Nikhil Ahluwalia

For Patients

Choosing the right rate-control drug

Learn about the different rate-control drugs available to manage atrial fibrillation, including beta-blockers, calcium channel blockers, and digoxin. Discover the latest evidence from the RATE-AF study and find out which drug might be the best choice for different patient groups.

Rate control- how fast is too fast?

A rate control strategy describes a management plan to slow down the inappropriately fast heart rate caused by AF, often above 100 beats per minute, sometimes much higher. We know this inappropriate fast rate can be deeply uncomfortable for some people and can lead to heart failure and so rate

November Trials update: AFFU-AW, AFHF, CSAF-AW

November Trials update: AFFU-AW, AFHF, CSAF-AW AFFU-AW study Active since: 26-Jan-2022 Patients enrolled: 78 Target total recruitment number: 172 AFHF study Active since: 21-Jan-2022 Patients enrolled: Target total recruitment number: 104 CSAF-AW study Active since: 04-Feb-2022 Patients enrolled: 16 Target total recruitment number: 192

Amiodarone

We’re going to focus on rhythm control medications today, in particular amiodarone. Amiodarone is a potent anti-arrhythmic drug that can be take as a tablet or an injectable infusion (in the hospital). It suppresses AF through a combination of different anti-arrhythmic mechanisms. Although several rhythm control drugs exist, your

Rate vs. Rhythm control

Medications to manage AF directly are categorised as either ‘rate control’ or ‘rhythm control’ treatments. Rate control drugs (such as bisoprolol or diltiazem) work to slow the rate that the heart beats and can make the AF tolerable by managing the fast heart rate. Rhythm control drugs (like amiodarone or

Which anticoagulant is best?

We've spoken about the role of blood thinners to reduce the risk of stroke in patients with AF. If you had AF in the year 2010, the decision was pretty straightforward- warfarin was by far the most commonly used blood thinner in the vast majority of AF patients

October Trials update: AFFU-AW, AFHF, CSAF-AW

The research team has really worked hard to recruit for the AF studies this month. We have been referred patients from all round the country to screen- from the East of England all the way to Cornwall. The virtual nature of the AFFU-AW study consent and enrolment process helps to

Gender and AF

Men are more susceptible to developing AF than women. However, the cumulative lifetime risk of ever developing AF is similar (around 30%). This is due to the increasing likelihood of having AF as you get older and the fact that women tend to live longer than men. Women tend to

The CHADSVASc score

"Just because I have AF, does that mean I'm at an increased risk of stroke?" The short answer is yes, but like many things in medicine, there's much more to it than AF=stroke. So let's dive into the grey... AF is

More on Coffee and AF!

I want to revisit the relationship and recommendations about coffee and AF. In May we looked through the existing data on this. Ultimately, the evidence was lacking to suggest any increased AF risk from drinking up to 5 cups of coffee per day. This is important because many patients are

AF and the pulmonary veins

A lot of Cardiologists don't understand this so buckle up for this one... What are the pulmonary veins? Four blood vessels bring blood back from the lungs to the left atrium (the top left chamber of the heart. These are called the pulmonary veins. They're approximately

September Trials update: AFFU-AW, AFHF, CSAF-AW

AFFU-AW study Active since: 26-Jan-2022 Patients enrolled: 60 Target total recruitment number: 172 AFHF study Active since: 21-Jan-2022 Patients enrolled: 42 Target total recruitment number: 104 CSAF-AW study Active since: 04-Feb-2022 Patients enrolled: 12 Target total recruitment number: 192

Atrial Flutter- AFs little brother

You have two types of doctors- those who care about the difference between atrial flutter and atrial fibrillation and those who class it as the same thing- ‘flutter/fib’! I used the term 'little brother' above in jest- Atrial flutter can be equally debilitating as atrial fibrillation and

Pace and Ablate vs AF ablation

These are technically both different types of ablation used to treat AF. So which one is better for you? AF ablation may be better for some patients and 'pace and ablate' better for others. It depends on your circumstances, previous treatments, and the reversibility of your AF. For

'Pace and Ablate' part 1

'Pace and ablate' is short-hand for 'implant a pacemaker and perform an AV node ablation'. It is a treatment for atrial fibrillation because the 'AV node ablation' part blocks any intrinsic heart rhythm from setting the heartbeat and the implanted pacemaker takes over, ensuring

Sleep apnoea and AF- the importance of RCTs

If you want some background, our June article "What is Sleep Apnoea and why does it matter in AF?"  nicely explains what obstructive sleep apnoea (OSA) is and that it's commonly found in individuals with AF. The reason we're doubling back on this topic

Valvular AF

Do I have valvular AF? If you were born in the UK and have AF, the probability is low. However, if you were born in India or Africa, the chances are much higher! Read on... When AF co-exists with a condition called "rheumatic heart disease" (an autoimmune reaction

August Trials update: AFFU-AW, AFHF, CSAF-AW

Despite the school holidays and the heat, research and clinical cases continued at St Bartholomew's Hospital and so we were able to enroll and treat more participants. Our research team continues to think of important questions from a scientific point of view to try and understand AF and

Shortness of breath

The second most commonly reported symptom is associated with atrial fibrillation, present in up to two-thirds of patients. Limiting hobbies, commutes and even simple activities of daily living; patients with AF frequently report shortness of breath on exertion. However, AF is rarely an isolated condition. Heart failure, coronary disease, muscle

AF and Cardio-pulmonary exercise testing

A cardiopulmonary exercise test (CPEX) measures cardiac and respiratory function whilst the participant exercises up to their maximum capacity. A CPEX can be a useful tool for diagnosing heart and lung disease or working out why someone is breathless or quantifying fitness. It is commonly used by anaesthetists to assess

AF and Holter monitor testing

A Holter monitor is a wearable, continuous ECG recording system that is usually worn for 24-72 hours at home. It's lightweight and portable- see the picture below (six-pack not included 😉). Whereas a 12-lead ECG gives your medical team a 10-second snapshot of your heart rhythm whilst you'

Early AF rhythm control

The ABC approach to AF treatment (Anticoagulation, Better symptom management, Comorbidity risk management) importantly put stroke risk mitigation as the first stage of AF management. The downside of a stepwise approach was that patients may have a number of consultations before 'rhythm control strategies are considered for symptom management;

July Trials update: AFFU-AW, AFHF, CSAF-AW

The AFHF study is a team effort- with our participants getting a comprehensive heart MOT across all the departments and showcases the breadth of cardiac expertise at St Bartholomew’s Hospital. Our scheduling teams went the extra mile in July as clinical volumes of Cardio-pulmonary exercise tests and cardiac MRIs

First-line AF ablation

This has been one of the hottest topics in AF research in 2021/22. There are many different ways to manage AF and the decision about which therapy to pursue first is individual- made between the patient and their medical team. Nonetheless, there is universal agreement that lifestyle changes such

Measuring the impact of AF

The impact of AF symptoms can vary greatly from none at all, to debilitating symptoms requiring hospital admission. They also can guide the treatment approach to be taken- the worse the impact, the greater the benefit:risk ratio of different treatment options. Health related quality-of-life (HRQoL) scores are patient reported