Treatment? - Vagal Mediated Atrial Fibrilation

[Alan__0]

  I just received the subject diagnosis and wanted to do some research.  I have been unable to find anything specific to this form of A-Fib.  I have the utmost confidence in my internist and electrophysiologist, yet still would appreciate some verification.
  I am a 44 year-old male in relatively good health, but have heredity stacked against me.  I fought high-cholesterol (300+) with diet to no avail. Zocor, diet, and exercise have kept it 190-210 for the last four years.  Family history of Diabetes caught up with me three years ago, and Amaryl, diet, and exercise have kept that under control.
  Symptoms of PVCs were explained as normal four years ago after above normal results from a stress echo.  Symptoms of atrial fibrilation experienced earlier this year were again explained as normal after an EKG.  Increased frequency of A-Fib created further concern and a need for more agressive diagnosis, which was captured with an event monitor; definite A-Fib.  Internist suggested slight hypertension and recently prescibed Altace, while changing the Diabetes medication to Glucophage since I was having frequent hypoglycemia.
  With all of these health issues I have been diligent with my exercise.  I run or do some form of aerobic activity 3-4 times a week.  My resting heart rate is between 45-55.  Most all of the A-Fib events happen while at rest or sleeping, and range from a few minutes to two to three hours.
  With this diagnosis, what are the recommended drug options?  What are the potential interactions and long-term implications of this daily drug regimen?  Is aspirin of any benefit?
  Thank you for your review.
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Dear Alan,
Vagal mediated afib is a well described phenomenon and often occurs in older athletes.  Hypertension is also a potential and more common cause of afib.  As far as ************** there are many different options and would have to be customized to the particular situation.  Blood thinners are often prescribed to reduce the risk of blood clots.  Aspirin does not have any benefit in reducing clots although it does have other benefits for the heart.  Pacemakers are sometimes used for vagal-mediated afib as well.  I have enclosed some general information of afib below.
Atrial fibrillation
Definition:
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.
Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria.
The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body.
Causes of atrial fibrillation and flutter include 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. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart.
Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age.
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. Atrial flutter is usually a short-term problem.
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.
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.