Is AFib at 64 manageable without medicine?

Question

Hello doctor,

I am 64 years old and was recently diagnosed with atrial fibrillation following a routine ECG. I have not noticed many symptoms, apart from an occasional fluttering in my chest and some tiredness now and then.

My cardiologist has recommended starting Apixaban (a blood thinner) and a beta-blocker. I would appreciate it if you could help me understand, in simple terms, what is happening with my heart rhythm and why these medications are necessary, especially since I do not feel unwell.

I am also quite concerned about the risk of stroke. How do I know I am adequately protected? And will I need to stay on these medications long-term? Please help.

Thank you so much for your guidance and support.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

In your case, atrial fibrillation (AFib) means that the upper chambers of your heart are beating irregularly and sometimes too fast. This irregular rhythm may cause:

Fluttering sensations in the chest.
Occasional shortness of breath.
Fatigue or low energy.
A sense of anxiety (in some individuals).

During AFib, the atria do not contract properly, causing blood to pool in these chambers. This raises the risk of blood clot formation. If a clot breaks free, it can go to the brain and cause a stroke. Clots can also spread to other areas of the body, such as the limbs or intestines, potentially leading to catastrophic problems, including mesenteric ischemia(blood flow to the intestines is reduced or blocked).

To lessen these risks, your doctor may give anticoagulants (blood thinners). The choice to begin these medications is based on a detailed evaluation of your risk for blood clots versus your risk for bleeding, which is generally done using recognized scoring systems.

AFib often results from underlying conditions, such as:

High blood pressure (hypertension).
Coronary artery disease.
Structural abnormalities in the heart.
Electrolyte imbalances.

Identifying and treating these underlying causes is essential for effective AFib management.

Management of AFib often involves:

Controlling heart rate.
Controlling the heart rhythm.
Using anticoagulants when needed.
Treating the underlying causes.
Interventions such as catheter ablation are used when appropriate.

Catheter ablation is a minimally invasive procedure that uses heat or cold energy to eliminate the heart tissue that causes AFib, thereby restoring normal rhythm. If rhythm-control drugs are ineffective or symptoms are severe, cardioversion, a safe treatment that administers a brief electrical shock to the heart, may be employed.

More advanced techniques, such as electrophysiological (electrical activity of the body, especially the heart or nervous system) tests with ablation, may be considered in some patients. Even after ablation, most patients continue to take beta-blockers and blood thinners to manage their heart rate and lower their chance of having a stroke.

With adequate treatment, continuous follow-up, and medication adherence, the long-term risk of AFib problems can be greatly minimized.

I hope this helps.

Thank you.