What to expect in the long term with atrial fibrillation? -

I am a 38 year old male who was recently diagnosed by a cardiologist with atrial fibrillation. I experienced a period of about 3 weeks where I would have very brief series of palpitations throughout the day (maybe 3 or 4 series of 3 to 4 palps) each day. The feeling of each palpitation never lasted more than a moment, but I would feel several at a time. At the cardiologists office, I was given an EKG, a Holter to wear, and ECGs (both resting and stress test). Everything appeared normal except on the Holter results which showed several periods of arrythmia. Thankfully, the results of the ECGs show that my heart is structurally normal and there does not appear to be any blockage (I believe the stress test is used to evaluate this). I have been treated for several years by my family doctor for hypertension, including the medication Toprol XL (50 mg), and my blood pressure readings have been great for about a year or more. I have not experienced any palpitations for about a month now (that I am aware of). My questions concern the long term outlook for myself with this condition. I talked at length with the cardiologist, and he felt confident that with my young age, the fact that I take an aspirin and Toprol daily, and that my episodes of a fib were brief, that I did not need any other meds and that my risk of stroke was low. He mentioned that if my symptoms came back and were worse, that he would likely recommend an increase in the Toprol dosage. But my question is what should I expect for my quality of life going forward? Can I ever drink alcohol without getting new episodes of a fib? The Dr. said I could drink (I assume he meant socially), but should I be worried if I do? Is my life expectancy shorter because of this diagnosis? I appreciate any feedback as I try to get used to this new and troubling development in my life.

Paroxysmal atrial fib is a chronic condition that can predispose you to stroke, though is rare for a young person. After age 65, you gain benefit by being on chronic anti-coagulation therapy, e.g. taking Warfarin daily. Before then the risk of taking the anti-coagulation in aggregate is riskier than the benefit. Afib in a young person does beg the question of why? (Very common for 80 year olds at 25%) Afib typically comes from multiple sites in the atria where pace-making cells are generating a signal for the heart to beat (as opposed to one source.) A common source in a young person is sleep apnea, especially in the context of high blood pressure. If you have not been evaluated for this possible condition, it is probably worth your while to do so. Alternatively, it may just be a congenital abnormality with no real source or cure - sort of a birth defect. If you have not discussed this condition with an electrophysiologist (cardiac electrical specialist) then it may be a reasonable to do so. He/she MIGHT be able to map the source of this extra signal. If it is from one or two places then an ablation of those foci can be done to destroy the source and effectively cure you of the entire problem - forever. Its worth attending an appointment to discuss. I doubt your quality of life will be in anyway affected unless you run marathons or are a pro basketball player. Day to day your heart should do just fine whether it is beating normally or fibrillating. If you are not doing well and get into a situation of tachy/brady syndrome, then at last resort an ablation could be done. This procedure ablates the connection of the top of your heart with the bottom and inserts a pacemaker to take over the job of regulating your heart rate. Alcohol should not effect you too much, in moderation. A couple drinks of at a time should be your limit. Any binge drinking could make your condition worse or prompt an afib attack. In sum, this is one of those things, whereas not great news, the sum total of how this will effect your life is very little. On the other hand, the condition can have some complications so it would be nice to have it entirely off your plate. Discuss my suggestions with your physician. Good luck.

C-shuman gave a great response. My 13 y/o nephew has just had a pace maker inserted and is much happier now - so I suggest you get a second opinion on management.

Even though you are well controlled at present with low dose Toprol, you have already experienced some breakthroughs. A couple of points, one, if youhaven;t had a complete medical work-up, now is the time to really get a thorough physical, and lab evaluation to rule out any occult disease e.g. thyroid. Second, because of your age I wouldn t wait to see and Electro physiologist(cardiologist) You may be a candidate for an ablation either non-invasive or open. The longer you have dysrhythmias the greater the risk. You lose up to 30% of your effective heart function with atrial fib and you certainly don t want to wait until it is chronic.