Outlook After an Episode of Atrial Fibrillation

Atrial fibrillation may be of brief duration, prolonged or permanent.

The first known episode of atrial fibrillation may be stop spontaneously, or stop after administration of medication or an electric shock across the chest.

What could happen in persons under the age of 40 years that have atrial fibrillation?

One study reported on the outcome of persons with an average age of only 37 years and after one episode of atrial fibrillation (the study was presented at the Annual Scientific meeting of the American College of Cardiology in 2001).

After 20 years, 63 percent had had no further problems, 36 percent had had further episodes of atrial fibrillation, and only one percent had developed permanent atrial fibrillation.

What are the chances of successfully keeping the heart in normal rhythm in older persons that have had atrial fibrillation for more than one year?

At times, we consider using drugs or electrical shocks administered under general anaesthetic, to stop atrial fibrillation and restore normal heart rhythm. Another large study (SAFE-T)reported on success rates in older patients that that had been in atrial fibrillation for more than one year- the study reported on the chances of remaining in normal rhythm vs reverting back to atrial fibrillation.

This study found that there was a greater than 90% chance of failure without use of any heart rhythm drugs. With use of amiodarone, the success rate at one year was less than fifty percent. In other words, if atrial fibrillation has been present for a prolonged period then it is often best to accept this rhythm disturbance and not try to get the heart back into normal rhythm.

General Comment

We need to consider many factors when deciding on the best treatment approach for an individual patient with atrial fibrillation. For younger persons who do not have any other problem with the heart we may be more inclined to attempt to restore normal heart rhythm. For older persons with other conditions that affect the heart we are inclined to accept that the heart will remain out of rhythm.

There will be many instances when we should accept that we should not attempt to get the heart back into normal rhythm, leave the heart's rhythm in atrial fibrillation but ensure the heart is not racing and consider using warfarin to keep the blood thin.

Dr Hitesh Patel
Ascot Integrated Hospital
Auckland