March 25th, 2011

The Best Tool for Treating Atrial Fibrillation

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog, Dr John M.

Today, I would like to tell you about the most effective way to treat the most common heart ailment — atrial fibrillation (AF).

It’s not the novel new blood-thinner, dabigatran (Pradaxa). Though it’s obvious that preventing stroke without using a rat poison represents a huge advance.

It’s not burning the left atrium with an ablation catheter. Though it’s clearly true that we can ablate AF much more safely and efficiently than we did in past years.

It’s not freezing the atria with cryo-balloons. Though I look forward to learning this new technique.

You know it’s definitely not Multaq.

By far, the most effective way to treat AF patients is to provide them with information. Knowledge is king. AF patients need to know stuff about their crazy new disease.

AF is nuts. It can cause heart failure and stroke, or it can cause nothing. It can disable some, and others don’t know they have it. Its incidence increases with age, degree of inflammation, and general wear-and-tear, but it can also afflict the athletic and nimble. (Though there is little doubt that doctors, lawyers, and engineers have more AF than yoga instructors.)

Here’s a sampling of twelve things that I often tell AF patients:

1. I am sorry that you have AF. Welcome to the club, there are many members.

2. I know how it feels.

3. Your fatigue, shortness of breath, and uneasiness in the chest are most likely related to your AF.

4. AF may pass without treatment.

5. AF isn’t immediately life-threatening, though it feels so.

6. Worrying about AF is like worrying about getting gray hair and wrinkles. Plus, excessive worry makes AF more likely to occur.

7. Emergency rooms treat all AF in the same way.

8. There is no “cure” for AF.

9. The treatment of AF can be worse than the disease.

10. The worst (and most non-reversible) thing that can happen with AF is a stroke. For AF patients with more than one of these conditions: Age >75, high blood pressure, diabetes, heart failure, or previous stroke, the only means of lowering stroke risk is to take a blood thinner. Sorry about the skin bruises; a stroke is worse.

11. The treasure of AF ablation includes eliminating AF episodes without taking medicines. But AF ablation is not like squishing a blockage or doing a stress test. It will be hard on you. It works 60-80% of the time, has to be repeated one-third of the time, and has a list of very serious complications.

12. If your AF heart rate is not excessive, it’s unlikely that you will develop heart failure. Likewise, if you have none of the 5 risks for stroke, or you take blood-thinning drugs, AF is unlikely to cause a stroke. In these cases, you don’t have to take an AF-rhythm drug(s) or have an ablation. You can live with AF. You might not be as good as you were, but you will continue to be.

There’s obviously more than twelve things to say about AF. It’s a complicated disease with many different ways to the same end. We need adequate time with our patients to give them this kind of powerful knowledge. They need time to digest all the possible treatments, or perhaps no treatment. Patients need to weigh the disease against the treatments.

That’s why AF treatment shouldn’t be rushed.

5 Responses to “The Best Tool for Treating Atrial Fibrillation”

  1. Rafael Perez-Mera Perez-Mera, MD says:

    My comment to the above is that I do agree.

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  2. Perhaps somewhere between #9 and #10 we may add that sometimes treating other diseases such as Hyperthyroidism may help reduce the recurrences of AF. ( such as President George HW. Bush )

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  3. Stephen Austin, MD says:

    Nothing beats educating people and providing reassurance that doom is not imminent–Amen!!

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  4. izaskun obieta fresnedo, MB, MPH says:


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  5. I am not a cardiologist and this is in the public domain but anyway, it’s always good to remember that alcohol, as opposed in other types of heart disease, even used in moderation, doesn’t do much good to any type of AF.Kodama S, et al “Alcohol consumption and risk of atrial fibrillation: A meta-analysis” J Am Coll Cardiol 2011; 57: 427-436

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