July 08, 2009

Atrial Fibrillation Treatments

Atrial fibrillation involves the two top small chambers of the heart. They quiver instead of coordinating a strong beat which makes patients with a fib often feel palpitations with an irregularly irregular heart beat.

Last year I had a patient with atrial fibrillation. She was hospitalized for a splenic infarct after discontinuing her warfarin because she found out she was pregnant. Luckily for her, it was only her spleen that got hit and she agreed to go back on the warfarin after an elective ITOP -- things did not work out as planned with her ex-boyfriend apparently. My chief resident had me read about the ground-breaking AFFIRM study, which showed that rate control was equivalent to rhythm control, with less drug side effects since antiarrhythmics can induce arrhythmias (go figure.)

This week I started my cardiology rotation with a day FULL of patients with atrial fibrillation -- some newly diagnosed, some medication induced, some status post valvular repair! It was as if the medical gods convened to help me learn something new.

My cardiologist encouraged me to read further on this subject so I found two other trials: ACTIVE-A and ACTIVE-W. I performed a Critically Appraised Topic (CAT) review on these different treatment options for anticoagulation in a-fib.

After presenting the results to my preceptor, he asked me about mortality data. Unfortunately, I didn't look into that as closely as it was a small part of the primary end points (stroke, MI, non-cerebrovascular embolic events and vascular death.)

Enough about medical interventions.
Here's an excellent video on one of the surgical procedures for removing the ectopic foci in the pulmonary sleeves. I didn't know it was so involved with the computerized models using US and CT to create a digital image of the heart!
Atrial Fibrillation Ablation (Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, 2/11/2009) - MedlinePlus: Videos of Surgical Procedures

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