Larry Chinitz, MD: Best Options for Atrial Fibrillation

Atrial fibrillation does not have a perfect therapy. But it does have a series of differing therapies, managed by physicians trained to personalize options for particular patients. Though it's not a perfect path to care and stroke prevention, it could lead to the same outcome.

In an interview with MD Magazine®, Larry Chinitz, MD, director of Cardiac Electrophysiology and clinical director of Cardiology at NYU Langone Medical Center, explained how this process of care have developed over time, and what the best atrial fibrillation care options look like now.

MD Mag: What is the current state of care for atrial fibrillation?

Chinitz: Well, I think it’s first important to say that I'm not sure that we have proven therapies, but we do have a lot of options for the treatment of atrial fibrillation, and we've learned a lot about it over time. That certainly helps us in making the appropriate choices.

So, one thing we do know about atrial fibrillation is that it never goes away by itself. It is a progressive process such that over time, patients are going to experience more and more episodes of atrial fibrillation, and that over that period of time, it's going to be more difficult to keep them in a normal rhythm.

So one of the things that we've learned is that we need to intervene relatively early—whether we're going to intervene with medical therapy, or intervene with catheter ablation, or whatever tool we decide. We need to make a decision that somebody needs to be treated and we need to treat them early, because that will translate into greater success.

And one of the reasons that you really need to intervene is because of the very substantial risk of stroke. Stroke risks vary based on patient age and other factors, but we need to identify the patient's we need to recognize that they need therapy and we need to deliver that therapy in a prompt manner. And I think that sort of is the theme that overrides everything else that we talk about, because you can argue for hours about medical therapy versus catheter-based therapy versus surgical therapy. And there are cogent arguments that can be made in each of those areas.

We believe very strongly in catheter ablation, and I think recent data has shown that it can be a very effective procedure in the right patient, that we can perform it safely and that patients clearly have a better quality of life after catheter-based therapy. And there is some provocative data to suggest that stroke risk could be lowered, that longevity could be affected. So in the proper hands, catheter ablation is a very powerful tool.

But then there clearly are patients who are more amenable for medical therapy, and if they're managed well, they will do well. So for me, it's not so much that I know exactly the right way or the best way to treat it. I think it needs to be individualized. But what we have learned in the past decade is that it needs to be addressed.

I think in the past, physicians often said, “Well you know, you could live with this, just forget about it, or take an aspirin.” I think there was a time when we really didn't have that much to do and we didn't know as much about it, so it was under-emphasized. I think we've come full spectrum away from that, and I think we urge our primary care colleagues to make sure patients are appropriately monitored and identified, and intervened upon relatively early.