Question: I currently take Coumadin for atrial fibrillation (AF), and I've been told I will have to take it for the rest of my life. I know what AF is, but what causes the erratic electric impulses to take place, and is there any remedy that could free me of Coumadin? Also, does AF have a genetic component?

Dr. Hibberd's Answer:

Atrial Fibrillation (AF) is an abnormal heart rhythm involving the two upper chambers (atria) of the heart. The atria prime the pump for the main pumping chambers of the heart called ventricles. In atrial fibrillation, the atrials lose their coordinated contraction and become irregular, and place its victims at risk for stroke.

A genetic connection has not been established, but I believe that there may likely be a genetic predisposition. This could explain why some patients experience atrial fibrillation at a much younger age than often seen in the general population.

Many AF patients have previously been advised to remain on anticoagulant medication, such as Coumadin, for life to reduce stroke risk. Major changes are underway at present, and many, if not most atrial fibrillation victims, can have their condition erased by a catheter guided electophysiological intervention called ablation.

Although the EP procedure is expensive, the success rate is very high. Ablation is usually successful and eliminates the atrial fibrillation. Elimination of AF will free patients from the need for lifelong anticoagulant medication with its risks, nuisance, and expense ... not to mention the need for routine monthly blood testing, dietary restrictions, and problems of interactions with other medications.

As you can see, I favor an ablation review with a cardiologist experienced in electrophysiology for all patients who have atrial fibrillation; whether the atrial fibrillation is intermittent or continuous. Not all patients will be best served by an ablation, but all certainly deserve consideration.