The best tool for treating atrial fibrillation

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 anticoagulant drugs. Though it’s obvious that having stroke prevention options other than warfarin represents a significant 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. I tried that strategy and found it equivalent to RF ablation.

You know it’s definitely not dronedarone — or any other anti-arrhythmic drugs.

By far, the most effective way to treat AF patients is to provide them 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 are 13 things I tell AF patients.

  1. I am sorry that you have AF. Welcome to the club, there are many members. (Six million Americans and counting.)
  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. Important new work suggests AF is modifiable with lifestyle measures. As in you can help yourself.
  6. AF isn’t immediately life-threatening, though it feels so.
  7. Worrying about AF is like worrying about getting gray hair and wrinkles. Plus, excessive worry makes AF more likely to occur.
  8. Emergency rooms treat all AF in the same way. One hammer — often a big one.
  9. There is no “cure” for AF. (See #5)
  10. The treatment of AF can be worse than the disease.
  11. 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 an anticoagulant drug. Sorry about the skin bruises; a stroke is worse. Know you CHADS-VASc score.
  12. 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.
  13. 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 anti-coagulant 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 13 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.

All this is why AF treatment should not be rushed.

JMM

Comments

  1. Jaynie Martz says

    Love your delivery….concise, charming, compassionately light style. And thank you for the uber-digestible amount of info encapsulated in each post. And thank you for nary a whiff of condescention or pomposity. Very refreshing!

    I’ve take the liberty of posting some of your blog essays to the WomenHeart.org discussion board because of all the above wonderful features of your writing. The women showing up in droves daily are starved for information of any kind. Your AF description will be remarkably helpful to many posters. I’ve suggested they print this one out and carry it around for a few days while they assimilate the info…..to help assuage the information vacuum most female heart patients are highly distressed about. You are correct that heart functions are intricate, mysterious and take a long time to understand…..while living with and around them.

    Again, thanks for the succinct adult-to-adult delivery Dr. John M. I’ve recommended subcribing to your blog. You offer those in-depth discussions there is never time for in an office visit!

  2. Helen Lawce says

    Amen. Beautifully said, wise, compassionate, and after 10 years with atrial fibrillation, I can attest to the truth of it. Thanks Dr. John. Helen

  3. Campykid says

    Dr. John-I wish I’d come across these dozen tips a dozen years ago, after my first AF episode. Instead, over the course of all those years, I was given my own dirty baker’s dozen: blood test for pheochromocytoma, an SSRI, Ambien, allergy shots, allergy pills, steroid nasal sprays, albuterol inhalers, atenolol, flecainide, Multaq, propafenone, a thallium stress test, and 4 CT scans. –Glad to still be cycling and a proud engineer!

  4. Debbe says

    Spot on, Dr. John! Now that I’m on the other side of a PVA, I heartily agree. I’ve re-posted this to our Facebook AF Support Group. Thank you :-)

  5. Lynda M O says

    Thanks for the concise approach. I linked you to my brother to print out for our parents. Hope they get a bit out of it too.

  6. Dr Barry J. Goodman says

    Aquarian Yoga & Holistic Health. Dr. John, my godfather, a voracious reader and retired from Internal Medicine, forwarded me your website and recent post. Thank you.
    I am a Afibber since I was 35, now 52. I was featured in Newsweek Oct 2007 ina follow up to a cardiothoracic robotic ablation performed in 2005, in which I was one of the younger persons to have the advancements in the technology of ablation applied to.
    I continue to suffer, in fact, I am leaving in a few minutes to an ECHO and will have a touch up ablation later this month. I have worked hard to bring the complementary and natural approach to the world of AFib and wanted you to be aware of the work I am doing. Beleiving and practicing in the benefits of yoga & meditation, is no different than the cyclist knowing the benefits of that ‘experiential’, ‘active’ practice benefiting the heart client/patient/person.
    Help yourself.
    I posted your piece on my blog today. Thank you and I hope your message continues to help people like myself, and through me even more!! I stand to really gain little by posting your article yet the world need your info so I kind of ‘payed it forward’!!!
    Blessings to you and hopefully our paths will cross.
    If you are ever interested in participating in a chapter or two of a couple e-books I am publishing let me know!! They are specifically designed for Health of the Aging Population and The Benefits of a Meditative and Yogic practice, while complementing the existing Medical Model in their lives!
    Again, blessings in well being,
    Barry

    • Dr John says

      Namaste right back atcha Dr Goodman.

      Thank you for the kind words, and for re-posting my blog. That’s a lot of good will, which is very heart healthy, and perhaps anti-fibrillatory.

      Good luck with your AF.

      Thank you.

  7. Ken45140 says

    D. John: Great blog. Comment on #8. My afib is gone..eliminated….”cured”….via surgical technique (TTM/5Box). Strong technical basis for elimination. Strong (although admittedly short term so far) statistics that it works much of the time (like 90% to 95%). More minimally invasive than a PVI but the results warrant the added recovery period (and little chance of needing a second go-around).

    My observation is that many electrophysiologists do not talk to cardiac surgeons and vice versa. Professional wariness, different beliefs, not sure what, but the patient loses unless he or she is knowledgeable enough to bridge the divide. I did. I am satisfied.

    Thanks for listening.
    Ken

  8. Dave says

    Terrific blog…on cryano balloon ablation, do the studies say how many procedures are needed for an otherwise very experienced physician to complete the cryano learning curve? Also, in getting ablated at a teaching hospital, how can you be sure you get the procedure done by the experience physician who attracted you to the hospital as opposed to a relatively inexperienced fellow who went there to learn how to do procedures?

    • Dr John says

      Ah…

      Dave.

      These are splendid questions. I am going to learn the cryo-balloon catheter next month. I’ll keep you posted. I think the number of cases to reach a plateau for any new procedure is highly variable. Atul Gawande writes about this topic in Complications.

      On academic centers versus busy clinical practices…that’s a great question. I will say this, in places like my center, you get me, and only me. I have don’t as many as the leaders in Bordeaux, but I have done more than their fellows. Tough call. Perhaps a blog topic?