Atrial fibrillation Reflection

Atrial fibrillation and philosophy…

Patterns. As a doctor, you learn to see patterns. Biologists call the patterns of organisms phenotype–as opposed to genotype, the genetic makeup.

For twenty years, I have observed the phenotypes (patterns) of people afflicted with AF, and have come to believe, and data are beginning to confirm, that the disease doesn’t just happen. It’s not a fluke. AF happens to people because of something about them.

I’m not talking about the obvious AF associations, such as obesity, high blood pressure, sleep apnea, and structural heart problems (heart failure and valve disease, etc). These are all diseases that disrupt the atrial muscle and its electrical function–by excess stretch, scar and fatty infiltration. These are easy concepts to understand; they are biologic effects.

What’s more interesting, yet no less consistently observed, is the typical persona of the patient with AF. That’s not a typo; I meant to say persona. Oodles of science has shown the heart and mind are connected, so what I refer to here is the character of one’s subconscious, their psyche. their spiritual and emotional, rather than biologic heart.

At various times, I’ve dubbed AF, the A-student disease, or the over-achievers disease, or even this…the frowny-faced-person disease. I see CEOs, lawyers, doctors, engineers, ministers, and yes, let’s put masters-aged athletes in this category as well. These are all people whose material gifts and accomplishments should leave them joyous and celebratory. But yet it often seems the opposite.

Perhaps it is seeing and interacting with these phenotypes that has fostered my interest in the philosophy of everyday life.

It’s why I’ve taken liberties with the strict biologic definition of inflammation. When I speak of the “inflammation of life,” I don’t mean to confuse the action of white blood cells and chemical mediators with the chronic anxiety of life. Cliche alert: Of perpetually being “on the gas” physically, mentally and emotionally.

With this introduction, may I present Swiss-British writer and everyday-life philosopher Alain de Botton, who recently visited the Kentucky Author Forum. I think he is on to something that my help AF patients and doctors alike.

Here is his 50-minute Great Conversation from that visit.

Here is his TED-talk : A kinder, gentler philosophy of success


5 replies on “Atrial fibrillation and philosophy…”

Spot on John. Before my ablation one of my major triggers was stress or emotional overload.

You just nailed it.
Me: 55, surgon, overachiever, ultramarathoner, never content with what I’ve achieved.
Just had my first 12 hour episode of a fib….

Also, I didn’t bother to listen to the video, have a 15 mile run to get done before dinner — training for a 50 M race next weekend!


I raced road and mountain bikes for nearly 10 years with affib. But stress set my heart off more often than the bike ever did.

As I read this piece, I thought the demographic of your patient population obviously showed selection bias as the A type lawyers/doctors/endurance athletes have sought you out because you are obviously a stud doctor and that is what A type people do–find the best.

Then it occurred to me that I am an A-type former endurance sport junkie, and attorney (with afib) and I have never seen you. Maybe you are on to something.

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