythm doesn’t change your risk of a clot.
Sometimes we choose aspirin, more often we choose coumadin. The risk of clot depends on your age and other medical problems. Some people can’t be on anti-clot medications because of risk of bleeding.
This is a great question though–talk about this with your cardiologist, or if he/she is difficult to reach, your primary care doctor, so you understand your treatment plan.
Hi Dr Smith,
You have been away for a while, you must have been busy! Apart from coumadin, do you plan to start prescribing DABIGATRAN or RIVAROXABAN as alternative to coumadin?
What are your thoughts about an EP study and/or ablation for this very symptomatic patient?
Glad to have you comment on my blogs,