With AFib, a fast referral to a cardiologist is best.

Atrial fibrillation (AFib) is risky. And common.

The Centers for Disease Control and Prevention estimates that 12.1 million Americans will have AFib, the most common heart arrhythmia, by 2030. People with high blood pressure, coronary artery disease and obesity are most at risk.

The condition, which increases the risk of stroke and sudden cardiac arrest, contributes to about 158,000 deaths in America annually.

AFib can be episodic — known as paroxysmal or intermittent AFib — or ongoing, known as persistent AFib. If left untreated, intermittent AFib can become persistent, said Thomas Kambur, MD, a specialist in clinical cardiac electrophysiology at Novant Health Heart & Vascular Institute in Charlotte.

AFib is also a chronic condition. “There’s no cure.” Dr. Kambur said. “Even surgical ablations don't cure it, but they’re the best way to control it.”

Early referrals save lives

When Dr. Kambur performs ablations on people with persistent AFib, he often wishes he’d seen them when they were still paroxysmal. “Ablation can work even better if we do it before AFib has progressed to a persistent state,” he said.

Help your patients get treatment, fast.

Dr. Kambur suspects the news about how ablations have improved hasn’t spread widely.

“Also, not everyone understands AFib’s risks,” he added. “Even some physicians may not realize how AFib affects patients’ energy levels and long-term quality of life. We didn’t used to have great treatment options, so the prevailing wisdom was to leave people with AFib alone if they seemed OK. But today’s improved ablations have altered that thinking.”

How have ablations improved?

“Advancements in mapping techniques — 3D maps and intracardiac echocardiography, or ICE (similar to an ultrasound) — have made the procedure safer,” Dr. Kambur said.

It's also faster. “Ablation catheters have greatly improved,” he said. “We have a better understanding of how much energy we can use, so we get better lesions in less time.”

Treatment options

Treating AFib sometimes starts with lifestyle changes, including:

• Losing weight
• Diagnosing and treating sleep apnea
• Controlling conditions such as diabetes or hypertension
• Avoiding potential AFib triggers like alcohol and caffeine

If a patient makes lifestyle changes and still has AFib symptoms — extreme fatigue, heart palpitations, dizziness or fainting, shortness of breath, chest pain — it’s time to consider other options.

“For some patients, drugs aren’t a good idea,” Dr. Kambur said. “If I don’t think any of my antiarrhythmic drug choices are safe for them, I’ll generally recommend going straight to ablation. There are also patients who want to minimize the medications they’re on for the rest of their lives. I understand that concern.

It’s often reasonable to do an ablation before trying drug therapy. We know ablations are effective and safe. And today, it’s a short procedure with same-day discharge most of the time.

“It’s often reasonable to do an ablation before trying drug therapy,” he added. “We know ablations are effective and safe. And today, it's a short procedure with same-day discharge most of the time.”

According to the National Institutes of Health: “Catheter ablation has been established as an effective, durable and safe method to manage arrhythmias. In some cases, catheter ablation has become the preferred strategy compared with lifelong medical treatment.”

The ideal candidate for ablation? Someone with “the highest chance of success and the lowest risk of complication,” Dr. Kambur said. “Those with the highest chance of success have paroxysmal AFib. They have about an 80% to 85% chance of controlled symptoms a year after the procedure.”

The importance of a referral

“I often tell other physicians not to think of it as referring a patient for an ablation,” Dr. Kambur said. “Instead, they’re referring their patient for a conversation. The patient and I discuss AFib, how it’s affecting them, their overall health and what their health goals are.”

If an ablation is right, patients should know recovery is easy. “I generally recommend limited activity for the first week,” Kambur said. “The heart’s fine. But lifting weights — or doing anything strenuous a few days after the procedure — could injure the groin.”

Ablations have become the “go-to” for many patients with AFib. The procedure can change — and possibly save — their lives.