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What is Atrial Fibrillation and How to Treat It

Atrial fibrillation is a disorganized rhythm that originates in the top chambers of the heart and usually causes the bottom chambers to beat rapidly and erratically. Although sometimes unnoticed by the patient, usually there are symptoms of palpitations and heart failure many times develops. In addition it can lead to the development of blood clots within the heart which can migrate to other parts of the body including the brain, sometimes causing some mild neurological defects but also potentially causing large and devastating strokes. It was first described centuries ago and the first treatment was discovered by a Scottish physician, Dr. William Withering in 1785. After one of his patients had gone to a local gypsy and received a concoction with surprisingly good results, Dr. Withering was able to break down this medication and found that the main ingredient was a plant, purple foxglove. This medication became the mainstay of treatment for atrial fibrillation, even going into the 20th century.

Atrial fibrillation is the most common sustained atrial arrhythmia among adults, affecting 2% of the US population. This number increases dramatically to 5-7% in the 70-85 year old population. The prevalence of atrial fibrillation (afib) identified hypertension as an independent risk factor for afib and as the most common cardiovascular condition associated with it. In fact hypertension is present in up to 80% of individuals with afib. There are numerous strategies that have developed to help reduce the incidence of afib, starting with lifestyle modification, aggressive pharmacological treatment regimens and most recently invasive intervention of pulmonary vein isolation to relieve the burden of afib and improve outcomes.

Although not a new technique, catheter based renal sympathetic denervation (cutting nerves that are controlled by the kidneys which will stimulate the nervous system and increase the overall blood pressure) to treat hyperten

sion has emerged as a potential treatment for resistant hypertension. There have been conflicting views about this procedure both in terms of efficacy and also in the potential risks this invasive treatment option presents. In new data presented by physicians from the University of Pittsburgh (ERADICATE-AF study), substantial benefits were noted both in controlling BP and afib when sympathetic denervation was used in conjunction with the more traditional treatment of pulmonary vein isolation. This study presents a major advance in adding to the armamentarium in treating these 2 major medical problems (hypertension and atrial fibrillation) that are associated with numerous correlating effects, such as renal disease, congestive heart failure, strokes and myocardial infarctions. Further evidence is needed from ongoing trials before renal artery denervation becomes a standard clinical approach, but the present study gives reason to believe this is a new potential treatment option that can help millions of mostly older patients both in reducing disabilities and improving survival.

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