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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 of life.

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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