Should my atrial fibrillation be managed by a specialist?

Given the fact that the response to this question is being provided by someone who specializes in the treatment of atrial fibrillation, there may of course be a natural degree of bias. However, an important question when considering who should treat atrial fibrillation is ‘are there missed opportunities that should have been considered in the management of your atrial fibrillation?’

For patients with a new diagnosis of atrial fibrillation, the first point of contact with the medical profession may vary significantly. Common points of initial contact include a general practitioner or an emergency department physician. The default initial treatment of atrial fibrillation typically involves starting blood thinning medications to prevent stroke (if appropriate) and medications to slow the pulse rate (as atrial fibrillation is typically associated with an abnormally fast heart rate). In a large proportion of patients, treatment may not extend beyond these measures.1,2 A subset of patients may be referred to a heart rhythm specialist. Therefore, only a proportion of patients receive highly specialist input on the management of their atrial fibrillation. The focus of this article is the potential incremental benefit of seeing heart rhythm specialist (a cardiac electrophysiologist).

There are two main options for the treatment of atrial fibrillation; the first focuses on keeping the heart in a normal rhythm, while the second involves accepting atrial fibrillation and using medications to reduce how fast the heart beats. While the second option can be managed in a non-specialist setting, the first option is commonly managed in specialist setting. The role of treatment options that focus on maintaining a normal heart rhythm (as opposed to accepting atrial fibrillation) is expanding in modern atrial fibrillation management. In this context, the role of interventional procedures, referred to as catheter ablation procedures, is expanding (discussed in more detail, with illustrative videos here).

It is important to note that specialist treatment of atrial fibrillation does not focus solely on interventional procedures. A specialist may also recommend medications and acceptance of AF. A potential advantage of specialist input is the option of personalized treatment for your AF. A comprehensive approach to atrial fibrillation management  should take into account all available options, including treatment with medicines, interventional treatments and lifestyle measures that may enhance success rates of treatment for atrial fibrillation (covered here).

This and other related articles in this blog highlight the complexities when considering the optimal strategies for the management of your AF. Management by a physician who specializes in treatment of atrial fibrillation has the potential advantage that the treatment decision can be tailored to a patient’s specific circumstances.

Citations

1.         Fosbol EL, Holmes DN, Piccini JP, et al. Provider specialty and atrial fibrillation treatment strategies in United States community practice: findings from the ORBIT-AF registry. J Am Heart Assoc. 2013;2(4):e000110.

2.         Kirchhof P, Ammentorp B, Darius H, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events–European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2014;16(1):6-14.