Dr. Camm Silent A-Fib, Boston A-Fib Symposium 2004

[Guest guest]

(In memory of Dr. McGovern)

Dr. Camm, St. 's Hospital Medical School, London,

England

Author's Note: From a public health aspect, perhaps the most

important presentation was by Dr. Camm on silent (asymptomatic)

A-Fib.

Patients with A-fib often experience symptoms such as

palpitations, difficulty breathing, chest discomfort and anxiety,

sweating, fatigue, and dizziness. But many people with A-Fib (33%)

experience no obvious symptoms and no noticeably impaired quality of

life. These people are at risk not only of stroke which occurs four

to five times more often, but also of heart failure due to irregular

and fast heart beat. There is a threefold risk of heart failure in A-

Fib. Due to silent ischaemic attacks (hemorrhagic strokes) and silent

cerebral infarcts (strokes), patients may develop mental problems

ranging from forgetfulness to dementia. Forty percent of A-Fib

patients have one or more silent cerebral infarcts. Patients with A-

Fib report a substantial deterioration in attention and memory.

From a patient's perspective, we need to be concerned not

only about the obvious symptoms of A-Fib, but also about the long

term risks of A-Fib---stroke, heart failure, reduced mental capacity.

These long term risks are especially important if you have silent A-

Fib.

Dr. Camm cited several studies such as:

• AIDA (Automatic Interpretation for Diagnosis Assistance)

where half the patients with A-Fib experienced silent A-Fib,

• the CARAF study where silent A-Fib patients were most likely

to be male and older,

• the PAFAC German study in which 89% had silent A-Fib,

• and the ALFA study where many patients with permanent A-Fib

(16.2%) reported no obvious symptoms.

According to Dr. Camm, " The persistent and permanent forms of A-Fib

are less symptomatic... " In one study 80% of people who had a stroke

didn't know they had A-Fib.

Even patients with symptomatic A-Fib have silent A-Fib

episodes. In monitoring Paroxysmal A-Fib, silent episodes occur ten

to twelve times more frequently than symptomatic episodes. Under drug

therapy symptomatic A-Fib episodes may turn silent, because the heart

rate does not accelerate or become irregular. This is of particular

concern to those of us on antiarrhythmic drugs. Even though we are A-

Fib symptom free, we may still have silent A-Fib.

Dr. Camm pointed out that quality of life may deteriorate in

patients with silent A-Fib. In the CTAF study (Canadian Trial of

Atrial Fibrillation) patients with paroxysmal or persistent A-Fib

reported better quality of life and had significantly higher scores

in most estimates while they were in sinus rhythm. In Dr. Camm's own

study patients with silent A-Fib reported significantly lower

perception of general health compared to age-matched healthy subjects.

Dr. Camm concluded, " ...the risk of morbidity and mortality

due to A-Fib is probably the same as in patients with A-Fib

symptoms. " But patients with silent A-Fib had a higher mortality rate

(7%) than those with A-Fib symptoms (3%), perhaps because they

weren't being treated appropriately. Patients with silent A-Fib are

more likely to develop heart failure, stroke, and mental problems

because their A-Fib remains unrecognized and untreated for longer.

Early treatment is of particular importance.

As Dr. Ruskin pointed out at the conclusion of Dr. Camm's

presentation, these finding have huge public health implications.

Someone in the audience asked, " should we screen everyone age 60 and

above for A-Fib? "

Dr. Camm mentioned that successful AV Node ablation and the

insertion of a pacemaker produced a remarkable improvement in cardiac

performance and better reported quality of life.

A-FibFriendSteve

[Guest guest]

> (In memory of Dr. McGovern)

>

> Dr. Camm, St. 's Hospital Medical School, London,

> England

>

> Author's Note: From a public health aspect, perhaps the most

> important presentation was by Dr. Camm on silent

(asymptomatic)

> A-Fib.

> Patients with A-fib often experience symptoms such as

> palpitations, difficulty breathing, chest discomfort and anxiety,

> sweating, fatigue, and dizziness. But many people with A-Fib (33%)

> experience no obvious symptoms and no noticeably impaired quality

of

> life. These people are at risk not only of stroke which occurs four

> to five times more often, but also of heart failure due to

irregular

> and fast heart beat. (snip)

I can wholeheartedly agree with Dr. Camm. In March 2003 I was

diagnosed with chronic afib. I had had it some unknown period of

time prior -- having noticed high heart rate on occasion but no other

symptoms. I was finally driven to the ER with severe shortness of

breath, that was eventually attributed to heart failure as a result

of the afib induced rapid heart rate. Rate control restored my

ability to function without shortness of breath, but a successful

cardioversion in August greatly improved my sense of well being.

That sense, unfortunately, has now been destroyed by aflutter, with

which I am not to symptom free. Good article.

Ed in VA

[Guest guest]

> > (In memory of Dr. McGovern)

> >

> > Dr. Camm, St. 's Hospital Medical School, London,

> > England

> >

> > Author's Note: From a public health aspect, perhaps the most

> > important presentation was by Dr. Camm on silent

> (asymptomatic)

> > A-Fib.

The article is both encouraging in that they are learning more, and

somewhat discouraging, in that it reenforces the fact that afib

really does cause a deterioration of the quality of life. Otherwise,

the people who didn't know they had it wouldn't be reporting a lesser

quality of life.

Maybe I'll print it out and show it to the next doctor who tells me

I'm overreacting ;-)

However, I was thinking the other day that when I first learned I had

afib, a lot of the discussion in here was about the maze procedure.

So a giant leap forward has been made in just the past three years.

Who knows what wonderful advances may be made in the near future.

[Guest guest]

In a message dated 4/21/04 5:48:23 PM Eastern Daylight Time,

a-fibfriend@... writes:

> Dr. Camm, St. 's Hospital Medical School, London,

> England

>

Thank you Steve. Your efforts are appreciated.

Rich O