Stroke Prevention continued...
In 2010, the FDA approved a new drug, dabigatran (Pradaxa), specifically to prevent stroke in people with AFib not caused by a heart valve problem. Although this drug also carries with it a risk of bleeding, it doesn’t require the same monthly blood tests that Coumadin does.
“It’s more convenient and it may be slightly more effective,” Wylie says. “On the other hand, it’s also more expensive and not all insurance plans may cover it, and it’s more difficult to reverse quickly if someone is in a traumatic accident that causes bleeding.”
Rivaroxaban (Xarelto) is an even newer drug in a similar category. It does not need to be monitored with monthly blood tests and is prescribed only once a day. Eliquis is also a blood thinner that does not require monthly blood tests. It's taken twice a day.
Getting the Right Heartbeat
Once stroke risk is under control in a patient with AFib, doctors turn their attention to the actual heart rhythm problem. Not everyone needs their AFib corrected. Some people with atrial fibrillation can go years without any treatment other than stroke prevention.
“A lot of people have so-called chronic AFib, where it’s there all the time, but as long as their heart rate isn’t too fast, they’re able to live their lives normally, and in some cases don’t even notice it,” says Whang.
So if you don’t have symptoms from your AFib and your heart function is normal, your doctor may not try to get your heart back into a normal rhythm. “There’s no evidence showing that doing this will make a person live longer or have a lower stroke risk,” Wylie says. "So it’s hard to make the case for prescribing drugs and surgical interventions, which have their own risks."
If you do have symptoms, that’s a different story. Symptoms of atrial fibrillation include:
- Fatigue and lack of energy
- Shortness of breath
- Heart palpitations
One of the first options to convert atrial fibrillation to normal heart [sinus] rhythm is a procedure called cardioversion. The patient is placed under anesthesia and doctors deliver an electrical shock to the chest to reset the heart’s rhythm back to normal.