Atrial Fibrillation – What are the top 5 strategies for getting back to sinus rhythm?
The field of AF is moving at a rapid pace, and at the same time, its moving right back to basics. The paradigm for AF ablation is pulmonary vein isolation, where the pulmonary veins, which drain blood back from the lungs into the left atrial chamber, are electrically isolated and therefore ectopic firing beats from the pulmonary veins can no longer trigger and sustain AF. Pulmonary veins can be isolated using either radio frequency energy, generating heat, or cryoablation, where tissue is frozen to create a line of scar around the pulmonary veins which isolates them.
Therapeutic strategies beyond pulmonary vein isolation, have been studied extensively, but as of mid-2020, there is no accepted “conventional” strategy across different centers beyond pulmonary vein isolation.
Top 5 strategies for getting AF back into sinus rhythm
1) Treat AF EARLY
Which means see your doctor as soon as you detect AF, this is important as “AF begets AF” – which means exactly what is says on the tin – the longer you have AF, the more difficult it is to get you out of it, whatever strategy is chosen? How long is long ? Well, most electrophysiologists feel that beyond 4 years of AF persistence is a threshold beyond which it would be difficult to restore normal (sinus) rhythm (<40% success rate).
2) Stay healthy
Live well – exercise and diet well. There is a large body of compelling data which now clearly show a link between sleep apnoea, obesity, the “metabolic syndrome” and AF. Staying healthy with lifestyle choices and losing weight is one of the most important ways to prevent and treat AF.
3) Be mindful of obvious triggers and avoid them
Some common triggers for AF are extreme stress, fatigue, strong caffeine or alcohol intake – if there are repeated triggers for AF which are avoidable, its important to recognise what these are and obviously take precautions to avoid these triggers.
4) Treat medical conditions which can cause/predispose to AF
These include thyroid function abnormalities, electrolyte abnormalities, diabetes, hypertension, ischaemic heart disease, recurrent infections (typically chest infections), especially in patients with existing lung conditions such as COPD and sleep apnoea.
5) Catheter ablation with Pulmonary vein isolation
This remains a cornerstone and should be the baseline ablative treatment of choice whenever ablation is considered. Choose a cardiologist who has experience in ablation, and ideally in a high volume centre. The cardiac specialists (electrophysiologists) who have an active research profile usually have a good understanding of contemporary research in AF including the latest ablation techniques and use of state of the art technology to treat AF.
Watch a video of Dr Lim explaining AF treatments, including anticoagulation and ablation strategy: