Atrial Fibrillation: Why Your Treatment is a Lifelong Journey

Story Highlights Atrial fibrillation affects every patient differently Some experience mild fatigue while others are sidelined by the condition Atrial fibrillation is a chronic condition that needs to be treated

 

 

 

 

 

For patients with atrial fibrillation, an extremely fast and irregular heartbeat, treatment options range from medication to clinical procedures and surgery. The treatment plan will vary, based on the severity and nature of the condition as well as the wishes of the patient.

“Therapy is different for every patient,” said Colin Movsowitz, MD, a cardiologist at the Main Line Health Heart Center at Paoli Hospital. “There is no ‘one size fits all’ treatment plan that works for every patient.”

Though not life-threatening, atrial fibrillation is a serious malfunction of the heart. In the most serious cases, it can lead to stroke.

“Fortunately, we have considerable resources to treat each patient’s atrial fibrillation,” said Dr. Movsowitz. “The treatment plan depends greatly on the patient.”

It’s important for patients and their doctors to establish a good working relationship as they plan a course of action. “There’s a give and take,” he said. “A good doctor needs to hear what the patients want to do and be open-minded.”

According to Dr. Movsowitz, the three most critical issues that a doctor will need to address in treating patients with atrial fibrillation are:

• The severity of the patient’s symptoms
• Preventing a stroke
• Minimizing the risk of heart failure

Symptoms. Patients experience atrial fibrillation differently, he explained. Some feel mildly tired while others are completely sidelined with a heart that’s beating too rapidly and feels as if it’s going to jump out of the chest.

Stroke. Atrial fibrillation triggers about 100,000 strokes a year in the United States among the three million Americans with the disorder. The chaotic heartbeat from atrial fibrillation can cause blood to pool in the heart, and then clot. If a clot breaks off and travels to the brain, a stroke can occur.

Heart Failure. Heart failure can occur because the rapid beating of the upper chamber of the heart – called the atria – can cause the bottom of the heart, the ventricles, to beat faster too. Over time, the ventricles can weaken, which can lead to heart failure.

“When a patient walks in, my first goals are to assess the symptoms, the risk of stroke, and how well the ventricles are performing in response to the atrial fibrillation,” he said. “From there, a decision has to be made: Do we want to restore the heart’s normal rhythm? Or do we simply want to control its rate?”

According to Dr. Movsowitz, arriving at the right answer can be challenging. Some patients with minimal symptoms and no sign of heart failure can do well just on medication to prevent a stroke.

Others might benefit from drugs that help the heart restore and maintain normal heart rhythm. But those drugs can present challenges, too.

“The drugs used to restore and maintain rhythm can be difficult to tolerate. You have to choose the drug with the least potential side effects. And patients should be open to the possibility that they may need to change medications.”

For some patients, the atrial fibrillation can correct itself over time.

One type of treatment is catheter ablation. A catheter, a thin tube, goes into the heart and delivers energy that destroys or disrupts the area causing the arrhythmia. However, this relatively new therapy has a 1 to 2 percent chance of a serious complication, including stroke.

“As a cardiologist, I have to be mindful of all of these options, present them to a patient, and then be open-minded and really listen to what they have to say. I want to learn how affected they are by their symptoms and how much risk they’re willing to accept.

“Together, we can map out a treatment plan that makes the most sense for them.”

Treating atrial fibrillation is a journey, he explains. “I assure patients that we can help them, but that atrial fibrillation is a chronic condition that requires us to work together to achieve the best outcome. The good news is that we have many options to come up with the best strategy.”