Two AF cases — and my changing view of AF

I receive many emails about AF. I don’t often answer them because it is bad practice to doctor without seeing the person. Recently, however, I received a note with more general questions. The sender suggested I could use the response as a blog post. The reason I am posting these two cases along with my response is that my views on AF are changing. I am in the process of putting these global thoughts on AF together as a more general update, but these cases are a start. Here is the email from a reader: (a doctor). Dear John, What would you recommend? My med school roommate and I are 69 years old and in good health, normal BMIs, non-smokers, social drinkers. We both exercise almost daily. He takes something for mild hypertension. I’m on no meds. He has had 3 episodes of PAF in his life–one in 1984 and two in the last few months. They all converted spontaneously to NSR. His doctor worked him up fully including an echo. His heart is structurally sound and no clots were noted. He has been strongly advised to start taking Coumadin or Pradaxa. I have also had 3 episodes–one at age 26 which reverted to sinus after one dose of quinidine (I am old) and two about 6 months ago a couple of days apart which disappeared in about 12 hours after a good night’s sleep. I did not see a doctor about this. I had a normal echo 10 months ago because a routine EKG done as part of a preop eval for shoulder surgery showed nonspecific changes and I didn’t have a previo...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs