If you or somebody you care about has been diagnosed with Atrial Fibrillation (AF), you likely already know this about the diagnosis: it’s an irregular heart rhythm affecting the heart’s upper chambers (the right and left atria) – and it’s also the most common heart-related reason for hospital admission. As Kentucky cardiologist Dr. John Mandrola likes to describe the disorder:
“AF is both a disease and a consequence of actions. It’s your body talking to you.”
Dr. John is a bike racer and one of my favourite writers in cardiology. As my heart sister Jaynie Martz once sized up his writing: “concise, charming, compassionately light, adult-to-adult, uber-digestible with nary a whiff of condescension or pomposity.” Amen, Jaynie. His particular cardiac specialty is electrophysiology, the diagnosis and treatment of heart rhythm disorders. Here’s his overall take on the diagnosis of atrial fibrillation, as delivered to a Utah conference of his fellow electrophysiologists recently:
1. AF is a growing and major health problem – and it afflicts a diverse patient population.
2. Though things continue to improve, we offer imperfect treatments.
3. Nearly all approaches to patients with AF are preference–sensitive. No patient really “needs” to have an ablation or take an anticoagulant drug.
4. Information and effective communication in the doctor-patient relationship is everything.
And here’s a more specific list, from his blog:
13 things to know about Atrial Fibrillation
“Here are 13 things I tell AF patients.
- I am sorry that you have AF. Welcome to the club, there are many members. (Three million Americans and counting.)
- I know how it feels.
- Your fatigue, shortness of breath and uneasiness in the chest are most likely related to your AF.
- AF may pass without treatment. Really.
- Important new work suggests AF is modifiable with lifestyle measures. As in, you can help yourself.
- AF isn’t immediately life-threatening, though it feels so.
- Worrying about AF is like worrying about getting gray hair and wrinkles. Plus, excessive worry makes AF more likely to occur.
- Emergency rooms treat all AF in the same way. One hammer — often a big one.
- There is no “cure” for AF. (See #5)
- The treatment of AF can be worse than the disease.
- 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 your CHADS-VASc score.
- 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. UPDATE: Read Dr. John’s essay on ablation (March 11, 2017).
- If your AF heart rate is not excessive, it’s unlikely that you will develop heart failure. Likewise, if you have none of the five 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.”
And here’s what patients love to see, which is empathy of the highest order: Dr. John’s own description of being diagnosed with the same condition that he treats every day in others (from his Utah presentation):
“On a hot summer bike ride in 2010, my heart rate monitor started producing quirky data. About that same time, power left my legs, I gasped for air, sweated profusely and felt faint. When I got home – hours later – it was clear that an AF doctor was in AF.
“This year-long experience with AF taught me a lot – not the least of which was that it is one thing to prescribe a therapy such as Flecainide – it is yet another to swallow that white pill yourself.”
- UPDATE – December 2016: Dr. John Mandrola’s new book The Haywire Heart is out! Recommended for anybody who competes in endurance sports (running, cycling, triathlon, cross-country skiing) and who needs to know that going too hard or too long can damage your heart forever.
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- Why are women with atrial fibrillation treated differently?
Q: What’s been your experience with Atrial Fibrillation?