I was more than a week into a 2-week camping trip recently, feeling so happy that I was healthy and able to enjoy every minute of it. Unlike the previous several camping trips, there had been no AFib episodes (not even a hint of one coming) and no stomach issues. Then I got a text from a friend that her husband had an AFib episode the day before and heard about a different experience of AFib than my own.
My friend’s husband – let’s call him Henry – had just had lunch and was relaxing on the couch taking a nap. He’s had a history of high cholesterol, but as far as I know, no other heart issues. He woke up with a start and his heart was beating irregularly (ranging from mid-90s to over 120 bpm). He also noticed that his pulse was irregular. He went to urgent care, which immediately sent him to the ER. The ER did a cardioversion, and the several-hour episode was over.
Next came the reflection on what possibly could have triggered this first-ever AFib episode. The usual triggers all didn’t seem to be relevant. Previous AFib episodes? No. Too much caffeine? Nothing different than usual. Excess alcohol? Nope, didn’t drink the night before. Unusual food? Didn’t think so. Extreme exercise? No. And Henry is very fit. High stress levels. No, Henry’s retired. Lack of sleep. No. Henry finally came up with three possibilities: Epinephrine: He’d had a medical procedure earlier in the week for which the docs gave him a small amount of epinephrine, which can cause arrhythmias. Sleep apnea: While resting after lunch, he’d fallen asleep on his back without using his usual CPAP. Sleep apnea can cause arrhythmias. MSG: The previous night’s food was Asian, possibly with large amounts of MSG, and the food was very good (i.e., he ate a lot of it). MSG can cause arrhythmias.
After a few days, Henry went in to see an electrophysiologist (or EP, a doctor who’s different from a regular cardiologist). The EP scheduled an echocardiogram, which has yet to be performed. The doctor told Henry that often, a patient has one AFib episode that cannot really be explained, and then there are no more episodes. What I call “one-and-done.” The EP put Henry on blood thinners for a month and will reassess the situation then.
Come to find out, the one-and-done situation is not that unusual. My friend (Henry’s wife) has since heard quite a few stories of people she’s known for years who “have AFib.” Most had one episode, trigger undetermined, and no more; for some, the sole episode was many years ago. My husband has an exercise friend who had an episode several years ago. He regularly goes on all-day bike rides, and he rode cross-country for a couple of months last year, with no more AFib episodes. To be fair, he has also permanently cut out obvious potential triggers like caffeine and alcohol.
My friend’s husband, Henry, is a doctor. He knows a lot more about the medical specifics of AFib than most patients. He is familiar with the data and the risk calculations. He knows that it’s possible that his is a one-and-done situation. Yet he will live the rest of his life wondering whether/when he’ll have another AFib episode. He’ll probably also be more aware of possible triggers, and avoiding them may put him into the one-and-done category.
Optimism that the first AFib episode may also be your last should not make you complacent. From everything I’ve read, repeat AFib episodes, if they do occur, often increase in frequency and duration, and warrant attention to eliminate the risk of blood clots and stroke. All to say, just because you had one AFib episode does not mean that you’ll definitely have another. But you should stay aware of your heart’s activities (get to know your pulse), and do what you can to reduce possible triggers for a future episode.
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