Some of the people with the heart rhythm disorder ‘atrial fibrillation’ are better off with a different treatment than they are currently receiving. Researchers write this in the journal today The New England Journal of Medicine. It is expected that this will prevent strokes, heart failure and heart attacks in several hundred patients every year in the Netherlands. The chance of death also decreases.
“In healthy people, the heart beats regularly and about 80 times per minute”, says Harry Crijns, head of the cardiology department at Maastricht UMC and one of the project leaders of the study. “A quarter of all people over 40 will experience atrial fibrillation at some point. The heartbeat then becomes irregular and the number of beats per minute increases. People can experience palpitations, dizziness and a tight feeling in the chest. In addition, they walk. , especially in the first year after diagnosis, more likely to have serious complications such as stroke, heart failure or myocardial infarction. “
Currently, there are two strategies for treating atrial fibrillation. Patients who do not experience symptoms such as palpitations, fatigue and chest pressure are given blood thinners to prevent clots and are given medicines that slow their heart rate to a normal number of beats per minute. The treating physician then accepts that the rhythm is irregular.
In patients who do experience complaints, doctors try to restore the heart rhythm with medicines or by switching off the part of the heart that disrupts the rhythm by, for example, freezing.
Extra risk
Large-scale research in 11 countries now shows that it is wise to restore the heart rhythm in some of the people without complaints. A total of 2,789 patients participated in the study who were diagnosed with atrial fibrillation less than a year ago. The participants ran an extra risk of complications because they had previously had a stroke or were, for example, over 65 and had high blood pressure or diabetes. Fate determined who received which treatment.
In patients who did not try to restore the rhythm, 5 percent developed a serious complication such as stroke, heart failure, myocardial infarction within a year. Some even died. In the group where doctors did try to restore the rhythm, 3.9 percent developed complications.
Cardiologist Crijns estimates that there are about 15,000 to 20,000 patients in the Netherlands each year in whom it is wise to restore the heart rhythm and he expects that this will save about 200 people from serious complications.
Gamechanger
“This is an important study into a common heart rhythm disorder,” says professor Folkert Asselbergs, cardiologist at UMC Utrecht. “In practice, we always ask ourselves whether you should only slow the heart rate or whether you should also strive to restore a regular heart rhythm. Previous studies showed different results, but this study shows that people are better off with a normal heart rhythm. . “
Asselbergs expects the study to find its way to the clinic soon if follow-up research shows that the treatment is cost-effective. “I think we will try to get a normal heart rhythm back more often in people who have recently been diagnosed with atrial fibrillation and who are older than 65 and who are at extra risk in some other way. . “
Cardiologist and professor of atrial fibrillation Joris de Groot of the Amsterdam UMC also shares this analysis. “This is really one gamechanger. Previously we limited efforts to restore the heart rhythm to patients with complaints of atrial fibrillation, mainly because of side effects of the drugs. But the results are good and the side effects are not too bad. I think the policy in our hospital will change from Monday. “
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