Treating Atrial Fibrillation Without Ablation

By Chirag Sandesara, MD, FACC, FHRS

Patients are often referred to me for catheter ablation as a treatment to reduce the frequency of their symptoms from atrial fibrillation (AFib).

In some cases, that may be the most appropriate action to take. But for many patients, the most appropriate first line of treatment is more conservative, non-invasive and addresses many of the underlying issues that contribute to AFib. These include:

  • Obesity
  • Sleep apnea
  • Inactivity
  • Alcohol use

 In some cases, treatment and prevention of underlying triggers of AFib may forego the need for catheter ablation altogether.

I had a young patient see me to discuss ablation for his symptomatic AFib. But my first question to him was “How did you get to where you are today?” He weighed 350 pounds and admitted that he had gained close to 100 of those pounds over the course of three or four years. He had recently been diagnosed with high blood pressure, sleep apnea and diabetes.

He wanted to try to avoid having an ablation, so the first thing I did was get him started on the Ideal Protein weight loss program. He lost 140 pounds in one year and as the weight fell off, his exercise picked up.

As a result of these lifestyle changes, he no longer needed his blood pressure medication, his blood sugar was controlled, and his sleep apnea went away. And so did his AFib.  Before long, he was running regularly and ultimately ran in a half-marathon!

We were able to resolve four disease processes without medication or surgery.

In other cases, however, despite aggressive efforts at lifestyle modification, AFib persists and the symptoms can be bothersome. These patients are often started on medications, or if noted early in the course of the disease, can go straight to ablation therapy.

The key for all patients with AFib is to seek an evaluation as soon as possible after the onset of symptoms. The sooner we can address the problem, the sooner we can make significant improvements in the patient’s quality of life.

The good news for our patients at Virginia Heart is that we can offer the evaluation and support they need to address AFib all under one roof. At our Lansdowne office, we have the expertise and resources of electrophysiologists, dieticians and sleep medicine specialists in one location. So when I refer patients for weight or sleep evaluations, they simply walk across the hall. 

This multi-disciplinary, team approach to treating patients with AFib is what leads to the best outcomes. Working together with the patient (and their family), we can create a customized treatment plan that addresses many of the issues that contribute to AFib and make significant strides in reversing the condition—without a trip to the Electrophysiology (EP) lab.

Of course, in some cases an ablation may be the best and last course of action to take. But in many others, much less costly interventions enable patients to enjoy life again without the fear and stress that an uncontrolled, irregular heartbeat creates.

Chirag Sandesara, MD is an Electrophysiologist board certified in Clinical Cardiac Electrophysiology and Cardiovascular Medicine. He manages complex heart rhythm disorders through lifestyle modification, medical therapy, device implantation, and ablation.