afib in teen

My son, now 18yrs old, was dx with lone afib last year.  Ended up on propafenone for 8 months.  He was taken off this in april 2002.  Had 2 episodes within 2 weeks which resolved after 2 doses of propafenone each time.  Since then he has been afib free and has not been on propafenone since april.  He's in his first year of college and the only big change is he is not playing competitive sports as he did during high school (basketball mainly). He just does intramural basketball.   He has an appt with the cardio for a 6 month follow up this week. One thing he never had was a stress test. Another teenager, whose mother posts on web sites, said her son was dx with laf last year and treated with meds etc.. As of late, he was given a stress test and his bp shot up to the 200's which threw him into afib during the test.  My queston is should my son be given a stress test at this point  or since he has not had anymore episodes should i just be thankful!? I just always wondered if his activity was the main cause of his afib or if it was a combination of things.  I know that once you have  had  afib, your chances of it coming back is high.  thank you in advance for your response.

[CCF-M.D.-RCJ]

ozark,

Thanks for the question.

Lone atrial fibrillation (which is characterized as atrial fibrillation in a younger person without risk factors for stroke, such as hypertension, previous stroke, diabetes, or heart failure) is generally considered benign.  The natural history of lone atrial fibrillation is largely unknown, but recurrence can be expected in at least 70%.

It would be imprudent of me to give specific advice to you regarding your son, but I can speak in more general terms.  If I see a healthy, young person in my clinic with lone afib, I generally ensure that they are otherwise healthy.  I will do a complete history and physical, which includes assessment for drug and alcohol use, sleep deprivation, emotional stress, and potential exercise triggers.  I will generally obtain basic lab values, including a thyroid panel.  I also obtain an echo, ekg, and chest xray.  I do not routinely order a stress test unless I suspect ischemic heart disease.  Ischemic heart disease would be very uncommon in a 20 year-old.

Hope that helps.