Dr. John Day, Cardiologist

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Get Out of AFib as soon as Possible

A recent study reported that your risk of cardiac death, stroke, or hospitalization could be decreased by 22% if you can get out of AFib as soon as possible. If you’re feeling okay, is there really a rush to get your heart back in rhythm? In this article we discuss the research behind the title of this article–get out of AFib as soon as possible.

EAST-AF Study

The EAST-AF Study was the recent study reporting 22% fewer cardiac deaths, strokes, or hospitalizations with an early rhythm control strategy for AFib. This study was a well-designed randomized controlled multi-center study published in the most prestigious medical journal in the world.

Indeed, of the 2,791 patients followed for over 5 years, the EAST-AF researchers found that all of the bad things mentioned above (cardiac death, stroke, or hospitalization) could be significantly reduced if patients could get out of Afib within 12 months.  I could only imagine how much more successful the results of this study would have been if they had gotten their patients back in rhythm within a day, like we do in our practice, rather than wait up to a year!

“Get Out of AFib” also Benefits Heart Failure Patients

In a follow-up to the EAST-AF Study discussed above, a new sub-study just looking at heart failure patients with AFib was published. As AFib patients with heart failure are the highest risk AFib patients, it makes sense to see whether early rhythm control also benefits the sickest of the AFib patients.

As you might expect, the 798 patients with heart failure patients with AFib in this sub-study also benefited significantly from a strategy to get out of AFib. Taken together, these two studies provide a very convincing message that people do best when their hearts are beating in normal sinus rhythm.

How Long Do You Have to Get Out of AFib?

The real question from the EAST-AF main study, as well as the sub-study, is how long do you have to get out of AFib? We certainly know that the longer you are in AFib the harder it is to correct. This is because people that have been out of rhythm too long start to have enlargement of the upper chambers of their heart from too much scar tissue.

Indeed, my co-author on the best-selling book, The AFib Cure, Dr. Jared Bunch, and I wrote an article a few years back discussing the “AFib tipping point.” The AFib tipping point is when you have been out of rhythm so long that normal sinus rhythm is no longer possible. Based on the best research available, electrical degenerative changes to the heart can start to develop within as little as 5 hours of AFib. Even more worrisome is that new scar tissue can develop within 5 weeks of uninterrupted AFib.

This AFib tipping point varies from patient to patient but in general the older you are the faster the tipping point comes. Obviously, if your goal is normal sinus rhythm then the sooner you can get out of AFib the better.

The Longer You Wait for an Ablation the Lower the Success Rate

The AFib tipping point also plays a factor when looking at ablation success rates. Indeed, in our study of 4,535 atrial fibrillation ablation patients, the sooner they could go from AFib diagnosis to ablation the better their long-term freedom from AFib. And this only makes sense as AFib causes degenerative changes to the heart so the sooner you can get out of AFib the better.

But just getting back in rhythm quickly with an AFib ablation is only half the story. The other key finding of our study was that with an early ablation our patients could also cut their death rate in this study by 2.5x as well as cut their hospitalization risk by 1.7x! Once again, when the heart is out of rhythm bad things are more likely to happen.

Dr. Day’s 5 Thoughts on Early Rhythm Control for AFib

1. The sooner you can get back in rhythm the better. As we’ve covered in this article, the longer you are in AFib the greater the chance of degenerative changes to your heart and the higher risk you put yourself in for premature death, strokes, or hospitalizations.

2. If your goal is normal sinus rhythm then why wait? If you know you don’t want to live the rest of your life out of rhythm then it only makes sense to get treatment earlier rather than later.

3. Every patient’s AFib tipping point is different. You really don’t know how long your heart can be in AFib before permanent degenerative changes occur. For some, it could be weeks to months before the AFib becomes permanent while for others it could be many years.

4. Be proactive in getting the care you need. If you are suffering from fatigue, shortness of breath, or “brain fog” from AFib then advocate for normal sinus rhythm. Sadly, I’ve seen many second opinion patients left in AFib for years all because they didn’t complain loudly enough about their AFib symptoms to their original cardiologist.

5. Discuss your AFib case with a cardiac electrophysiologist. Every AFib case is different. And because it is impossible to know what AFib treatment is right for you or when your AFib will no longer be treatable, get in to see a cardiac electrophysiologist or “EP.” EP’s are cardiologists who specialize in arrhythmias like AFib. To find an EP near you, please follow this link.

If you want to learn more and about the importance of getting your AFib treated as soon as possible, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it is a picture my daughter took of me on one of our regular trail runs overlooking the Salt Lake City valley.