In the longer term, most patients with A-fib can be treated effectively and safely with medication, usually beta blockers and calcium blockers, which help the heart maintain a normal rhythm. Patients are also given an anticoagulant to prevent blood clots.
Several currently popular anticoagulants, including Xarelto (rivaroxaban), which Mr. Hallick is taking, have sustained anticoagulant effects even when patients skip a dose or two, which can help prevent a stroke. These anticoagulants, unlike their predecessor, Coumadin (warfarin), which was the leading anticoagulant in the treatment of A-fib for many years, do not require close repeated monitoring of their effect on clotting. Coumadin has an important advantage over the newer drugs in that its anticoagulant effects are almost immediately reversed when patients have to stop taking it to prevent excessive bleeding, for example before an operation or after an injury.
Can A-fib drugs stop working?
Yes, that happened to Mr. Hallick. He was doing well on medication for seven years, until a routine check-up in May found that his A-fib had come back without his knowledge and his heart was beating 165 times per minute, about twice as much.
“I was a little out of breath and found it more difficult to walk uphill, but I wrote it down,” he recalled. “I thought I am 70 now and maybe really out of shape thanks to the pandemic.”
A change of medication and two shocks to restore a normal heart rhythm only helped briefly, and Mr. Hallick has just undergone a procedure that promises more permanent benefits: destroying the cells along the back wall of his heart’s left atrium that transmit irregular signals the ventricles. The procedure, known as ablation, involves inserting a catheter through a vein into the atrium and usually the cells that are misfiring are either burned or frozen.
How effective is ablation in treating A-fib?
Controlled studies have shown that ablation over time is significantly more effective than drug therapy in correcting A-fib. In a recent study of 203 patients, ablation successfully prevented A-fib a year later in about 75 percent of patients in one group, while drug therapy helped only 45 percent of patients in the other. In otherwise healthy people like Mr. Hallick, the ablation can often be done on an outpatient basis, followed by a few days of restricted activity while the heart heals from the resulting inflammation.
Dr. Vanderbilt’s Stevenson said that some patients with persistent A-fib prefer to have an ablation rather than constantly taking medication, which can cause bleeding problems or other side effects. On the other hand, the benefits of ablation are sometimes delayed. In the first few months after the ablation, about half of patients have arrhythmias and may need cardiac shock or drug treatment until the heart has fully recovered from the procedure.