Atrial Fibrillation, an abnormality of the electrical system of the heart, is more prevalent after 60 years old. I found the explanations about cause, treatment, prognosis to be inefficient in our daily office visits, and misunderstanding and confusion lead to noncompliance with treatment.

Social media advertising regarding anticoagulation therapy, – Xarelto, Pradaxa, Eliquis and coumadin, is also misleading, emphasizing only the potential side effects, without stating the major benefit of taking them: preventing a debilitating stroke. Yes, you may have a bleeding episode, but how about if you have a stroke by not taking anticoagulation? . Having a parent with recurrent strokes, I can tell you that this debilitating disease is not only tragic for the patient, but also for the entire family.

What is Atrial Fibrillation?

• An irregular heart beat, or quivering of the heart, that can lead to blood clots, stroke, heart failure

• It is intermittent, ” coming and going” initially, until it becomes permanent. It’s hard to diagnose, since it’s not present all the time. Being intermittent by nature, you still have it , with the risks of stroke and heart failure, even though may not be present for days or months. This is the reason we don’t stop treatment , when fibrillation is not present, or ” quiet”.

• More common in older age, and more prevalent in older women, without a triggering  event. Age related changes in the structure of the heart, predisposes us to Fibrillation.

What’s the cause of  Atrial Fibrillation?

• Older age is a predisposing factor, with older women being affected more.

• Coronary disease, Heart failure, Obstructive sleep apnea, Thyroid disorder, Hypertension

• Stimulants – medical or ” natural” dieting drugs

• Alcohol abuse or intoxication.

• Post Open heart surgery

• Valve disorders

Symptoms of Atrial Fibrillation?

• Frequently , no symptoms at all. Confusing , since the absence of symptoms drive many of us to stop treatment. Remember – its intermittent, or may be well tolerated,and asymptomatic. Its still there!!

Atrial Fibrillation , vs Normal, Sinus Rhythm

Here are real patient’s stories about Atrial Fibrillation

• ” felt nausea, dizziness, and gasping for air, but no palpitations”

• ” fast heart rate, with tiredness, and slowing down; not able to climb one flight of stairs”

• ” chest pressure, heaviness, uneasy feeling over my chest”

• ” no symptoms, found it accidentally at the doctor visit”

Treatment of  Atrial Fibrillation

Treatment consists of Controlling the heart rate and Preventing the Stroke

Heart Rate Control starts usually with Betablockers, Calcium Blockers, Digoxin, which slow down the heart rate, eliminating cardiac symptoms. While being on these medications, ” breakthrough ” episodes of palpitations will appear. As long as these symptoms are short lasting and don’t interfere with your activities and lifestyle, you don’t need to go to the next treatment level. These medications won’t cure fibrillation, but wont allow any heart damage; they have minimal side effects and toxicity.. An echocardiogram is done periodically, to assess the strength of the heart, or EF. ” Breakthrough episodes ” are acceptable, as long as the EF on echo remains normal and you can sustain your normal level of exertion.

I am asked many times why not go directly for  ablation? ” I was told by my internist or a friend to go for ablation and not waste time with simple medications”. My answer is simple :  ablation, – have more than 30% failure rate, and is an invasive procedure; relapses are frequent; even after ablation, patients still require anticoagulation. Thus, if the response to simple treatment is great , why go for more? Why not wait until the easy treatment fails? Some patients do not ever require more than benign drugs.

Two pathways of treatment in A.Fib.

If first treatment plan fails, you are a candidate for Antiarrhythmic drugs, – Amiodarone, Flecainide, Sotalol. These medications will keep your heart rate into normal rhythm, reducing the fibrillation episodes. They need close monitoring for side effects, and toxicity, and some requires hospitalization to be started.

The next level is cardioversion, – an electrical, painless shock applied to the heart, which restores normal rhythm. It’s not a permanent solution, since relapses are quite frequent. Even after cardioversion, anticoagulation is frequently not stopped. Read more about cardioversion (Cardioversion)

For patients who remain symptomatic or show signs of ” failing heart” on echocardiogram, Ablation is indicated.

During an ablation, tiny areas of the heart, that are firing abnormally, are destroyed .Atrial Fibrillation can be eliminated in about 70% of patients. The procedure is done in the hospital, lasting about 3-5 hours.

A new invasive and appealing treatment emerged recently , gaining more and more success – Watchman Device

Watchman Device

Watchman device , newly approved FDA, is a small , permanent heart implant, which reduces the risk of stroke and eliminates the need for anticoagulation. Most patients are able to stop blood thinners about 45 days after procedure.

My answers to the most common questions about Atrial Fibrillation .

• What is the cause of it?. Many times only aging of the heart, with associated changes in heart structure.

• Do I need a pacemaker? No. Pacemaker won’t treat or correct Atrial Fibrillation.

• Why do I still have palpitations if I’m taking my meds? . It’s very difficult to cure A Fib. Breakthroughs of symptoms are not dangerous and do not indicate different treatment, unless there is sign of ” weak” heart on echo, or symptoms are long, interfering with lifestyle. Two- three episodes a year are acceptable.

• Why do I need to take blood thinners if I didn’t have fibrillation for a few months?. A Fib is intermittent, or asymptomatic. By nature, it’s recurrent, carrying the risk of stroke. No symptoms does not mean you don’t have it.

• My doctor told me to take only aspirin. Stroke is not prevented by aspirin.

• I had ablation. Why do I still have AFib, and why the need for blood thinners?. In 30% patients, ablation is not successful. Blood thinners are necessary if you have other risk factors that may trigger A Fib recurrence. ( heart failure, previous heart attacks, open heart, valve disease).

• I heard on TV only bad things about blood thinners. It’s always your choice about blood thinners. There is a risk of bleeding with them, but a much higher risk of stroke without them.

• Which one is better coumadin or the new blood thinners?. In short, the efficiency is almost the same, and dangerous  bleeding risk a little higher with coumadin, despite common beliefs. The new ones are more expensive , but more convenient to take.

Each patient is unique in regards to symptoms and response to therapy. Each patient has the right to choose which option is best for his lifestyle and beliefs.

Make an informed decision, based on medical evidence.

Disclaimer : The article has teaching, and general information purpose only; it is not meant as a medical advice and it’s not intended as a replacement of a cardiac consultation.