AF Information & Advice For Patients
Our experts answer your AF-related questions
The following questions have been answered by Dr Dhiraj Gupta, consultant cardiologist and electrophysiologist at Liverpool Heart and Chest Hospital.
I have paroxysmal AF. I have also had a few sessions when I have been stuck in AF with a heartbeat of up to 300 per minute for some hours and had to attend hospital. I was started on flecainide in hospital which initially made me go into atrial flutter but then stabilised. Sinus rhythm was restored after about 4 days and I was discharged after another day. My consultant said that I should try to avoid going to A&E if possible. More recently I have had a couple of bouts of AF lasting a few hours initiated by norovirus attacks, but these have reverted to sinus after those few hours. What should I do if I have long lasting episodes of AF again?
I would be reluctant to advise pill in the pocket flecainide to someone who has had flutter documented, and in particular, given that your heartbeat has gone up to as high as 300 on occasion. I would actually have a very low threshold of advising potentially curative catheter ablation for you.
The following questions have been answered by Dr Andrew Grace, consultant cardiologist at Papworth Hospital. Dr Grace specialises in catheter ablation techniques particularly for atrial fibrillation.
How long should I take a particular medication for before trying another, if it is not controlling my symptoms or if it is producing side effects?
There are two major objectives in managing patients with atrial fibrillation. The priority is to minimise the risk of AF-related stroke with the second objective being improvement of quality of life. The determinants of duration of drug therapy differ dependent on the specific objective. Read more
What rights do patients have when asking to be referred to an EP? What can they insist upon with their GP?
Patients comment that the doctors they encounter vary in terms of their willingness to listen, to help, and even adapt to changing practice. So patients need to recognise this and do all they can to engage the doctor in order to achieve what will be best for them. Read more
What is the value of undergoing an electrophysiology study?
An electrophysiological study is a diagnostic investigation. The defined purpose is to identify the presence or the nature of an underlying cardiac arrhythmia. The indications have changed considerably both through greater experience in the management of arrhythmia and the availability of novel non-invasive diagnostic manoeuvres. Electrophysiological studies are fundamentally safe necessitating placing wires up to the heart (usually from the femoral vein at the top of the right leg) and then testing the heart’s electrical properties and its predisposition to arrhythmia. Read more
What tests should GPs be doing and how frequently? E.g. blood pressure, pulse, blood tests, ECG, Echocardiogram.
Tests are needed at three distinct time points in course of the patient journey. At the outset tests will be needed to make the diagnosis and look for an underlying cause. Further tests may be needed to assess the response to drugs or other interventions and beyond that to evaluate the patient’s evolving condition more generally. Read more
What drugs and other treatments for AF are currently being tested and what changes can we expect in the next few years?
Whilst treatments to protect patients against the risk of AF-related stroke have improved enormously, drugs directed to control the cardiac rhythm have shown little significant advance. In fact, the majority of drugs currently used for the management of AF symptoms have been around for over 30 years. Read more
Are there guidelines about when to seek help from clinicians for an AF event?
There are two settings in which an individual might seek assistance from a clinician in regard to an AF event: this might be the first episode of AF for which medical assistance has been obtained; or alternatively the person with known AF has noticed a change in their condition. Read more
Should there be regular testing of people with AF who are on medication to check that it is not causing other damage? What, if any, guidelines exist?
There are widely publicised guidelines available for patients and clinicians from the manufacturers of drugs, from international regulators and from other organisations, such as NICE, providing guidance as to how patients might best be managed on medication. In addition there may be local synopsis guidance/shared care guidelines regarding the best use of particular drugs. Read more