13 things to know about Atrial Fibrillation

Here are 13 things I tell AF patients.

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

10 comments

  1. Brilliant! I’m going to go embroider these gems on a pillow . . . I’d love your permission to run this as a guest post on my blog, please and thank you.

    regards,
    C.

  2. Regarding point #8, I would suggest that “emergency rooms” don’t really treat AF at all, while emergency physicians do!

    Ok, being less cheeky: what is the “one big hammer” to which you refer? It sounds like there’s a larger story there, one that deserves its own post.

    Frankly, I think emergency physicians are fairly aware of the multiple manners in which atrial fibrillation presents. Sometimes an elderly lady skipped her morning metoprolol. Other times, we find it in an alcoholic who is withdrawing. And of course, sometimes it is concomitant with sepsis. I would like to think that most of my colleagues don’t use the same big hammer (whatever that tool may be) on all three of these patients in the same way.

    Thanks for writing – As both a dilettante electrophysiologist and past Cat 2, I love your blog!

    1. I’m a little behind on my reading (story of my life), but +1 for an EP’s take on the management of a-fib in the ED. I would love to hear your take.

  3. Thank you for that. I’m female (strike 1), had a TIA 2 years ago in the right frontal lobe in the form of a weird headache (strike 2), and will be 65 in 4 years (another strike ?)

    But I’m not going to worry about it (#7).

  4. 1. Thank you.
    2. One brief “hiccup”? Only an inkling.
    3. …and/or the medication(s)!
    4. The general rule is: It gets worse.
    5. Many abuse themselves with lifestyle and never get AF.
    Others of us who’ve always taken good care of ourselves do get AF.
    The extremes and the exceptions are the best opportunities when problem
    solving.
    6. Stroke causes death. AF causes stroke. Therefore… (Plane geometry.)
    7. Don’t worry about my heart… or the elephant in the room.
    8. Too right!
    9. What about the 60 – 80%? (#12)
    10. Atrio-esophageal fistula, yes. Phrenic nerve palsy, however, is a breeze
    compared to worsening AF. What else?
    11. Right.
    12. Well worth that percentage.
    13. “…might not be as good as you were…” Right. At what point does QoL enter the equation? Ask us.

  5. Are there any statiscics regading #4 ?

    BTW:
    I have athlete’s heart, resing pace about 40, small doses of sotalol don’t work anymore and larger ones causes my HR to drop to 30bpm – that is dangerous.
    Now I have amiodaron as an option but I’m fearful with its side effects.
    Sorry about my bad English.

      1. thanks
        So that everybody says: It becomes worse and worse…
        Currently I wait for ablation, but on – on the other hand – I know person, who still suffers from serious AF after 4 ablations.

        1. It’s not perfect, but ablation is about the only chance people now have of being free of AF without the debilitating and sometimes counterproductive – even toxic – side effects of medication. Ablation does have its own risks. What’s worse?

          Take your carefully written out list of questions to your electrophysiologist and have a heart-to-heart.

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