A Common Heart Problem That’s Easy to Miss
In the longer term, most patients with A-fib can be safely and effectively treated with medicines, usually medicines called beta-blockers and calcium channel blockers, which help the heart to maintain a normal rhythm. Patients are also given an anticoagulant to prevent blood clots from forming.
Several currently popular blood thinners, including Xarelto (rivaroxaban), which Mr. Hallick takes, have long-lasting anticoagulant effects even if patients miss a dose or two, which can help prevent a stroke. These anticoagulants also do not require close and repeated monitoring of their effects on clotting, unlike their predecessor Coumadin (warfarin), which for many years was the main anticoagulant to treat A-fib. Coumadin has a significant advantage over newer drugs of almost immediate reversal of its anticoagulant effect when patients must stop taking it to avoid excessive bleeding, for example, before surgery or after injury.
Can A-fib medicines stop working?
Yes, that’s what happened with Mr. Hallick. He was doing well on medication for seven years until May, when a routine exam revealed that, unbeknownst to him, his A-fib had reappeared and his heart was beating 165 times per minute, about double the rate. normal.
“I was a little out of breath and it was more difficult to ride, but I canceled it,” he recalls. “I thought I was 70 now and maybe really out of shape thanks to the pandemic.”
A change of medication and two shocks in an attempt to restore a normal heart rhythm only helped briefly, and Mr. Hallick has just undergone a procedure that promises more lasting benefit: destruction of cells along the back wall of the body. left atrium of his heart which transmits erratic signals to the ventricles. The procedure, called ablation, involves passing a catheter through a vein in the atrium and usually burning or freezing cells that have misfired.
How effective is ablation in the treatment of A-fib?
Controlled trials have shown that over time ablation is significantly more effective in correcting A-fib than drug therapy. In a recent study of 203 patients, ablation was successful in preventing A-fib one year later in about 75% of patients in one group, while drug therapy only helped 45% of patients. the other. In otherwise healthy people like Mr. Hallick, the ablation can often be done on an outpatient basis, followed by a few days of limited activity while the heart heals from the resulting inflammation.
Dr Stevenson of Vanderbilt said some patients with persistent fib A prefer to have ablation rather than continually taking medication, which can cause bleeding problems or other side effects. On the other hand, the benefit of ablation is sometimes delayed. In the first few months after the ablation, he said, about half of patients experience abnormal heart rhythms and may require cardiac shock or drug treatment until the heart fully recovers from the procedure. .
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