Atrial Fibrillation and Life Insurance

Atrial fibrillation/flutter (AF) is an arrhythmia with an irregular pulse. It may be paroxysmal (intermittent) or chronic (permanent).

Causes of AF include both cardiac and non-cardiac conditions such as valve disease, hypertensive heart disease, conduction disorders (e.g., sick sinus syndrome), coronary heart disease, cardiomyopathy, hyperthyroidism, fever, alcohol ingestion and many others.

The presence of atrial fibrillation/flutter often signals the presence of underlying heart disease, but not always.

Studies have shown that chronic AF, even without other heart disease, carries an increased mortality risk. Clients with chronic AF may develop blood clots in the heart, which may lead to a stroke.

When AF is found, medication or electrical stimulation is used to convert the heart rhythm to normal (i.e., cardioversion). If successful, the client usually will continue on medication to keep the rhythm normal. If cardioversion is unsuccessful or if chronic AF develops, medication (or pacemaker) is used to control the heart rate, but the pulse remains irregular and a blood thinner is needed to decrease the risk of stroke.

Surgical intervention is often used to permanently prevent AF. The most common procedure is pulmonary vein isolation (PVI), wherein the site of electrical irregularity is ablated via catheter access into the heart.

Chart 1 illustrates how atrial fibrillation/flutter is rated.

Chart 1
Ratings for Atrial Fibrillation

Current AF without cardiac evaluation                                                   Table G

Paroxysmal AF (infrequent episodes) with no                                   No rating
underlying heart disease, normal echocardiogram,
and normal current ECG

Other paroxysmal AF or chronic AF with no                                         Table C*
underlying heart disease and normal echocardiogram

With mild to moderate underlying heart disease or              Debits will be summed
with mild to moderate abnormal echocardiogram

One year after successful pulmonary vein isolation (PVI)              No rating
With severe underlying heart or lung disease    Decline


*Credits available for five years of stability, negative stress imaging with good exercise tolerance within past year, negative angiogram within past year, and normal current NT-proBNP.

Author’s Bio
Joanne Mambretti, MD, FLMI, ALHC
MD, FLMI, ALHC, is vice president and medical director at The Prudential Insurance Company of America.

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