Atrial Fibrillation: Surgical Treatments (cont.)

MEMBER QUESTION:
I am currently on medication for AF, including amiodarone. The more I read about it, the less I like it. I'm wondering if down the road sometime I will need some surgical procedure. Will having taken the amiodarone be a risk as it stays in your system, or can, for years?

GILLINOV:
Amiodarone is the most effective medication for treating atrial fibrillation. Unfortunately, it also has the greatest number of side effects. Long-term treatment with amiodarone, meaning over the course of years, is a very unfavorable situation. Being on amiodarone does not complicate the minimally invasive surgery, but being on amiodarone for years and years is almost certain to result in complications.

"You should only consider having an intervention for the atrial fibrillation if the atrial fibrillation is causing a problem for you."

MEMBER QUESTION:
Do you think medication should be tried and exhausted before ablation is performed?

GILLINOV:
We think that medication should be tried before ablation. However, if a patient fails two or three different medicines, we would then consider going on to ablation. A person need not try every single medicine before considering curative therapy.

MEMBER QUESTION:
I am anxious about having anything done to fix my atrial fibrillation; scared might be more accurate. Can you offer any advice to ease my fears?

GILLINOV:
Yes. You should only consider having an intervention for the atrial fibrillation if the atrial fibrillation is causing a problem for you. If you are having symptoms or cannot tolerate the medicines or have had complications like a stroke, then you should think about a form of ablation. On the other hand, if you are asymptomatic and tolerating Coumadin or another anticoagulant, it is reasonable to consider this continued medical therapy.

MEMBER QUESTION:
If you have the ablation, should you be able to stop taking the medications?

GILLINOV:
If a person has ablation and at six months after the procedure we document no atrial fibrillation, then we stop the medications.

MEMBER QUESTION:
What do you mean by minimally invasive surgery?

GILLINOV:
The minimally invasive surgery is performed with scopes or keyhole type incisions. It does not require a large incision, nor does it require use of the heart/lung machine.

MEMBER QUESTION:
Is it likely that surgery will become a first line of defense against atrial fibrillation, to cure it, instead of being on meds forever? I'm 47 and don't want to take warfarin and Tambocor the rest of my life for my occasional AF.

GILLINOV:
Many people are now considering earlier minimally invasive surgery. It is always appropriate to try medicines first, but for the reasons we reviewed earlier, many people are now leaning toward earlier curative procedures.

"Atrial fibrillation has many risk factors for its development."

MEMBER QUESTION:
What is your opinion of flecanide as a long-term treatment?

GILLINOV:
Flecanide is an appropriate medical treatment for atrial fibrillation and is successful in many people. It has an acceptable risk profile for long-term use.

MEMBER QUESTION:
Could atrial fibrillation be caused or worsened by a person being overweight most of their life?

GILLINOV:
Atrial fibrillation has many risk factors for its development. Obesity alone is usually not an important risk factor. Advanced age, high blood pressure, heart failure, and valvular heart disease are more common in patients with atrial fibrillation.

MEMBER QUESTION:
If the atrium stretched out due to being overweight for 20 years, will becoming thin relieve the atrial fibrillation?

GILLINOV:
Being overweight does not cause the atrium to stretch out. Losing weight will probably not make the atrial fibrillation go away, but of course there are a lot of good reasons to get in shape.

MEMBER QUESTION:
Have you seen an association with low-carb diets and atrial fibrillation?



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