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Treatment of Atrial Fibrillation

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Understanding AF treatments

Living with atrial fibrillation (AF) can be frustrating and confusing. With various treatment options available, it's natural to wonder what's right for you. This guide aims to break down the key strategies your doctor might suggest, empowering you to make informed decisions about your heart health.

My priorities are:

  1. Preventing Stroke: Stroke is a serious risk for individuals with AF. We assess your risk using the CHADSVASC score and may recommend anticoagulant medications, unlike aspirin which doesn't offer significant benefits in this case. Newer options like NOACs are often preferred due to their effectiveness and convenience.

  2. Controlling Heart Rate: During AF, your heart beats irregularly. Beta-blockers, calcium channel blockers, and sometimes digoxin help slow down your heart rate, improving symptoms and reducing heart failure risk.

  3. Restoring Normal Heart Rhythm: Two main approaches exist:

    • Medications: Drugs like amiodarone can be effective but come with potential side effects. Other options with fewer side effects are also available.

    • Ablation: This minimally invasive procedure uses heat, cold, or electricity to target and disable areas causing AF, offering a more definitive solution.

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Prevent Stroke

Assess your risks of stroke with AF and provide blood thinners as appropriate

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Control the heart rate

Make sure the heart is not racing all the time and prevent heart failure from occuring

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Restore normal rhythm

Catheter ablation is the most successful way of ensuring normal rhythm is restored and maintained, but other options are available

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The Ablation Procedure

  • I usually performed cases under general anesthesia, almost always as a day case. Local anaesthesia can be used.

  • Tiny catheters are inserted into a leg vein and guided to your heart.

  • The abnormal electrical pathways are targeted using various techniques.

  • Normal rhythm is restored, or electrical cardioversion may be needed.

  • The procedure usually takes from between 35 minutes to 1.5 hours in my hands

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Success rates and Complications

Success rates vary depending on AF type, duration, and overall health.

  • Paroxysmal (intermittent) AF has higher success rates (70-80%) than persistent AF (50-60% from a single procedure, but some cases might have a 30% or even less).

  • Repeat procedures might be needed, but overall success can reach >80% for paroxysmal and >70% for persistent AF.

  • Remember, this is a journey, and open communication is key.

Potential Risks and Complications:

  • Minor and temporary issues like bruising, chest pain, or temporary AF episodes are most common.

  • Nerve injuries (affecting digestion or breathing) are rare but usually resolve within weeks.

  • Serious complications like blood leaks or leg vein injuries occur in around 2% of cases. Death is very rare, less than 1 in 2000 cases.

Post-Procedure Considerations

  • Anticoagulants might still be needed depending on your stroke risk.

  • Medication to help with healing and prevent AF recurrence may be continued for a while.

Further Resources:

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