This post is in introduction to my most recent column over at Trials and Fibrillations on Medscape | Cardiology.
If I had just one thing to say to patients and doctors about the disease atrial fibrillation it would be this:
Be as scared of AF treatment as you are of the disease.
Yes, it is true: AF can make people feel bad. (It sure did that to me.) It induces fear in both patients and caregivers. And, AF also increases the risk for stroke and heart failure in the future. The emphasis being on the future–as in weeks, months, and years, not usually tomorrow.
One striking aspect of the mainstream—non-electrophysiology—way of treating AF is the urgency. It seems everyone is in a rush. This is not good, especially when the topic of shocking the static fibrillating atria back to regular rhythm is concerned. Here I am talking about cardioversion, which is a severe euphemism for high-voltage shocks. (Wait. can euphemisms actually be severe?) But make no mistake; shocking the heart is no small thing, especially when patients are not taking an anticoagulant drug.
As an AF doctor, I spend endless hours undoing fear—and the dangerous stuff that comes from fear. One is surely the rush to get people out of AF quickly. These are busy people who are feeling terrible, after all. They need to get back to their inflamed lives.
There exists this legend that if AF has been ongoing for less than 48 hours, it is safe to shock (cardiovert) the patient without using an anticoagulant drug.
A new study from a Finnish research group, published today in the Journal of the American Medical Association, sheds important light on this frequently encountered scenario–a decidedly cautionary light.
Many years ago, I was involved in the care of middle-aged professional man who died after such an unprotected cardioversion. This case, and the new data, moved me to write about the matter of shocking people without the protection of anticoagulant drugs.
Here is the link and title of the post: Cardioversion for New-Onset AF: Time to Hit the Pause Button?