Question Title: Atria Fibrillation

Dear Doctor: I am 28 years old and exercise daily by jogging and doing
weights. I have had 7 episodes over the course of the last 10 years. My
episodes last from 36-48 hours. It was only a year ago that my doctor was
able to catch the problem on an EKG( I could never get to the doctor in
time to catch the problem). He sent me to a Cardiologist to confirm his diagnosis. The Cardiologist did an echo and confirmed the diagnosis. The
root of the problem was not "ideopathic" as my family doctor had guessed.
The Cardiologist said something about a valve but I did not quite understand what he was saying because I was so in shock over something
being wrong with my heart. Why did I never have an episode during the first 18 years of my life? The Cardiologist wanted to put me on a daily Beta-Blocker but my family doctor gave me a prescription of Toprol only to be taken when I have an episode. Am I a little to young to be taking heart
medication for a problem that only occurs once every 1-2 years? My family
doctor gave me coumidun and lanoxin during that visit and it did the trick
to put me back into rythum so why did he prescribe me Toprol for the next episode? Is my exercise routine something I need to stop because of my
condition? I asked the Cardiologist about this and he said,"exercise-you can...climb Mt. Everest-no". What does that mean? I guess I am a little scared because when I have an episode, I KNOW IT! It is a very scary feeling! Oh yeah, my first episodes seem to occur the day after I drank alcohol. Since I made this connection I stopped even having one drink.(I have not had any alcohol in 6 years and never did drink much). Since that
time my episodes begin in my sleep and startle me. Therefore, I take two
aspirin every night before I go to bed to keep my blood thin in case of an episode. What else can I do to stop these episodes?

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Dear Shan,

Thank you for your question. Atrial fibrillation is a disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles. There are many potential cause for atrial fibrillation. Some potential causes are: dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause.

When no cause can be found the term "lone atrial fibrillation" is used. This generally caries a better prognosis than other types of afib but is still a chronic condition.

There is no single method used in the treatment of lone afib. In general, blood anticoagulation with warfarin is not recommended for those patients less than 60. Treatment with antiarrhythmic drugs such as beta-blockers may or may not be indicated depending on the situation.

Prevention:
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.

Symptoms:

sensation of feeling heart beat (palpitations)
pulse may feel rapid, racing, pounding, fluttering,
pulse may feel regular or irregular
dizziness, lightheadedness
fainting
confusion
fatigue
shortness of breath
breathing difficulty, lying down
sensation of tightness in the chest

Note: Symptoms may begin and/or stop suddenly.

Signs and tests:
Listening with a stethoscope (auscultation) of the heart shows a rapid or irregular rhythm. The pulse may feel rapid or irregular. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter
the heart rate may be 100 to 175. Blood pressure may be normal or low.

An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring--Holter monitor (24 hour test)-- may be necessary because the condition is often sporadic (sudden beginning and ending of episodes of the arrhythmia).

Tests to determine the cause may include:

an echocardiogram
a coronary angiography (rarely)
an exercise treadmill ECG

Treatment:
Treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include digitalis or other medications that slow the heart beat or that slow conduction of the impulse
to the ventricles.

Electrical cardioversion may be required to convert the arrhythmia to normal (sinus) rhythm.

Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition.

Complications:

incomplete emptying of the atria which can reduce the amount of blood the heart can pump
emboli to the brain (stroke) or elsewhere--rare

Calling your health care provider:
Call your health care provider if symptoms indicate atrial
fibrillation or flutter may be present.

Q: Are there other safe drugs I could take at home to avoid cardioversion?
A: There are many different drugs that are used in the attempt to keep the heart in sinus rhythm (SR) but as with any medication they all have various side-effects. You doctor can work with you on finding the best drug for your case.

Q: What are the side effects to Toprol.
A: Toprol XL is a long acting version of metoprolol. This drug is a beta-blocker. Potential side-effects of beta-blockers include fatigue, problems with diabetic control, and impotence.

Q: It seems that the better physical shape I stay in the less I have a problem with A.F. Could exercise have an impact?
A: There is no known effect of exercise on atrial fibrillation (AF).

Q: Is a pacemaker an alternative?
A: In some people who are unable to be controlled with drugs the electrical connection between the atria (upper heart chambers) and ventricles (lower heart chambers) is electrically severed and a pacemaker is placed to control the ventricles. The atria remain in fibrillation but the side effect of the rapid heart rate is eliminated. Chronic anticoagulation is required, as there is a risk of blood clots forming in the atria.

Q: I have an uncle that was diagnosed with IHSS. Are IHSS and Mitral valve prolapse related problems?
A: No.

The links below are good sources of information about atrial fibrillation.

http://www.med-edu.com/patient/arrhythmia/atrial-fib.html
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/afib.html
http://www.merck.com/!!vDXoe16kTvDXpz08Of/pubs/mmanual_home/chapt16.htm

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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