Chronic Afib - From the Senior's Perspective

[kathy2]

Many thanks for participating on this forum.

Same problem as with the last poster (chronic afib 24/7 but without any racing pulse) only the subject is a very dear relative; male, 86 years old, thin, non-smoker and in good health. Has had afib for about two years now and knowing what I know now about afib by reading forums like this, I wonder why his doctor didn't try to cardio convert him at a much earlier point. Is 84 or 85 too old for cardio conversion? Why not now?

But my main question is: since he has decided not to go with coumadin, what options are available to him? Would a daily baby aspirin do him any good? Other drugs, ablation? Since he is doing nothing right now (his doctor has not recommended any other options and we will be questioning why not during the next visit), is a stroke inevitable?

Any thoughts would be much appreciated. From a very concerned Kathy.

[Mobunny]

My Dad has had atrial fibrillation all his adult life. He was on Coumadin and they kept raising his dosage due to his pro-time blood test. In 2005, he had a massive brain stem hemorrhage from Coumadin. Blessedly, he survived with only a balance problem and some left arm weakness.

They immediately took him off Coumadin and have told him to never take it again.

He's still with us!! Unfortunately, he has esophageal cancer now...

Coumadin gives me pause due to our experiences. I should think the aspirin would be the better bet. Perhaps fish oil. Never "that ole rat poison" as my dear departed Grandpa used to call it.

[UncleJohn]

I have recently buried a dear friend who has spent the last three plus years in a vegetative state due to a stroke.  It was not a good time.  That is why I did not offer any objections when my cardiologist put me on coumadin.  UncleJohn

[Al Dente]

I would highly encourage doing everything possible to minimize the stroke and other risks with afib.

I lost my mother to SCD while she was in afib

[Forum-M.D.-bkj]

kathy,

Overall the biggest risk of atrial fibrillation in most people is the risk of stroke associated with the stasis of blood in atrium from the fibrillation. This risk is decreased by the used of anticoagulants.  The overall stroke risk associated with fibrillation is determined by a number of factors but in all comers is decreased by coumadin and aspirin. In patients with higher risk (which your relative would qualify) coumadin is more effective than aspirin, but aspirin is still very helpful.  Risk means exactly that, there is a risk of something happening. So I wouldn't say it is ineveitable, but more likely.

84 is not old for cardioversion. However, cardioversion would not be performed if a patient will not take coumadin as there is still a high risk after performing the procedure.

Generally, if your relative has no symptoms and their heart rate is controlled, there isn't a specific reason to get them out of fibrillation. I would however, look very closely and try to convince them to take anticoagulation to decrease the stroke risk. A stroke is a devastating event especially in the elderly.

good luck