The problem with AF treatment is that we do not (really) understand the underlying causes of the disease.
Why does the heart fibrillate? What gets those pesky premature beats started? Why do intermittent episodes persist? Why does AF come back after shocks or ablation?
AF has been thought of as its own disease. You have high blood pressure and AF, diabetes and AF, depression and AF. And when there are no other obvious diseases, we used to say “lone” AF, which wrongly assumed that AF was its own disease.*
Atrial fibrillation was just another problem on a list of things to address. It was in a silo–cardiac.
That mindset is changing. And it is a good news/bad news thing.
The good news is that we are finding answers to the basic questions of AF. We are closer to a cure. Really, we are. I have seen cure happen.
The bad news is that there will be no single pill or procedural cure. That is because atrial fibrillation is (most often) an effect not a cause. The top chambers of the heart, with their thin walls and closeness to nerve endings and exposure to blood volume and pressure 100,000 times per day, are like a window onto overall health.
When we are well, our atria are well.
When the balance is perturbed, our atria will tell us. The nerve endings that connect the brain and heart fire. Premature beats begin. Initially, the premature beats are extinguished. They are just single beats, a thud and that is it.
Over weeks, months and years the premature beats wander out into the atria and find diseased cells and pockets of scar tissue (fibrosis). We name this process remodeling. Single premature beats can now start rotating around the sites of disease into rotors. (Picture an eye of the storm and hurricane.) AF starts.
The remodeling process is complex. It happens inside the atrial cells (ion channels), between the cells, in the scaffold surrounding the cells and in the nerve endings connected to the cells. It is so NOT one thing.
But why it occurs is not mysterious at all. Remodeling occurs because everything in our body is connected. The brain and the heart are connected. The lungs and the heart are connected. The immune system and the heart are connected. And so on.
Dr. Prash Sanders and his team of scientists are getting doctors to pay attention to the entire patient–not just her atria.
Listen to my friend explain this new way of thinking. In the Q & A after his lecture, the second question leads to a very disruptive thought for cardiologists.
JMM
* In very rare cases, AF can be its own disease, sort of like a fluky atrial tachycardia.
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