Be Cautious on A-Fib
I represent the three cardiac electrophysiologists in Moore County (Mark Landers, M.D., Rodrigo Bolaos, M.D., and I). We read with concern the article "A-Fib Surgery Helps Decrease Stroke Risk," in The Pilot, Sept. 24. As specialists in heart arrhythmia, we feel ethically obligated to correct the implied and erroneous conclusion of the article.
Atrial fibrillation is the most common rhythm disorder. Its association with risk of clot formation and stroke has been known for decades. Certain risk factors further increase the risk of stroke. These include rheumatic valvular heart disease, congestive heart failure, hypertension, diabetes, age and stroke history.
The only treatment proven to decrease risk of stroke with atrial fibrillation is anticoagulation with warfarin (Coumadin). In low-risk patients, aspirin may be substituted. This has been formalized in international guidelines published jointly by the American College of Cardiology, the American Heart Association and the European Society of Cardiology.
Treatment of atrial fibrillation includes medications, electrophysiologic study with catheter ablation, traditional Maze surgery and the recently developed minimally invasive Ex-Maze surgery. Success with each treatment is highly variable, depending on the type of atrial fibrillation (paroxysmal, persistent, chronic) and left atrial size.
Catheter ablation has been available for atrial fibrillation for 10 years, with mixed results. The Ex-Maze is awaiting published two-year outcome data. When atrial fibrillation recurs after any treatment, it may be associated with minimal or no symptoms. This means that a patient, unaware of the recurrence, would still be at increased risk of a stroke.
We strongly advise any patient not to undergo invasive treatment for atrial fibrillation, if the only goal is to stop taking warfarin. Each a-fib patient should discuss options with a primary care physician, cardiologist or cardiac electrophysiologist.
Ker Boyce, M.D.
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