Afib treatment

[Alisa W]

My husband who is 49 has had two episodes of afib that lasted about 8 hours. These two espisodes were ten years apart. He has occasional bouts of irregular beats that last less than a minute. These short bursts usually happen less than every six months but sometimes happen twice in a day. When he had the longer episodes his heart rate went up to 135 bpm for several hours and then calmed down to 95 for the remainder of the 8 hour episode. My husband has always been healthy and is not on any regular medications. He feels that since his episodes self convert and are so infrequent that he would rather not be on medication for this.   While his CHADS2VaSC score is zero do you believe taking 81mg of aspirin would be called for?  His doctor seems okay with no treatment considering his episodes have all converted on their own in less than 24 hours.  I wanted to get you opinion on this decision.  I know there are many factors that play into choosing the correct treatment and many different points of view on this.   Thanks in advance for your reply.
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[CCFHeartMD 12]

Great question. Management of atrial fibrillation is a long and complex topic, mostly due to variations in patient population, preexisting medical conditions and available medications.  As far as I can tell, your husband is a healthy 49 year old with occasional short runs of atrial fib - what we call paroxysmal + lone atrial fibrillation.   Usually there is very low risk of cardiovascular risk such as a stroke in this population; however, it should not be completely ignored.  

I recommend at least an echocardiogram to confrim heart muscle and valve function (if not already done), AND a holter monitor to confirm his "afib burden", ie.find out how much atrial fib he is really having -- those he can and cannot feel.  

If after these tests are done he truly is CHADS2VaSC = 0, risk of stroke is very low at 0.78 per 100 person-years.  He might choose to NOT be on any stroke-preventer.  IF he were my patient, I would recommend aspirin daily -- usually a full 325mg dose is recommended, although 81 and 325 mg doses have never been compared head-to-head in a large trial.  So if dose of aspirin is a concern, try 162mg.

[Alisa W]

I meant to include that he does take ibuprofen nightly.  If he decides to take aspirin it would need to be 30 minutes prior to the ibuprofen or 8 hours afterwards, correct?