By now you will understand that atrial fi brillation is a common medical condition, the symptoms of which can come and go, come and hang around for a while, or come and stay. In any scenario, once you have it, you have it for the remainder of your life. It cannot be cured, only managed. Although its likelihood of occurring increases with a person’s age, it can aff ect the young to the old, men and women, and more often than not comes when the body is under stress for other reasons; the very time you don’t want an extra problem. You can reduce your own atrial fi brillation risk by ensuring your blood pressure is well managed over your lifetime, maintaining a healthy weight which will also reduce your risk of obstructive sleep apnoea, and refraining from excess consumption of alcohol. Most people feel the symptom of palpitation or notice a change in their physical capacity, yet not everyone knows that they have it. For some people, the fi rst sign of the condition can be a collapse and for others it may be a stroke. In others, it may be discovered incidentally during another medical procedure. For many suff erers, the symptoms can be debilitating, for others, they are an inconvenience. As your doctor, my aim is to minimise the symptoms as safely as possible and to maximise your prognosis. I want you to “live as well as possible, for as long as possible”. Medications and several procedures are available for treatment. Often, the more eff ective the drug, the greater its side-eff ects and one treatment does not fi t all cases. Successful treatment is highly personalised and can take patience and perseverance to establish and maintain. In each case, the Don’t be surprised when you develop AF if you are a snoring, overweight, committed imbiber with poorly controlled hypertension. 155 risk-benefi t of any treatment needs serious discussion between the patient and the treating doctor. Symptoms aside, the biggest concern regarding atrial fi brillation is risk of stroke, a catastrophic consequence that will occur on average at a rate of fi ve percent a year in an untreated group of atrial fi brillation suff erers. Blood thinners can reduce the risk of stroke by reducing the likelihood of the formation of a clot within the left atrial appendage of the heart. The blood thinners include good, old-fashioned warfarin which works by blocking vitamin K, and also the newer agents, the Non-vitamin-K-blocking Oral AntiCoagulants, NOACs. People with atrial fi brillation need blood thinners, but people with AF also need operations and people with AF have accidents. Atrial fi brillation is a bleeding problem for those on blood thinners and a clotting problem for those not on thinners. The risk of stroke must be balanced with the risk of bleeding, and both risks increase with age and the complexity of other medical conditions being suff ered by the patient. Development of the NOACs has been one of the single most signifi cant advances in the management of atrial fi brillation in recent years as their ease of use provides much more convenient anticoagulation without the fl uctuating dose adjustments and repeated blood tests needed with the use of warfarin, with the same or better effi cacy. If we look into a future that always holds promise, we can see electroporation, a new catheter ablation technology that can isolate culprit areas of the heart and pulmonary veins, without scarring. This will allow more extensive ablation therapies which should result in better outcomes. Under development, also, is a system that uses ‘proton cannons’ to ‘shoot’ protons from outside the body into very specifi c locations within the heart to replicate the invasive catheter ablation techniques. Sounds amazing doesn’t it? There is also work going into the understanding of the ‘brain’ of the heart, the ganglia, the collections of nerve cells that form control centres adjacent to the atria. Current research is suggesting that these nerve centres have 156 signifi cant infl uence in the development of atrial fi brillation and that they may well prove a viable target for intervention. However, until the future arrives, I strongly suggest now: if you • are already the ‘proud owner’ of AF, then visit your doctor for a thorough health check. Hypertension, diabetes, coronary disease and renal disease are common travelling companions of atrial fi brillation and these should be properly evaluated and managed; • do not have atrial fi brillation, then see your doctor for a thorough health check. Hypertension, diabetes, coronary disease and renal disease are common travelling companions of atrial fi brillation and their early control could delay or prevent its onset, especially as you age; • carry too much weight (you don’t need your doctor to tell you, but you do need to fi nd a reason to make a change), have a serious conversation with your loved ones and start to look after yourself; • snore (your spouse has probably already told you), lose weight and if you still snore, see your doctor, as sleep apnoea is not good for you; • drink more than two to three standard drinks a day (male) or more than two (female), it will catch up with you. Double the price of the wine you drink and halve what you consume. Alter your habits. Daily, I see the suff ering associated with heart disease and our specifi c interest here, atrial fi brillation. Simple lifestyle maintenance can reduce your risks substantially. However, if you already have atrial fi brillation, attention to good management with the help of your medical practitioner can considerably improve your symptoms and so your daily living, for some, even providing lengthy symptom-free living. My deep desire has been to provide you with information that can help you to be involved in your own destiny, to give yourself the best chance for a healthy life. It is now over to you. I wish you the very best. Good health. Dr Warrick Bishop Hobart, Tasmania, Australia April 2019