The argument for keeping the heart in a normal rhythm; a physician’s perspective

When deciding how best to treat your atrial fibrillation your physician will consider two broad questions:

1. Do you need treatment with a blood thinning medication to prevent a stroke?

2. Should the treatment of your atrial fibrillation focus on keeping the heart in a normal rhythm (or is it acceptable to leave the heart in atrial fibrillation and control how fast your heart is beating)? 

A more detailed discussion on whether a blood thinning medication is required is included here. This article will focus on the second question; what factors will influence your physician to focus your treatment on keeping your heart in a normal rhythm.

Intuitively, one might expect that keeping the heart in a normal rhythm is the best treatment option for all patients with atrial fibrillation. However, based on current research studies, while maintaining a normal heart rhythm is the best treatment option in some patients, accepting atrial fibrillation and controlling how fast the heart beats is more appropriate in others.

There are a number of questions that your physician will consider when trying to decide which treatment option is best for you:

  1. Does your atrial fibrillation cause symptoms?
  2. Do atrial fibrillation-related symptoms affect your quality of life?
  3. Is atrial fibrillation causing any complications, such as heart failure?
  4. Would you prefer not to take long-term medications?
  5. Do you have unpleasant side effects associated with medications?

If the response to one or more of the above questions is ‘yes’, the argument for treatments that keep the heart in a normal rhythm may be more compelling. Furthermore, if the answer to questions 4 and 5 is ‘yes’, your physician may offer you a procedure aimed at preventing atrial fibrillation, known as a catheter ablation procedure (discussed in more detail here).

In addition to a decision on whether to focus on keeping the heart in a normal rhythm, your physician should pay attention to the timing of treatment. If the goal is to keep the heart in a normal rhythm, the earlier the treatment is delivered, the better the outcome in terms of stopping progression of atrial fibrillation and potentially improving prognosis.1-3

The role of strategies that are aimed at maintaining a normal heart rhythm in patients with atrial fibrillation, particularly catheter ablation procedures, has grown significantly in modern electrophysiology. There is emerging evidence to indicate that the benefits of maintaining a normal heart rhythm, particularly in the early stages after a diagnosing atrial fibrillation, extend beyond symptoms control and may have prognostic benefits in specific patient groups.1 These considerations are discussed in more detail here.

It is important to note that management of atrial fibrillation does not involve unilateral decisions made by your physician. The impact on your quality of life, symptoms and personal preferences/beliefs are very important considerations when agreeing upon the best treatment option for you.

Citations

1.         Kirchhof P, Camm AJ, Goette A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020;383(14):1305-1316.

2.         Andrade JG, Wells GA, Deyell MW, et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. N Engl J Med. 2021;384(4):305-315.

3.         Kuck KH, Lebedev DS, Mikhaylov EN, et al. Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST). Europace. 2021;23(3):362-369.