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Re: atrial fibrillation

Posted By CCF CARDIO MD - CRC on January 01, 1999 at 15:54:58:

In Reply to: atrial fibrillation posted by ron eggleston on January 01, 1999 at 12:39:03:

i am 51 y/o male in good health except of atrial fib which started july,1993. the initial episode was handled with cardioversion and i have been on medications to contol the rate and arrythmia. i have been on procanamide, quinidine, flecananide, and amiodorone, none of which has controlled the atrial fib for more than 1yr.
the flecanided had to be stopped because i had an adverse
reaction of supervertricular tachycardia. after being on amiodorone (verapamil to control rate) for about a year i started having breakthroughs again as i had with all the other meds. this time my cardiologists recommended that i just go on coumadine and live with the atrial fib. the cordorone was stopped approx 4 mo ago and i now am experiencing an unexpected outcome. i am in normal sinus rhythm at least 80% of the time sometimes in nsr a week at a time before a short episode of atrial fib then back to nsr.
i am 51 y/o male in excellent health, exercise regularly, do not smoke and drink in moderation. i have had many echos, including esophageal echo, thallium stress tests, and even cardiac cath of all arteries including swan ganz pressures. all have been normal.
my questions are :
1) what could possibly cause atrial fib to occur in the first place ?
2)  is it possible for someone who has had atrial fib, found no control with medication, after 5 years to experience a reversal and go back into normal sinus rhythm ?
3)  would you recommend that i see an electrophysiologist to see if there is anything else that could be done, any other medications or treatment, if the atrial fib resumes again as the predominant rhythm ?
Thank you very much for any advice you may provide. i appreciate your service very much.  Ron
Dear Ron,
Thank you for your question.
Q: What could possibly cause atrial fib to occur in the first place ?
A: There are many causes of atrial fibrillation.  The most common causes are hypertension (high blood pressure) and underlying heart problems (valve problems and coronary artery blockages).  Many other less common things also cause afib such as overactive thyroid, infection, alcohol and other illnesses.  In some cases no underlying cause can be determined and the term "lone afib" is used.
Q: Is it possible for someone who has had atrial fib, found no control with medication, after 5 years to experience a reversal and go back into normal sinus rhythm ?
A: Yes, afib is a chronic condition with waxing and waning of the rhythm.  Some people are mostly in sinus rhythm and others mostly in sinus rhythm with others somewhere inbetween.

Q: Would you recommend that i see an electrophysiologist to see if there is anything else that could be done, any other medications or treatment, if the atrial fib resumes again as the predominant rhythm ?
A: An electrophysiologist is a cardiologist who specializes in rhythm disturbances.  If you have a particularly challenging case your cardiologist can recommend you to a good electrophysiologist.
Here is some general information concerning afib.
Atrial fibrillation
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.
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.
     sensation of feeling heart beat (palpitations)
     pulse may feel rapid, racing, pounding, fluttering,
     pulse may feel regular or irregular
     dizziness, lightheadedness
     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 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.
     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.
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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