How Can You Prevent Heart Failure in Patients on Rate Control?
When one picks a rate control philosophy or
strategy, what I discuss in the office with my patients is the following: the most
important thing here is to prevent heart failure. I must know that whatever therapy I’m giving
you is controlling your rate, not overdoing it, but is controlling your rate, to the point
that your heart rates aren’t running rapid all day long because I want to avoid a situation
of decreased heart pumping and heart failure. It’s a condition called tachycardia-mediated
cardiomyopathy. If caught early enough, in my experience,
it’s almost always reversible. I’m currently putting together a series. We have almost 50 patients with this, and
they are absolutely the same kind of patients. They come in not knowing they’re in afib;
it’s picked up on an exam at a doctor’s office, or they have shortness of breath.
And, you can usually turn this around. So, the critical thing is to make
sure you’re controlling it. So, it’s not good enough to send the patient home
with, here’s your 50 milligrams of metoprolol a day. Not good enough. It is up to you, as a physician, to be sure
that you get a follow-up Holter monitor, whatever you want to do, to see that
their rate’s truly controlled. That is a cardinal thing that must be done. So, you can’t just give a drug; you have to
give a drug and see if it’s working.