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Baltimore, MD
Editorial: Leaving the Patient in A-Fib—No! No! No!
Recently I corresponded with a fellow who just found out he was in “silent” Atrial Fibrillation with no symptoms.
I commend his family doctor for discovering he was in A-Fib during a routine physical. Otherwise, he might easily have had an A-Fib clot and stroke. (Of those with untreated A-Fib, 35% will suffer a stroke.) We don’t know how long he might have been in A-Fib before being diagnosed.
I wish I could commend his cardiologist too, but I can’t. His cardiologist just put him on the rate control drug, diltiazem, and left him in A-Fib.
That is so wrong for so many reasons!
Rate Control Drugs Don’t Really “Treat” A-Fib
Rate control drugs aren’t really a “treatment” for A-Fib. Though they slow the rate of the ventricles, they leave you in A-Fib. They may alleviate some A-Fib symptoms, but do not address the primary risks of stroke and death associated with A-Fib.
Effects of Leaving Someone in A-Fib
A-Fib is a progressive disease.
Leaving a patient in A-Fib can have long-term damaging effects with disastrous consequences. Atrial Fibrillation can:
• Enlarge and weaken your heart often leading to other heart problems and heart failure.
• Remodel your heart, producing more and more fibrous tissue which is irreversible.
• Stretch and dilate your left atrium to the point where its function is compromised.
• Lead to progressively longer and more frequent A-Fib episodes and within a year can progress to chronic (continuous) A-Fib.
• Increase your risk of dementia and decrease your mental abilities because 15%-30% of your blood isn’t being pumped properly to your brain and other organs.
I’m So Angry at Doctors Who Just Leave Patients in A-Fib!
I can’t tell you how angry I am at cardiologists who want to leave people in A-Fib.
Even if a patient has no apparent symptoms, just putting them on rate control meds and leaving them in A-Fib can have disastrous consequences (and verges on malpractice).
What Patients Need to Know
The goal of today’s A-Fib treatment guidelines is to get A-Fib patients back into normal sinus rhythm (NSR).
Treatment options includes antiarrhythmic drugs, chemical and electrocardioversion, catheter ablation (and mini-maze surgery).
Unless too feeble, there’s no good reason to just leave someone in A-Fib.1
Don’t let your doctor leave you in A-Fib. Educate yourself. Learn your treatment options. And always aim for a Cure!
- A cardiologist may cite the 2002 AFFIRM study to justify keeping patients on rate control drugs (and anticoagulants), while leaving them in A-Fib. But this study has been contradicted by numerous other studies since 2002.
In the AFFIRM study, most of the rhythm-control patients took antiarrhythmic drugs (AADs) to try to stay in sinus. Very few had catheter ablations. But AADs are known to have many toxicities which caused their own set of health problems and negatively influenced the results.↵
