The vagal triggers of AF are well known, and include large meals, slow heart rate at night, bending over, etc. as you have noticed. Actually extensive research has been done that shows that vagal nerve stimulation may trigger premature beats from the pulmonary veins, then can then initiate episodes of AF. The problem is eliminating the vagal triggers. Some recent research has shown that low level vagal nerve stimulation may actually reduce AF recurrence, but this treatment is not clinically available in the U.S. yet. We also know that ablation of the pulmonary veins may eliminate the triggers of AF. Thus, if you have not had a good response to antiarrhythmic drugs such as flecainide, then an AF ablation may be appropriate for you, to eliminate your symptoms. However, ablation is not always required if your symptoms from AF are tolerable. Just remember, that in some cases the frequency and duration of AF episodes may increase over time if not treated, eventually leading to persistent AF, which may be harder to treat. Vitamin supplements are not typically too helpful, although magnesium has helped some of my patients. Just as a reminder, previous studies have shown that even 5 hours of AF in a 24 hour perior increases your risk of stroke, and a more recent study suggests that even 5 minutes of AF may increase your risk. Thus, since you have a CHA2DS2VASc score of 2 (age over 65, and female gender), the European guidelines recommend that a patient with a CHA2DS2VASc score of 2 should be on an oral anticoagulant such as warfarin or one of the newer factor Xa or direct thrombin inhibitors to reduce the risk of stroke.
For Brugada or passing out from heart rhythm disturbances, the best person to see is a heart rhythm specialist. There are some tests which can provoke the Brugada pattern.
The Framingham risk score indicates the risk of developing significant disease in a decade. It is not for people who have known disease. Your risk score is relatively low, so continue to keep the risk factors down.
I am unable to answer all these questions as they are too specific without knowing the patient personally. I would suggest follow up with the doctor who prescribed the treatment and either accompany your mother or have a list of questions prepared that you would like answered.
I am sorry to hear about your boyfriend. The fact that he is responding after rewarming is a good sign. The doctors will likely look for infection as a cause of fever and begin medications for his heart and start rehabilitation when he is able.
With a normal heart and good exercise tolerance, your risk is considered low, but heart rhythm problems are occasionally seen in people with normal hearts. I would suggest seeing a rhythm specialist, who will likely order two types of monitors. One to see what your are feeling at night and another (which could be implanted under the skin) to see if you have any rhythm problems during episodes of passing out. Otherwise, the most common cause of passing out is simple fainting (vasovagal syncope).
With such a strong family history of AF, yours may indeed be familial (genetic). Nonetheless we typically treat it the same as sporadic or lone AF. According to your history you donít have a very high risk score for stroke (CHADS2 score 0, CHA2DS2Vasc score 1), since you are less than 65 years of age, and do not have congestive heart failure, hypertension, diabetes, vascular disease, or prior stroke. Therefore, you do not need to be on Coumadin. If your AF episodes are very frequent, and that depends on your perspective, but every 10-14 days if fairly frequent, then an antiarrhythmic drug may be advisable. We usually use flecainide 50-150 mg twice a day, with Toprol, to see if it helps suppress the AF. If AF continues to recur even on flecainide, then an ablation may be required.
Since your persistent AF is asymptomatic, rate control is an appropriate option for treatment of AF in your case. If you have been in AF for more than a year, it becomes much more difficult to prevent recurrence with either antiarrhythmic medication and cardioversion or ablation. You do not have to undergo treatment with an antiarrhythmic drug or ablation if you are asymptomatic. In fact, if you are under age 75 and have no other risk factors in the CHADS2 score (congestive heart failure, hypertension, age over 76, diabetes and prior stroke), you theoretically donít need to take Pradaxa either, just aspirin may be appropriate.
Beta blockers have many potential benefits that promote beneficial remodeling including reduction in cardiac response to stress hormones. They also have some effects directly on cells such as fibroblasts, but they are better known for blocking the signals that promote such activity.
I am sorry. I am not an expert in orthopedic issues. Certainly discuss this with your surgeon.