Patients are generally placed on a short course of anti-arrhythmic drugs while the procedure takes full effect.
McCabe says that ablation may also be used very
early on in people with intermittent AFib who have
fewer medical conditions. It is also gaining acceptance
for patients who have a more persistent AFib as well.
“We’re still looking at studies that should tell us whether
medication or ablation is the better treatment,” McCabe
said. “Ablation has actually not been around long enough
to know all of the long-term effects of it. In some cases,
AFib may return, so the ablation procedure may need to
Stacey Powers underwent an ablation in May 2015 and
was free of AFib for seven months. Then she had to have
hernia surgery and got a staph infection, which required
two more surgeries, six weeks in the hospital and a stay in
a skilled nursing facility. Her AFib returned.
While we were developing this article, Stacey
underwent her seventh cardioversion. “My new
electrophysiologist (EP) felt I had very high chances of
success because of the prior ablation being successful and
I’ve been on all the right medicines for a while now,” she
said. “My heart rate has been 135-140 beats/minute for
several months now, my blood pressure has been sky high,
my feet are grossly swollen, and I can’t keep going like
this, so I agreed to the cardioversion, but I made the new
EP promise no burning my chest! If cardioversion doesn’t
Stacey’s particularly challenging
journey with AFib may not be
typical. As we went to press, Stacey
had had the procedure, and the
cardioversion was effective. Using
a smartphone app called Kardia,
she can get a 30-second EKG that
she can then share with her medical
team. Meanwhile, she is taking
Sotolol™, a heart-rhythm drug,
and Xarelto™, one of the new
generation of blood thinners that is
replacing the tricky-to-use warfarin.
Living with AFib can be
uncomfortable and unpredictable.
As we’ve said, it can also lead to
stroke or heart failure. According
to McCabe, there’s some evidence
that suggests that AFib puts
people at risk for cognitive impairment and dementia.
“Also we know that when people have pre-existing
conditions such as heart failure, people with AFib do
worse, and have poorer outcomes than patients who
don’t have AFib but do have heart failure,” she said. “We
know that when people with AFib have a stroke, they
have poorer outcomes than people who have strokes not
related to AFib.”
Psychological and behavioral responses
Living with a chronic condition is challenging, and no
two people respond the same. McCabe has investigated
psychological and behavioral responses. “We found that
how a person perceives AFib, and the type of AFib that they
have, can affect their psychological response,” she said.
Through one-on-one interviews with patients with
recurrent AFib, she identified a variety of responses.
Some patients were distressed by their symptoms of
fatigue and shortness of breath because it interfered with
their ability to carry out their roles — parent, worker or
a productive community member. Other patients stopped
participating in social and recreational activities, afraid it
might stress them and trigger an episode; or they feared
being embarrassed if they had an episode in public.
Some were reluctant to go on vacation away from their
typical medical care. Others focused on finding out what
triggered their AFib — was it certain activities or certain
foods or drinks?