- Hey everybody, I'm Dr Morales.
I'm here at the Heart Rhythm Society Conference,
and I'm here with Dr Antonio Navarrete,
who's an electrophysiologist in the Indianapolis area,
and we're gonna be talking about the question
"Can AFib be cured?",
and so, Dr Navarrete, you know,
when patients are first diagnosed with AFib,
or they start thinking about doing procedures,
they basically wanna fix, they wanna know
if this is gonna fix AFib,
they want something that's gonna be gone forever
for the rest of their life, and that can be
a difficult conversation to have with patients.
So, how do you approach that topic of
"Can AFib be cured"?
- That's a great question.
I usually don't tell my patients
"I'm gonna cure your AFib", I definitely tell them,
the reason that we do ablation now
is to improve the symptoms,
so they're gonna feel better,
and they're gonna have a better quality of life.
In rare, rare circumstances, there are some people
where they can be free of AFib forever,
but the majority of patients, if you look hard enough,
you're gonna see atrial fibrillation.
But the key is that they're gonna have
a better quality of life,
they're going to have a decrease in their AFib borders,
that's usually what I tell them.
And hopefully, be able to decrease some of the medications.
- And obviously, there are some people
who get a procedure like ablation,
and they have a great success from it,
and they feel like it's gone, you know,
I've had years and I haven't had anything AFib,
but obviously, we both know
that doesn't mean that's the end story.
And so, how do you counsel patients
in term of the long-term management?
You had a procedure done, it's worked great,
you know, what are the steps to do well
for years down the road?
- I think the case, continue to work on the risk factors,
the patients need to make sure
they still are eating appropriately,
they're treating their sleep apnoea,
they're treating their hypertension, that's key,
and if they have occasional episodes they're short,
not very bothersome, I'm okay with that,
and I don't wanna start changing medications
or using new drugs, but in some circumstances
you have to go back and do another ablation
if the patients are having recurrences,
they're bothering for the patient.
- And I think a lot of times,
people don't always understand,
if AFib comes back, especially down the road,
it's not always that there was
a problem with the first procedure,
but just an actual progress of aging,
or other risk factors, kinda just leads
to more areas of AFib.
So, when you have a patient and is doing well,
do you kinda still manage them for years to come,
or do you kinda send them back to their referring doctors?
- I usually like to see them at least once a year
if they're doing well,
just to check how they're doing.
But I don't completely send them back
unless the patient had a clearly other arrhythmia
that was triggering atrial fibrillation,
so I feel like they weren't really cured.
But patients with atrial fibrillation,
I like to see them at least still once a year,
to see how they're doing,
I think that's important.
- And, on the same topic of cures,
is about blood-thinning medication.
You know, when people have a procedure
and they feel like it's very successful,
they assume that they don't need the blood thinners anymore,
which is yet another conversation to have.
So, how do you manage that conversation with patients?
- That's a good question.
I mean, many patients want to get off of blood-thinners,
and ablation is not the key for that,
so I usually continue following the guidelines.
If the patient had a high CHAD-VAS score,
I continue on anticoagulation.
If the CHAD score is low, one,
then that's when the problems start.
Sometimes I like to monitor these patients long-term
with a loop recorder and see how they do,
they don't have a pretty high burden of AFib,
short episodes,
I might continue monitoring with medications,
but if they have a high CHAD-VAS score, these are patients
that are gonna continue oral anticoagulation,
unless they have a watchman device,
or some kind of procedure to protect them from
being on oral anticoagulation.
- And you brought up the point about loop recorders
and other monitors, because, you know,
people will have even a wildly successful procedure,
if you have something that's recording your heart
all the time, you're gonna find a few minutes of AFib,
you might find 10, 15 minutes of AFib,
which is a dramatic improvement versus a previous ablation,
but that risk of stroke is still there,
and that's why that conversation about blood-thinners
still needs to be there in the long-term.
- That's right.
In the end it's always a conversation with the patient,
telling them this is what we know now,
we don't have enough evidence to support anticoagulation
of five minutes of AFib, or two minutes,
but if they feel comfortable,
and some patients want to take oral anticoagulation
because they're scared of stroke,
other patients, they don't wanna take them
and they're comfortable not to take them,
so it's an individualized conversation,
say this is what we know,
and there's definitely a risk in whatever it is,
a risk taking the blood-thinners too,
and they make that decision at the end of the conversation.
- Exactly.
Well Dr Navarrete, thank you for taking
a few minutes of time, I really appreciate it.