Tailoring atrial fibrillation treatment to patient needs

Leading cardiologist and electrophysiologist in Wolverhampton and Birmingham, Dr Anita Arya speaks to Top Doctors about how atrial fibrillation (AF) treatment is dependent on the type of AF the patient has. She goes into expert detail, considering medication, risks and benefits and lifestyle factors in this informative article.

What are the most common treatments for atrial fibrillation?

Atrial fibrillation (AF) is a heart rhythm disturbance that originates from the top of the heart. There are various treatments depending on what type of AF patients have, and also how symptomatic they are.

In some patients, it's about maintaining rhythm control because they're very symptomatic, and that might be through cardioversion or tablets, or even an interventional or small keyhole operation called an ablation.

In other patients, they have AF for a very long time and it doesn't really bother them. They might have rate control. So, it very much depends on the type of AF and patient.  

How effective are medications like beta blockers or calcium-channel blockers in managing atrial fibrillation?

They're good for slowing the heart rate and reducing symptoms, but they don't actually prevent an episode of AF or if you're in an AF episode, make it more likely to go back to your normal rhythm. One would require strong anti-rhythmic medication for that.  

What are the potential risks and benefits of atrial fibrillation ablation procedures?

The benefits are that, if you have an AF that's responsive to ablation, is that you'll have improvement in chances of maintaining more normal rhythm. We don't say 'cure' as such, because some people might have small episodes following the procedure, but they get a substantial improvement, reduction of frequency, and the duration of their episodes. 

There are risks. Although it's a keyhole procedure, there are small risks of stroke, heart attack and not coming through the operation. There are more obvious risks such as:

• bleeding;
• infection;
• bruising;
• damage to the arteries or veins in the leg. 

Can lifestyle changes, such as diet and exercise, help control AF symptoms?

It's always good to have a healthy lifestyle for lots of different reasons, not just the heart. We all know the benefits of exercise and health in terms of weight reduction and stress relief.

For AF, it depends of the patient. The presence of triggers is actually quite rare, so we look for excess caffeine and alcohol intake. In a few patients, it might be that their episodes are more at night, and in some people it's more during exercise. Those numbers are very small. 

In most patients, there are no triggers and these sorts of measures don't substantially influence AF in itself. Although in most patients, they don't substantially influence it, we would always advise that people regulate caffeine and alcohol intake. As well, they should keep their BMI in the healthy range.  

Are there any new or experimental treatments for atrial fibrillation currently being researched?

AF is hot bed of research of all sorts, from mechanisms to technologies for ablation. AF is probably not just one type of rhythm disturbance, it's many and it's very heterogenous.

There's lots of research looking at the triggers for AF and therefore the best methods to treat it. For certain types of AF, it really is quite complex. The other things that's being looked into is the ever-changing technology so the mapping systems for accuracy and pinpointing triggers, and also the ablation tools that we use are often changing.

If you're concerned about atrial fibrillation, arrange an appointment with Dr Arya via her Top Doctors profile.