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GENERAL ADVICE for NEW PATIENTS for DEALING with ATRIAL FIBRILLATION
Here are some suggestions for those who want to partner with their
doctors in determining how to deal with their AF.
First of all, you need to slow down and devote some time and energy to
educating yourself, as described below, and to learning from the
experiences of others -- from the
LAF Forum site
and others similar to it.
This can be difficult to do when you are want to relieve your symptoms
right away, but you will feel much better when you have a plan in place
that is well thought-out and which you and your doctor have concluded
has the best chance for success.
Warning: There is no advice that is foolproof or approach that is 100%
effective. There are many approaches that work for some – sometimes many
-- people, so you will be best served by doing your own research and
personal experimentation where feasible. Your doctor will of course be a
valuable source of information, and being an informed patient will help
you to ask the right questions.
Here are a couple of quick ways to get started with the learning aspect:
You can start with this FAQ.
This book
by
Hans Larsen is a good introduction.
This list of resources includes additional introductory
material along with ways to learn about AF in more depth, including
keeping in touch with new technological developments, for those who are
interested:
______________________________________________
A general strategy for action is to go through a stepwise process,
starting with steps that are least costly in terms of harmful or
unpleasant side effects. If any of these steps keeps you in NSR without
unacceptable side effects, you would probably stop at that point.
Here is Hans Larsen's
12 Step Plan.
Here is another similar list of steps:
1) Try making lifestyle changes, such as identification and avoidance of
triggers;
2) Try supplements, such as magnesium, potassium and taurine, plus
possibly COQ10, l carnitine (or GPLC) and d ribose. Ideally, you should
test for intracellular magnesium and potassium levels (with a test such
as the Exatest), as well as making
sure that your kidneys are functioning normally before supplementing
with these minerals. You would
ordinarily continue your supplements as well as lifestyle changes along with
whatever other steps are taken;
See the LAF Forum Conference Room Proceeding #61 for numerous
suggestions on lifestyle changes and supplements.
For a “starter package” of supplements and dosages, see
here
and
here.
3) Ask your doctor about using the PIP (“pill-in-the-pocket”) approach,
which usually consists of taking a relatively large dose of flecainide
or propafenone right after AF occurs in a manner that ensures immediate
absorption, sometimes preceded by a beta blocker.
4) Your doctor may suggest cardioversion to see how long this keeps you
in NSR. He may follow the CV with medication, such as …
5) Rate control medication ... to control the effects of high ventricular
rate during AF (rate control medication does not keep the atria from
fibrillating nor prevent consequences other than the high ventricular
rate), or …
6) Anti-arrhythmic medication ... to see if it will keep you in NSR
(“normal sinus rhythm”) with tolerable side effects.
If neither #5 or #6 produces satisfactory results, you can proceed to
consideration of:
7) Catheter ablation or surgery: Hopefully, one of these interventions
will reduce your AF burden (frequency x duration) to a tolerable level,
perhaps with a reduced dose medication or none at all; however...
8) A "touch-up" or additional procedure is quite common in order to deal
with reconnections of isolated areas or with new or overlooked sources,
including those created by the original procedure; or because the
medication that is still needed is not acceptable.
A critical part of the above strategy is to choose a cardiologist or EP
whom you respect and trust and, if you are contemplating catheter
ablation or surgery, who has an acceptable success- and complication
rate for your type of AF.
For more on these issues, please explore this site and others listed
in the Resource section. And see
Questions for doctors
for ways to assess the EPs or surgeons you
are considering.)
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