New guidelines for treating atrial fibrillation
If you experience the uncomfortable, quivering heart beat of atrial
fibrillation, you may simply want your old thump, thump back. But your
physician may have another goal in mind.
New guidelines from the American Academy of Family Physicians and the
American College of Physicians suggest treatment for atrial fibrillation
should foremost focus on restoring a normal heart rate. This signals
a departure from the generally accepted practice of restoring heart rhythm.
More than 2 million Americans experience the abnormal heart rhythm of
atrial fibrillation. The condition, which may be chronic or come and
go, results when the upper chambers (atria) of the heart contract rapidly.
Not all of these contractions pass on to the lower chambers (ventricles).
This causes an irregular heartbeat and inefficient pumping of blood.
While the condition signals alarm because it can be an indication of
another heart condition, it also allows blood to pool and clot in the
atria, which could possibly lead to a stroke.
Treatment in the past has mainly focused on restoring a regular heart
rhythm with medications or electrical shock. Medications can also be
used to slow the heart rate and thin the blood to prevent stroke. Results
of numerous studies have shown, however, that the medications for controlling
heart rhythm are no more effective than medications for slowing the heart
rate. In addition, the side effects of the medications for controlling
heart rhythm may be greater than the benefits of the drugs.
The new guidelines suggest:
- Most patients should receive medications, such as atenolol, metoprolol,
diltiazem, or verapamil, to slow their heart rate .
- Patients should also receive blood-thinning medication to prevent
stroke unless they have an increased risk of bleeding.
- If the abnormal heart rhythm of atrial fibrillation has a large
impact on their quality of life, patients may choose to have normal
heart rhythm restored with either medications or electrical shock.
- Once normal heart rhythm is restored, most patients should not continue
taking medications to maintain a normal rhythm.
Not everyone in the medical community fully agrees with this new set
of guidelines. The American Heart Association, the American College of
Cardiology, and the European Society of Cardiology offer a different
opinion. In the past, the recommendations from these associations have
highlighted the importance of designing treatment to suit each patient’s
situation. These recommendations will be updated soon and will likely
continue to include rhythm control as an important goal and heart rate
control for patients whose condition does not greatly affect their quality
If you experience atrial fibrillation, talk with your doctor about the
new guidelines and what they may mean for you. Find out about the benefits
and risks of any medication before you agree to take it. And be sure any
treatment decisions meet your goals for better, healthier living.
October 2004 Update
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