Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Treating Atrial Fibrillation

Thursday, 20 October 2011 08:37 AM

Question: How can atrial fibrillation be controlled? What are the new curative treatments?
Dr. Hibberd's Answer:
Curative treatments for chronic and recurrent atrial fibrillation are now available. A single isolated episode that converts to normal sinus rhythm does not always need intervention, except to correct the underlying cause and to search for precipitants.

Once converted to normal sinus rhythm, a stress test is usually offered to be sure it is not easily induced, as well as to evaluate for underlying coronary artery disease.

Though atrial fibrillation does not usually indicate coronary artery disease, the workup for new onset of atrial fibrillation will usually involve evaluating for undiagnosed co-existing coronary artery disease. Results will affect the treatment options offered.

In the past, we recommended almost all patients with chronic or recurrent atrial fibrillation be protected by daily oral anticoagulation medication (usually Coumadin, but more recently Pradaxa has become an alternative that is very appealing with its relaxation of blood test requirements and reduced bleeding episodes). Anticoagulants are used to reduce the significantly elevated stroke risk seen in patients with recurrent and chronic atrial fibrillation. When a medical cause such as hyperthyroidism is detected, treating the underlying condition will usually prevent recurrence.

The electrophysiology (EP) lab has revolutionized the approach to atrial fibrillation that has no known cause. It is now possible to offer ablation treatments to those with atrial fibrillation not related to valvular disorder or other medical causes that are correctable.

Successful ablation frees patients from cumbersome anticoagulation regimens or the expense of Pradaxa. The EP lab is staffed by cardiologists who specialize in conducting system modification of the heart using minimally invasive techniques, but the process is very expensive ($30,000 to $100,000), which may limit access to some patients who have restrictive insurance (such as HMOs and some PPOs). This is another reason to carefully examine your health insurance products before you purchase them, ideally with input from a physician you trust.

Using microcatheters inserted in blood vessels, the ablation procedure is accomplished in much the same way as a cardiac catheterization, so no conventional cutting is needed.

Always make informed decisions for your medical care with a skilled licensed professional medical doctor who you can trust. NEVER rely on Internet sensationalism, advertising, personal reading, magazines, self-evaluation, or casual advice from friends.

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Thursday, 20 October 2011 08:37 AM
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