The two types of Afib

Type 1 and type 2 AF

Most medical conditions in the western world are caused by one or more of the following conditions:

Age
Genetics
Luck
and Lifestyle.

Lets look at diabetes.
There is type 1 diabetes which is usually caused by bad genetics or just bad luck and affects young patients
and there is type 2 diabetes which affects older patient and is usually caused by age and lifestyle.
They are managed differently.
Type 1 diabetes is treated with Insulin
Type 2 diabetes is treated with tablets/diet and sometimes insulin (and lifestyle changes)

In the same way, i believe that there are 2 types of Afib and they are caused by different things but unfortunately they are thought of as one condition and therefore all Afib is managed in the same way but ideally they should be managed differently and if you understand the difference, it may allow you to target those treatments which will give you most benefit.

Type 1 Afib.
Whilst most patients with Afib is seen in older patients with comorbidities,
we do see it in younger patients who have no comorbidites…this has historically been termed lone Afib.
In these patients, the reason of Afib is usually genetic or bad luck
when you scan these patients they have normal sized left atria and often their Afib comes and goes and interestingly they seem to really not tolerate their Afib very well at all. When you follow them up, they have an exceptionally good prognosis with no increase in stroke risk and these patients seem to respond extremely well to ablation.

Type 2 Afib,
Older patients with Afib usually tend to develop it because of increased age and bad lifestyle. They often have comorbidites such as diabetes, hypertension, sleep apnoea and vascular disease. Interestingly when you scan their hearts they have big sized left atria and they seem to tolerate their Afib very well. Often many are found to be in Afib incidentally and they are often in persistent Afib. When you follow them up, they do very badly in the short to medium term and have a much higher incidence of strokes, heart failure and even sudden death and therefore need anticoagulation. Often they don’t respond as well to ablation and even if they do they often end up requiring more than one procedure and taking away the Afib does not alter their risk of strokes or overall prognosis.

and therefore I think that patients with type 1 Afib should be treated with reassurance and ablation
and patients with type 2 A fib do better with anticoagulation and lifestyle modification and ablation in the case of refractory symptoms