The diagnosis of atrial fibrillation remains remarkably straightforward: a single hospital visit, a pulse palpation, and an ECG. On a standard ECG, the organised P-wave representing the upper chamber’s contraction is replaced by chaotic F-waves, signalling disorganised activity. Modern technology, including Holter monitors and external loop recorders, has made it even easier to detect brief “atrial high-rate events” before they progress to full-blown AFib.
Management of the condition focuses on three primary goals: preventing clots, restoring normal rhythm, and controlling the heart rate. To prevent strokes, doctors use the CHA2DS2-VASc score — a system that weighs factors like age, hypertension, and diabetes — to decide when blood thinners are necessary.
Dr Mathew Iype explains that for many, beta-blockers are used to keep the heart rate in a safe range. In cases where the heart needs to be reset, doctors may use medication or electrical shock therapy, provided they first use echocardiography to ensure no clots are present in the atria.
Fortunately, medical science has moved beyond just managing symptoms. Dr. Namboodiri, who was the first Indian cardiologist to complete a specialised AFib fellowship in Australia, has pioneered interventional techniques at SCTIMST. One of the most significant advancements is catheter ablation — specifically radiofrequency (RF) and cryoablation. In these procedures, doctors map the triggers of the erratic signals, typically found near the pulmonary veins, and neutralise them using extreme heat or cold. SCTIMST has performed the highest number of cryoablations in India, offering a long-term solution for patients when medications fail.