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The Skeptical Cardiologist's avatar

Gerry,

It has been a fascinating journey with afib since I started my cardiology training in 1984.

Once studies came out showing the superiority of warfarin over aspirin preventing stroke in afib I gave lots of talks (paid for by DuPont, the maker of Coumadin) on anticoagulation and how the new-fangled INR was superior to measuring PT alone. This was, of course, before I became the skeptical cardiologist and declined Pharma gifts/money/talks in order to maintain my unbiased status.

Mandrola recognizes the value of AFIB ablation for select patients, the limited efficacy and the complications but thankfully is not a gungho enthusiast. Most recently on TWIC he described how there are multiple white areas in the brain in patients who have undergone ablation, presumably micro embolic events, significance TBD.

Dr. P

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The Skeptical Cardiologist's avatar

Chip,

I have many patients who have only had one episode of atrial fibrillation. Typically this is a patient who had an unusual event that caused the atrial fibrillation.

I have one patient, for example, who had an episode of atrial fibrillation 15 years ago at a time when he had acute pericarditis. The pericarditis has not recurred and neither has the atrial fibrillation.

Some patients have their first episode of AFIB at the time of a severe pulmonary infection and have not had recurrent spells for decades. Others might have it at a time of profound hyperthyroidism that is corrected and not recur. About 1/3 of patients undergoing open heart surgery develop atrial fibrillation and recurrence rate is low.

I wish we had a good category name for the "one and done" fibber. And I wish we had good studies informing how best to manage anticoagulation in this group.

Dr. P

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