AF ablation Atrial fibrillation

Changing trends in the treatment of AF

There’s very little in Cardiology that isn’t rapidly changing these days.

Treating AF exemplifies this trend. At least my approach to AF has evolved steeply over the past year. Amazingly so, really.

For instance,

I choose blood-thinners in a different way. Call it a more European perspective.

My threshold to discuss and recommend AF ablation is far lower.

My approach to burning AF moves steadily toward a minimalist approach. You can always burn more, but you can’t take a burn back.

And, as non-medical treatments like catheter ablation become easier (for both me and the patient), safer and perhaps more effective, my views on using rhythm drugs has also changed.

I plan to write about these “evolutions,” if you will, but here’s the thing: it’s hard.

The post on how I’ve changed my views on recommending a blood-thinner has undergone multiple revisions. You just can’t tap out a post on changing trends for preventing stroke in AF without getting the facts down accurately. There’s a lot details.

Stay tuned.


P.S. One notion–about heart disease in general, and AF in particular–that hasn’t changed: preventing the disease easily trumps any new therapy. You could even call this principle something smart-sounding, like axiomatic.

8 replies on “Changing trends in the treatment of AF”

Dr. John M – I have been receiving your information for almost a year now. Would you please address how Pradaxa works with blood clots in leg. I have been on Pradaxa for
4 1/2 months, before that another blood thinner. I had read eveything I could find before finding Hematologist who was happy to prescribe. My next appt. is Dec.

I am on 150 mg twice daily. At what point may I cut down to the lower 75 twice daily.
I have had dopplar and blood clot is gone~ Drs. are vague on when to cut down dosage.
I am thrilled with Pradaxa, however, I am small in build and “feel like there is too much in my system” – Is 6 months long enough for treatment and I will stay on lower dose remainder of life (since I have had 2 blood clots in past 2 years).

There seems to be a vagueness in this area. Can you help or at least tell me the concensus of opinion?

Los of vagueness. Pradaxa use in the US is limited to stroke prevention in AF.We think that there will be more clarity in its use for venous disease coming in the future.

Hi Dr. M
So…in reference to your “PS” (the first sentence)…I didn’t know A Fib is preventable. What could I have done to prevent mine? Hmmmm……

I know…water under the bridge, and all that. But I’m curious as to what I did wrong during the last 59 years.

Dr. John, could you explain more about prevention of AFib, if that is possible. I know in my case a cause was never identified. Thank you for this site. Your insights ate very helpful. Steve.

Steve D and Dr. John…Betsy here. My cause was never identified either.

All I know is that about 5 years ago, I was in the recovery room of our local hospital (and my place of employment…I’m a med tech in the lab) waking up after a routine bunionectomy, and the nurse called in the cardiologist because my ECG was showing AF. I really didn’t feel it at the time. Even so, I ended up in ICU and the cardiologist tried 3 times to convert my rythym…he said I was the only one he couldn’t cardiovert (I think that’s the word) in his 30 years of practice.

Dr. John, how are TSH levels and AF related? Before the surgery, I had been diagnosed with hypothyroidism, and have been taking synthroid since. Post surgery, my TSH levels went down…could this have done a number on my atrial rythym? My cardio highly suspected it, but could never prove it.

Hi John and other lurkers,
I am four weeks out from my AF ablation. I’m back to riding and training, 15 hours last week with a four hour ride at 7000′ elevation in Sun Valley. No signs of AF at all and no PAC’s, my heart just seems to run smoother all the time. Oh, and my energy level is so amazing, no more dragging ass after a hard ride.
The only down side is the warfarin which has sidelined me from racing cyclocross for a few more weeks. Overall I wish I had done the ablation sooner, the drugs did little to stop the AF and only allowed my fitness and mental state to slide downhill. Thanks to this blog for helping me move forward.
Oregon Cross Racer/Orthodontist

So, you say Pradaxa is not used for venous (blood clot in leg) in the United States.
It IS being prescribed – would you consider it dangerous to use? Dopplar indicates the clot in left leg is not there and so much quicker than the “other” blood thinner and is not controlled by what I eat. I would not go back to the “other” blood thinner, too many side effects and certainly limited my quality of life. I have complete blood work every 4 months and no problems have been found. The Hematologist I use is very comfortable in prescribing. How concerned should one be taking Pradaxa?

Thank you for your response.

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