Melanie discusses the treatments that are available to women with atrial fibrillation.
For atrial fibrillation there are many options. It used to be that doctors just maybe gave you a medication and sent you home and said, just live with it. These days we have a lot more options. Typically the first option is medication and there are couple of issues related to medication – first is, many doctors will give you something for the clot risk. You don’t want to develop blood clots so they may give you warfarin or Coumadin or if your risk factors are pretty low for blood clots they may give you aspirin or some other medication that can potentially help avoid having blood clots.
In addition to the anticoagulant, though, you want to do something about the rhythm or potentially about the heart rate. They want to slow the heart rate down and for that doctors may give a right medication, often a beta blocker or something similar. Or they may give you a rhythm medication to try to confer you back into normal sinus rhythm.
There’s a lot of controversy as to whether rate control or rhythm control is really the best. Studies have said that although it’s important to get folks back into normal sinus rhythm, that those who are on rate control do absolutely as well as those on rhythm control. Although post-study analysis has found that its not necessarily because rate control is as good as rhythm control, it’s just that rhythm control medications often have side effects that can cause other issues.
So right now the verdict is still out as to whether rate control is better or rhythm control is better. Although many of the electrophysiologists that I talk with say that they think it’s really better to get you back into rhythm because that way you are not risking overworking the heart, and there are lot of advantages to having you back in normal sinus rhythm.
But let’s say you’ve been on medication and it’s not working. You are still having problems or you are having severe side effects with the medication and even the best medications are only about 50 percent effective. So maybe you are considering what other options are there.
Well, you know, first of all there’s electrical cardio version which can put you back into a normal sinus rhythm but may not necessarily keep your normal sinus rhythm. Then there is a procedure called a catheter ablation. That can put you back into normal sinus rhythm by more or less cauterizing or creating a conduction block in the pulmonary veins that lead into the upper chambers of the heart. And it basically keeps those radical electrical signals from flowing from the pulmonary veins into the upper chambers of the heart.
For some folks, catheter ablations don’t work. For many people they do, but for some they don’t. Or it may take multiple catheter ablations. In those cases many doctors will recommend potentially a surgery and there are couple of kinds of surgery. One is a minimally invasive version, the other is an open heart version. They are both variations of what’s called the maze surgery.
Back in the 80s a surgeon by the name of Jim Cox created the Cox-maze surgery, which is considered the gold standard. Today there is a variation of that which is an open-heart surgery, and then there’s a minimally invasive version where they go in through the ribs or under your arms and replicate as best they can – the maze surgery. It’s a little bit less effective than the open-heart version but it is quite effective and it also removes the left atrial appendage which is the source of many of the clots.
I personally had the minimally invasive surgery – the mini-maze surgery because I was a stroke walking around waiting to happen, and for me it was more important to get rid of that left atrial appendage, the source of 90 percent of the clots than it was even to get rid of my A-fib. So that was what caused me to make the decision that I did. But for many patients catheter ablation which is less invasive, is completely effective and can put a stop to the A-fib.
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