In this interview we speak with Eric Prystowsky, MD about the AF Stat™: A Call to Action for Atrial Fibrillation (AF Stat). Dr. Prystowsky is the AF Stat Medical Chair and director of the Clinical Electrophysiology Laboratory at St. Vincent Hospital in Indianapolis.

Tell us about AF Stat™: A Call to Action for Atrial Fibrillation. Why was it important to form this national initiative?

If you go back in history and look at the problem of atrial fibrillation (AF), you’ll see it is an arrhythmia that was not treated very vigorously for many decades. When I recently researched a 100-year review of atrial fibrillation in the last century for a lecture I gave at the Heart Rhythm Society (HRS), it became apparent to me that although this arrhythmia has been known to exist for a long time, only a small section of the textbooks were dedicated to its therapy. This is understandable, for there was limited therapy available back then, mostly digitalis or coumadin. So in the mid 1990s, I and the other members of the American Heart Association’s (AHA) EP and ECG Committee wrote the first scientific statement on it, in which we discussed the management of AF. The next step, in addition to ongoing research, was when the ACC/AHA/ESC decided to develop full AF guidelines. This was a huge project, and I was fortunate enough to be on that initial committee in 2001 as well as on the 2006 revision committee.

We published a lengthy and detailed document on the management of AF. After that was published, I hoped we had really gotten the word out about AF, and that people would read it and begin to apply the management principles we put forth, leading to appropriate care of patients with AF. However, to my great dismay, even after the 2006 rewrite, this was not what happened. Patients were still not getting the appropriate anticoagulation, and many physicians did not understand that ablation was an option or which drugs should be used in certain patients. Making matters worse, incorrect interpretation of the AFFIRM trial led to many physicians assuming that rate control rather than rhythm control was the preferred therapeutic strategy for most patients. I think it all came to a head to me when I saw a patient a couple years ago who was about 17 or 18 years old at the time, and was referred to me in persistent AF. He had gone to the dentist and was having a procedure done when he went into AF. His local doctor decided that he was only minimally symptomatic, so he left him in AF. So here was this teenage kid who is in persistent AF, and nobody had tried to cardiovert him. He had come to see me about four months later because his family wanted a second opinion. I worked with him to get him back to normal rhythm, and it has now been a year and a half, and he has stayed in sinus rhythm with no drugs. But throughout this case, I couldn’t help but wonder, “This is outrageous! Why would a doctor decide to allow a teenager to stay in AF for the rest of his life?”