I have atrial fibrillation. When do I consider cardioversion?

Question

Hello doctor,

I am 65 and recently diagnosed with atrial fibrillation after feeling palpitations and shortness of breath.

My resting ECG confirmed AF, and my CHADS2-VASc score is three. I was started on Apixaban and Metoprolol 50 mg twice daily.

My BP and heart rate are under control now, but I still feel lightheaded occasionally. My concerns are:

Is this a side effect of the medication or a symptom of AF itself?
Can AF go away permanently with treatment, or is it a lifelong condition?
Also, when is cardioversion or ablation considered, and how effective are they in the long run?
How closely should I follow up?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Atrial fibrillation is a rhythm disorder in which the upper chamber of the heart is producing an irregular, fast heart rate that can produce a variety of symptoms, including palpitations, shortness of breath, fatigue, and anxiety.

As the upper chambers of the heart are not contracting, there is blood stasis, leading to the formation of a blood clot.

This clot may dislodge and cause a stroke by obstructing blood vessels supplying the brain. The clot can also travel to the limbs and may cause limb ischemia.

If you still feel lightheaded or tired and get palpitations, then it means your heart rate is not adequately controlled despite being on beta blockers.

Please address the causes of worsening heart rate control in atrial fibrillation, including

Timely management of infections.
Avoiding dehydration.
Limiting caffeine and alcohol intake.
Managing stress.
Ensuring proper and adequate sleep.

If these are properly taken care of, then the heart rate will be in the ideal range and there will be less variation.

Please remember that atrial fibrillation (AF) often has a secondary cause, including hypertension, ischemia, structural heart diseases, and electrolyte imbalances. Therefore, it is important to identify and treat the underlying cause to prevent and manage atrial fibrillation.

The main pillars of treatment include heart rate control, rhythm control, anticoagulation as needed, treating the underlying cause, and, if necessary, intervention such as ablation.

Rhythm is reverted to normal sinus rhythm with the help of anti-arrhythmic medications first, and if unsuccessful or unstable, by delivering a shock, in which the patient is given sedation and paddles are placed over the chest, and a small shock is delivered.

This is a very safe procedure if proper precautions are taken previously.

Surgeons sometimes perform a maze procedure to treat atrial fibrillation, and an electrophysiologist can conduct an electrophysiology study by placing different electrodes inside your heart through your peripheral vein, locating the foci of atrial fibrillation, and ablating them.

These procedures are also being used very successfully.

Depending upon the cause, ablation may be effective in certain cases, while it may occur again from a different focus after ablation in some cases. Even if the ablation is done successfully, you will still need beta blockers and blood thinners.

You should follow up with your cardiologist initially every three months and then every six months if you are stable. If there are symptoms, then you should follow up with your cardiologist as needed.

I hope this information is helpful. Please let me know if you have any further queries, and I would be happy to answer.

Regards.