Clot Chronicles: Atrial Fibrillation Management

Dr. Sam Goldhaber discusses risk factor modifications for the management of atrial fibrillation.

This is Dr. Sam Goldhaber. I’m president of NATF, and today on Clot Chronicles I’m going to talk about risk factor modification for prevention of atrial fibrillation attacks.

We think of atrial fibrillation as a problem with the cardiac rhythm disturbance and nothing more than that, but as we do research on the topic of atrial fibrillation, we’re starting to understand that atrial fibrillation is a systemic illness. This systemic illness shows itself as atrial fibrillation.

Patients with atrial fibrillation often have other problems that cause systemic effects. These include cigarette smoking, obesity, diabetes, and hypertension.

Until now we’ve been focusing on giving anticoagulants to prevent stroke from atrial fibrillation. Sometimes we give special antiarrhythmic medication to try to suppress the atrial fibrillation itself. Sometimes, we take patients to the electrophysiology or EP laboratory and ablate the focus of atrial fibrillation in an attempt to cure it or reduce the frequency of atrial fibrillation.

But, what is now becoming apparent is that in addition to anticoagulation, or antiarrhythmic medication, or ablation, is that modifying common cardiovascular risk factors can play an important role in reducing the frequency of atrial fibrillation attacks, and in addition reducing frequency of stroke from atrial fibrillation.

And it’s quite straight forward if you quit smoking cigarettes, if you get the blood pressure under control, if you work with the internal medicine doctor or endocrinologist who control diabetes more carefully, these really straight forward measures can make a great deal of positive difference in reducing the frequency of atrial fibrillation, reducing important consequences of atrial fibrillation, such as stroke. Also, being active every day is very important in reducing overweight, reducing obesity, reducing what we call the metabolic syndrome, which would be a combination of a high blood sugar and being overweight, all benefit the patient with atrial fibrillation in terms of reducing these systemic manifestations of this illness.

So, now more and more frequently, we see a cardiologist or other specialist in atrial fibrillation, there will be an emphasis on stroke prevention of atrial fibrillation by prescribing an anticoagulant, but there will also be renewed and a more intensified emphasis on risk factor modification of reversible risk factors such as cigarette smoking, high blood pressure, and obesity.

This is Dr. Sam Goldhaber, signing off for Clot Chronicles.