Episode Details

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Welcome to Doctor Warrick's Podcast Channel.

Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get their best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.

Hi, my name's Dr. Warrick Bishop, and I'd like to welcome you to my consulting room. Today I'd like to speak a little bit about how we keep you in normal rhythm if you've had atrial fibrillation. Normally we have to make that decision to try and keep a normal rhythm based on a couple of things. First of all, we would be trying to keep normal rhythm if, in atrial fibrillation, you are getting unacceptable symptoms. We would also tend to try and keep you in normal rhythm the younger you are. That makes sense because, if you're quite elderly, then the time you'll spend in atrial fibrillation is less. If you're quite young, then it's liable you'll spend a long time in atrial fibrillation, potentially with those symptoms.

Lastly, we'd also want to look at the structure of the heart and in particular the structure of the left atrium. This is really important because the left atrium seems to be very important in recurrence of atrial fibrillation. If the size of the left atrium is large and capacious and dilated, then it's going to be very hard for that atrium to keep normal rhythm in the long term. On the flipside of course, if the heart looks structurally normal and the atria appear to be of normal size, then the chances of keeping someone in normal rhythm after atrial fibrillation are much increased. It's really important we don't forget the aims of treatment in maintaining normal sinus rhythm when we're undertaking that. And this will be something that your specialist will be making decisions about based on your specific situation and needs.

The main principles we keep in mind though are the following. There are six. First of all, we're looking to keep people in normal rhythm because of symptoms and we want to reduce their symptom load so that they feel better. Secondly, we understand that our treatments are effectively moderate in terms of their impact most of the time. So we rarely have a perfect cure. Three, that we accept that we're looking to reduce the recurrence rate and the time that people are in atrial fibrillation. Remember we're looking to reduce rather than to unnecessarily cure. Fourthly, that if we're dealing with one agent, one therapeutic maneuver, then it is quite possible we may need to add in another therapy, or we may need to swap therapies to achieve some reduction in atrial fibrillation for the individual. Five, we need to bear in mind that our agents and medications can be of their own pro-arhythmic. And that means that they can generate rhythms of their own and this can be a problem. Lastly, with that in mind, we always need to be making sure that we're balancing safety with the effectiveness of our therapy.

So, what are the simple steps that we undertake or what's the progression we undertake in trying to maintain sinus rhythm or normal rhythm in a person who has had atrial fibrillation? Well, first of all, the most simple and important thing to do is to address the reversible factors. If the patient is markedly overweight or significantly overweight, we immediately want to try and improve that. We know that weight has an impact on the way atrial fibrillation will recur and very importantly, weight has a big impact on obstructive sleep apnea or pausing breathing while asleep at night. So if this obstructive sleep apnea is present, we want to be addressing that because the heart comes under a significant loa