Atrial Fibrillation is not a “One Size Fits All” Disease

I am frequently asked questions from patients about a treatment for atrial fibrillation (AFib) that they heard about online, touting incredibly high rates of success. Other patients share anecdotes with me about friends or family members previously diagnosed with AFib, who underwent a procedure that was either successful or unsuccessful, and are wondering whether this is the right approach for them. This is frequently a “starting-off” point for a discussion in the office. However, before answering specific questions about particular treatments or causes, it is usually necessary to step back and learn more details about that patient’s particular experience with AFib.

The next step in the consultation usually involves a number of more detailed questions such as:

• “What are the symptoms experienced?”
• “How severe or debilitating are the episodes?”
• “How long do the episodes last, or is the AFib occurring continuously over a period of time?”
• “Are there particular triggers that may provoke an episode?”
• “Are there other disease present, called co-morbidities that may be relevant?”

The answers to these questions will vary greatly among patients, highlighting the fact that AFib is not the same disease for all patients. From the symptoms experienced, to the length or duration of the episodes and to the underlying mechanisms involved, there are tremendous variations. To my recollection, no two patients have ever described their symptoms in quite the same way, so each patient’s experience with AFib is truly unique! There is also a wide spectrum of symptom severity, ranging from patients who are asymptomatic (have no symptoms), to patients who are severely debilitated by even short episodes of AFib.

Based on the answers to these types of questions, my next job is to present the treatment approaches that will best serve that patient’s type of AFib.  A particular treatment that is highly effective for a patient who has paroxysmal AFib, meaning the episodes are self-contained and last for less than one week may be ineffective or have a low success rate for someone with persistent AFib, meaning the episodes last continuously for greater than one week. One of my most important jobs as an electrophysiologist is to sort out the unique conditions and circumstances for each individual patient, and to present the best treatment option or options for that patient. By using this approach, rather than a “one size fits all”, I believe we can reach the best possible outcomes for all AFib patients!