In people with a low risk profile including younger age, aspirin 162 mg may be beneficial and adequate to prevent strokes. Stomach lining erosion with gastritis, ulcers and acid reflux can be an important side effect of aspirin and aspirin should be used with caution in this setting as it may provoke serious acute gastrointestinal bleeding, the risks of which may far outweigh the potential for stroke, particularly in younger patients with an otherwise low-risk profile.

Lone atrial fibrillation is AF that develops without significant risk factors or heart disease, and therefore the risk of stroke is generally low, particularly in patients under 65 years, and Aspirin (or even nothing) is generally adequate to prevent strokes even for people who are in truly lone AF all the time. Since your heart rate is not too fast in AF, stopping diltiazem should be fine because it is not intended to prevent AF episodes, rather only to control the heart rate in AF. However it may be that the diltiazem maintains your heart rate in a reasonable range during AF episodes and that stopping diltiazem may allow your heart rate to become faster. Ablation is usually reserved for people who are symptomatic from AF AND who have failed medicines including antiarrhythmic agents. Daily antiarrhythmics or “pill in a pocket” approach in which antiarrhythmic agents are used only during episodes of AF may be a reasonable next step, and if that does not adequately suppress AF, THEN you may be a candidate for an ablation. Rarely AF may be considered in people who wish to avoid medications. It is very difficult to identify people who are likely to progress to more persistent forms of AF but currently you describe yourself as having paroxysmal AF; your low risk profile and absence of heart disease are in your favor.

PVCs can in some cases induce other arrhythmias, including SVTs. However it sounds like the kind of arrhythmia you were having is atrial flutter which is not classified as a PSVT. While this arrhythmia is generally unrelated to PVCs, it is commonly seen in association with AF. (In many ablations may be truly curative, but sometimes the same rhythm may recur, and at other times a similar heart rhythm – not necessarily the original rhythm that was ablated – may develop over time. PVCs can arise from many different areas of the heart, and an ablation to target PVCs from one area of the heart does not guarantee that PVCs from another area will not manifest. Frequent PVCs are not dangerous themselves but it may reflect an irritability of the cardiac electrical system due to blockages in the arteries of the heart (coronary artery disease), weakening of the heart muscle (cardiomyopathy), or just excessive sensitivity of a specific location to produce extra beats (i.e. PVCs) particularly in response to stress or anxiety or any source of excess adrenaline release. Depending on the underlying condition, ventricular tachycardia can develop.)

BP is difficult to measure in AF because of the irregularity of the systolic and diastolic phases that are required to obtain accurate BP measurements. However, if BP is reproducibly found to be elevated then it may be related to the following: AF decreases the cardiac output and may provoke a compensatory increase in vascular tone and thereby increase blood pressure, sometimes not just back to baseline but overshooting baseline. Further the anxiety provoked by AF can be enough to increase BP.

Shortness of breath in someone with mitral valve repair, and AF requiring cardioversion and Amiodarone, should be considered as either related to 1) the quality of the valve repair and degree of residual mitral regurgitation, 2) due to Amiodarone from pulmonary toxicity/pneumonitis/fibrosis, or 3) due to other causes unrelated to the AF or its treatment. Also in people with recent open heart surgery, they can develop fluid collections around the heart (pericardial effusion) or lungs (pleural effusion) that can cause shortness of breath. Pulmonary congestion related to progressive weakening of the heart muscle (cardiomyopathy) can also provoke shortness of breath, and finally blood clots that travel to the lungs can also cause shortness of breath – this option is less likely if chronic anticoagulation is continued with ability INR maintained between 2.0 and 3.0. Finally confirm that your shortness of breath is not in fact related to a recurrence of AF.

Frequent PVCs and atrial fibrillation are both common, and can occur in the same individual. Sometimes PVCs may become temporarily more frequent after an ablation procedure. Atrial fibrillation can become persistent (present all the time) and over the long term may be associated with an increase risk of stroke, heart failure, and death.

AV node ablation does not control AF, it only controls the ventricular rate the AF produces so you would still require coumadin. AV node ablation itself is usually associated with success rates >98-99%, however it results in complete heart block and therefore requires permanent pacing.

While the “pill in a pocket” approach is effective and is not just for emergencies, every patient and their AF should be individualized. While one patient may tolerate this approach, another patient may require daily antiarrhythmics to maintain adequate suppression of AF. Consult you physician regarding this possible treatment method.

Yes flecainide can increase risk of conduction block. Most antiarrhythmics do affect the conduction system in a manner that inhibits conduction of arrhythmias, but the normal rhythm can be affected as well.

While saw palmetto is known to have some beneficial effects for prostate enlargement and hair loss, it can increase warfarin levels and thereby increase the INR to levels higher than anticipated or required, which can then increase bleeding risk. According to most available resources, patients taking warfarin are cautioned against taking saw palmetto, and patients should consult their physician before starting or stopping saw palmetto.