Question: What do you recommend for sporadic atrial fibrillation?

Dr. Hibberd’s Answer:

Atrial fibrillation (AF) is an irregular heart rhythm. Recurring AF is associated with increased risk of stroke, especially in people older than 60.

Finding the cause of AF and stopping it is the ideal. Treat any underlying causes such as thyroid disorder, and you may not need to worry about AF any longer.

It’s important to avoid medications and substances that may precipitate AF such as amphetamine, ephedrine, epinephrine-like drugs, caffeine, and other stimulants.

Sometimes heart rate controlling medications such as beta-blockers and digitalis will suppress AF recurrence. Occasionally other medications or cardioversion, the use of an external defibrillator, are used to convert AF to regular rhythm.

Long-term use of powerful and toxic anti-arrythmic treatment combinations that have high complication and side effect rates is not recommended nearly as often as in the past.

With AF, clots form in the fibrillating atrial heart chamber, and this can result in stroke. The muscle of the atrium is lacking effective contractility, and it quivers or fibrillates and atrial contraction is lost.

The atrium (there is a left one and a right one) is the smaller, less muscular chamber of the heart that helps fill the left and right ventricles that pump blood forcefully away from the heart.

Most patients with persistent or frequent AF still take Coumadin to thin their blood and reduce clot formation, but are advised to have monthly coagulation testing and medication dose titration to make sure the dose is correct and doesn’t result in uncontrolled bleeding.

Today, we are at a crossroads regarding AF therapy. A new agent called dabigatran (marketed as Pradaxa) is as effective as and possibly better at preventing strokes than Coumadin and doesn’t require the monthly blood testing Coumadin does. Unfortunately, it costs approximately 10 to 15 times more than Coumadin. However, when less need for blood testing, physician dosing guidance, and diet management are factored in, the cost of dabigatran is competitive. Although bleeding episodes still occur with dabigatran, it appears to be safer than Coumadin.

Electrophysiological mapping of conduction pathways, a minimally invasive procedure using mini-catheters directed in from a vascular access site in the arm or groin, also is available. While its cost is high — $60,000 to $ 80,000 — no medications or hospital emergency room admissions are involved. Most patients are cured of their AF and its risks of stroke, and the procedures rarely become complicated or require pacemaker support.