There is more than one ap­proach to atrial fib­ril­la­tion

Prince Albert Daily Herald - - OPINION -

would be ab­la­tion. Should I get an­other opin­ion? -- P.D.

AN­SWER: Atrial fib­ril­la­tion is a com­mon prob­lem in older adults. It’s a chaotic rhythm dis­tur­bance, and prob­lems can arise from both too fast a heart­beat and from the pos­si­bil­ity of clots. Peo­ple with AFib of­ten are treated with med­i­ca­tion to re­duce stroke risk (war­farin or a new medicine like Xarelto is most com­mon, but a few peo­ple need only aspirin), and the atrial fib­ril­la­tion it­self is treated in one of two ways: rate con­trol or rhythm con­trol.

In rate con­trol, a medicine is used to slow the heart rate. Beta block­ers such as meto­pro­lol are a com­mon treat­ment, as is a cal­cium chan­nel blocker like ve­r­a­pamil. (Digoxin, a prepa­ra­tion of the fox­glove leaf, is RE­ALLY old-school treat­ment.) In rate con­trol, peo­ple stay in AFib but the heart rate is kept at a safe level.

Fle­cainide, on the other hand, is used for rhythm con­trol, to try to keep peo­ple out of the AFib en­tirely. Your car­di­ol­o­gist has cho­sen rhythm con­trol for you, and it sounds like you have had at least two episodes where you went back into AFib (prob­a­bly with a fast heart rate) -- which means that it’s not work­ing so far, and that’s why he may be ad­just­ing the dose. Some car­di­ol­o­gists do pre­scribe fle­cainide to al­low pa­tients to self-con­vert if they go into AFib: It’s con­tro­ver­sial, and other car­di­ol­o­gists pre­fer their pa­tients to be in a mon­i­tored set­ting be­fore get­ting fle­cainide. Some car­di­ol­o­gists will try a dif­fer­ent rhythm agent (such as so­talol or amio­darone).

Ab­la­tion is a pos­si­bil­ity as well, but it doesn’t work for ev­ery­body. An­ti­co­ag­u­la­tion re­mains nec­es­sary for most peo­ple with atrial fib­ril­la­tion, but can be dis­con­tin­ued if rhythm con­trol is proven suc­cess­ful.

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