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Forum Name: Arrhythmias

Question: 20 y/o A-FIB


 jshep - Sun Dec 14, 2008 4:33 am

Hello I am 20 years old and have been suffering from unknown chest pain for the last year are so, i had seen cardiologist and had all of the basic test done EKG ECHO STRESS TEST everything always turned up normal. till last week I went to the er with an episode of pain they told me i had Afib it went on about 10hours then i converted back to normal rythm. they watch me 36hours then turned me lose told me i was at a low risk for clots and told me ill be ok. they put me on 25mg metoprolol twice a day and a baby asprin once a day. i've been feeling fine since then. i just want to know should i be worried are does it sound like everything is going ok thanks alot
 John Kenyon, CNA - Tue Dec 16, 2008 12:25 pm

User avatar Hi there -

While atrial fibrillation is, in and of itself not a serious arrhythmia, I'm sure you're aware of the main secondary problem it poses. You've been told you're at low risk for clots, which may or may not be correct, since no one can be certain when or for how long you're in A-fib (except for the documented 10 hour episode). A Holter monitor or, if you can feel the A-fib happening, an event monitor, would be a lot more helpful in determining what the frequency and average duration of episodes are. Still, this is probably not the biggest problem in your case.

What the greater problem may well be is that protracted A-fib is unsual in otherwise healthy young men, and usually has an underlying cause. Most often this underlying cause is something called Wolfe-Parkinson-White syndrome (WPW), where the subject is born with (or perhaps develops early in life) an accessory bypass tract that can redirect the impulses from the atria (the upper two heart chambers, where the beat originates, in the sinus node in the right atria), directly to the ventricles without passing through the "watchdog" atrio-ventricular node (AV node) which lies between the upper and lower sets of chambers.

Why this can be a problem is, first, that for some reason people with this abnormal nerve tissue are also much more prone to develop A-fib. Again, in itself, this wouldn't be much of an issue in a young, otherwise healthy person, except, of course, for the possible risk of clots. However, because of the accessory bypass tract, the extremely fast and chaotic rate the atria beat at when in A-fib (normally geared down by passing through that AV node) can drive the ventricles to identical rates and rhythms, which may be intolerable and even life-threatening.

WPW needs to be conclusively ruled out for you. This is normally easy to do, because most of the time it is given away by a very conspicuous EKG abnormality called a delta wave. The delta wave is not always present in all cases, however, so one more reason the Holter monitor could be helpful in sorting this out. If WPW is present, people under 35 years of age are at greatest risk of developing a dangerous arrhythmia. By the same token, WPW is relatively simple to "fix", by means of catheter radio frequency ablation that destroys the accessory bypass connection and removes the risk.

Even if WPW is conclusively rule out, A-fib can be troublesome, bothersome, or at least uncomfortable. It can accompany other types of heart abnormalities as well, and can often be cured by the same ablation method that WPW can. If possible, it should be eliminated unless there is a known precipitating cause such as periodic heavy alcohol consumption (there are a lot of people who have this problem only around the holidays, because they drink more than usual, which sets it off temporarily; This is known as "holiday heart"). At any rate, this definitely deserves further study and a comprehensive cardiac workup by a cardiologist. The stress echo would seem to have ruled out coronary artery disease and structural heart disease, and no one has noted delta waves (or else, as is sometimes the case, they have been noted but unfortunately dismissed as unimportant). WPW definitely needs to be doggedly ruled out. After that a Holter monitor or other personal event monitor should be carried by you to see how often A-fib occurs. Then, if it seems problematic, an eletrophysiologist should evaluate you for possible RF ablation, after which you would likely never have the problem again. (The RF ablation is an in and out procedure which at most might keep you in the hospital for one night, usually allowing the patient to go home the same day).

At your young age it is especially important that this not be blown off as a "nothing."
It's not at all normal, although a few rare individuals do have it for no apparent reason and don't suffer any serious problems. There's just no reason to put up with the annoyance and risk when it is usually so easy to resolve. The beta blocker you've been given may or may not control the problem, but then you're married to this medication infefinitely. There really is a better, simpler way in most cases.

I hope this is helpful. Please follow up with us here as needed.

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