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Which Treatment Method Is Best For Atrial Fibrillation?
 

Atrial fibrillation (AFib) occurs when the upper chambers (atria) and lower chambers (ventricles) are not coordinated, causing the heart to beat too slowly, too quickly, or irregularly. Persons with AFib have a higher risk of getting blood clots, stroke, heart failure and other heart-related complications. Untreated AFib doubles the risk of heart disease related deaths and is associated with a 5-fold increased risk for stroke. Symptoms of AFib, including palpitations, shortness of breath, fatigue, and weakness, can be unbearable.

Medications or catheter ablation can lessen the burden of arrhythmia (frequency, impact, and symptoms) and improve quality of life. Nevertheless, they cannot reduce the risk of stroke. While the anti-arrhythmic drugs can stabilize the heart muscle tissue and help return the heart to its normal rhythm, it may come with serious side effects. Ablation is invasive as the abnormal heart tissue is destroyed by burning or freezing it but has a greater chance of reducing and even eliminating the symptoms. Nonetheless, ablation is expensive and may not right for everybody. So which treatment method is better?

Common medications to treat AFib may include blood thinners to prevent or treat clots,
beta-blockers or calcium channel blockers to control the heart rate, and sodium channel blockers or potassium channel blockers to slow heart rhythm. These medicines usually relieve symptoms. Some people take the medicines every day, while others take them only when they experience palpitations. These drugs may work well for some people, but not all.

Using medicines is easier than undergoing surgical procedures, and medication is typically less expensive than ablation, at least in the short term. But such benefits diminish with time. If the AFib results in repeated hospital visits and changes in the medications to better manage the symptoms, the cumulative costs may increase over time. Meanwhile, antiarrhythmic drugs have side effects including nausea, dizziness, diarrhea, breathing problems, and swelling. Certain drugs can produce serious side effects like causing scarring of the lungs, and it can interact with blood thinners. All anti-arrhythmic drugs can trigger life-threatening heart rhythm disturbances, such as ventricular tachycardia (fast heartbeat) or ventricular fibrillation.
 

Research shows that with medication, there is a good 40 to 60 percent maintenance of normal rhythm at one year. Ablation, however, has an average of 70 to 80 percent success rate. Those who are young, whose AFib is intermittent, and who have no underlying heart disease, can have success rates as high as 95 percent. Those with persistent AFib who are older and have underlying heart disease have a lower success rate, but still around 40 to 60 percent. The risk of complications of undergoing ablation is low: fewer than 5 percent of patients develops any problems. It is rarely that the use of the catheters can damage the blood vessel, or cause bleeding, or infection. More serious complications, like stroke and heart failure, is less than 1 percent.

The procedure takes about 2 to 4 hours, and patients can be discharged the same day or after an overnight stay. It causes little or no discomfort and is done under mild sedation with local anesthesia. But for 20 to 30 percent of patients, the first ablation does not work, and they have to go back for another. Ablation works best on patients who have the kind of AFib that comes and goes (paroxysmal) and are otherwise healthy. People who are not well suited for it are those with long-standing AFib who have underlying heart disease.

It may take up to 3 months for scars to fully form on the sites that were ablated and to know if the procedure worked. During that time, a patient may still experience palpitations and may be prescribed antiarrhythmic medication. Sometimes patients need both ablation and medication for things to work and result in significant oppression of AFib.

Even though guidelines issued in March 2014 by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society recommend ablation as a first-line therapy for AFib, most doctors would still advise their patients to take medicines first. Only when the medications do not work or have caused side effects, they would then propose ablation.
 

Date: August 7, 2020

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