A Paradime Shift in Atrial Fibrillation Management

Almost 10yrs ago in 2014,  I started my own AF/Stroke Prevention protocol and reported  my own observation in my own blog that I published in  July 24, 2019.  I reported  my personal thoughts about how to unmask AF and prevent its ugly twin called stroke. Our society in cardiology did not have any guideline and data was replete on how we detect and manage the high risk patients with occult Atrial Fibrillation. I wrote about  how I screen my high risk patients for stroke with the use of a simple legacy equipment called Holter Monitor. When I started to discover short bursts of SVT's (Supraventricular Tachycardia)  called Micro-AF, my dilemna started as if I may have inadvertently opened the pandora's box. A decision needs to be made as to whether to ignore and leave it as what our guideline  would suggest or should I intervene and nip it at the bud with anti-arrhythmic medication. The decision did not come easy but, with a reasonable logic and being upfront with my patients, I decided to share the decision regarding intervention with them. Most if not all of my patients would want me to proceed. I discussed and sometimes argue my findings with my colleagues and try to defend my protocol including the so called experts in the field. Almost everyone would look at my thought process as off, scary and outright potentially dangerous considering the paucity of data to defend it. They are absolutely correct  in their own right because my protocol did not have the necessary data to back it up. We doctors, have always been wired to follow guidelines and data in our day to day practice. I am not saying that it is bad but, if we get 100% dependent on data that may  never be available in all of our every day encounter with patients, then we should start using our God-given gift called common sense. 

 Fast forward 10yrs later, the EAST AFNET-4 was published by the American College of Cardiology in Oct. 11, 2024. This landmark clinical trial proved to be the beginning of a paradigm shift in the way we handle and manage our AF patients. This trial was terminated early in favor of  the Early Rhythm Strategy,  a strategy  I employed since 2014 which was not embraced by many is now the "in thing " and very much the way to go. I felt vindicated and thankful for the over 10yrs that my patients have benefited from an intervention that nobody would readily accept at that time. This proves over and over again that guidelines will always be a work in progress and we doctors need to open our minds and think outside the box. We should always remember and  not lose sight of the fact that sharing the decision with the patient is of paramount importance when untested protocols are being implemented.  Fear is normal, but what I can say is if you follow science it is difficult to go wrong and when you add knowledge into that critical thinking, reason will overcome whatever apprehension you may have and  fear will slowly ease away.