When the Beat Goes Bad
The fact remains: Restoring normal sinus rhythm is still the best regulator of heart rate. But drug therapy alone does a poor job of converting chronic AF into normal rhythm and keeping it there. However, there is a relatively new therapy called radiofrequency ablation that goes for the cure by walling off the misfiring cells in the pulmonary veins. To do this, the physician must thread several catheters into the heart and laboriously map the electrical impulses in the atria before zapping its targets. Success comes 50 to 80 percent of the time, more so with a second try. The downside is that it's a bear to do and demands lots of experience and finesse, confining it to a limited number of centers. Patrick Tchou, a heart specialist at the Cleveland Clinic (my old stomping ground) who performs hundreds of these procedures a year on patients with severe symptoms, says technology is in the works to make ablation an easier and more reliable option for rate and rhythm control.
But there are other mysteries of atrial fibrillation that, if solved, could also change therapy for the better: Some patients seem to have smoldering inflammation that might call for different drugs. If we can figure out why genes make some more susceptible to AF as they age, we might design new prevention strategies. Indeed, on occasion shedding extra pounds, controlling blood pressure, and avoiding tobacco prevents AF from recurring. All good things to do anyway as one ponders the rhythms and blues of the cardiac years.
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