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ATRIAL FIBRILLATION For the past few years, Vice President Cheney has made headlines because of his cardiac problems. Most recently, doctors detected an irregular heartbeat – atrial fibrillation – during Cheney’s examination for a lingering cough. Doctors proceeded to apply an electrical shock to restore his heart’s normal rhythm. Definition. Atrial fibrillation is a common heart problem. Statistics show that over 2 million Americans suffer from an irregular heartbeat in which the upper and lower chambers of the heart are not synchronized. The danger associated with this condition is the possibility that a person can experience a stroke if the atrial fibrillation is left untreated. Fifteen percent of people with this condition can eventually suffer a stroke. A stroke occurs because the uncoordinated beating increases the likelihood that a small blood clot will form in the lower chamber of the heart, called the ventricle. Eventually, a small piece of the clot can break off and travel to the brain leading to a stroke. Susceptibility. Atrial fibrillation increases with age. Up to 5 percent of all people over the age of 65 suffer from this arrhythmia. It is also associated with underlying heart disease and prior heart attacks. Treatment. Doctors must get the heartbeat back into a normal rhythm. This can be accomplished with a variety of medications like digoxin, beta blockers, and calcium channel blockers. Sometimes, as with Vice President Cheney, a low amplitude electrical shock may be delivered to the heart while a patient is sedated. This is a fairly common treatment that I utilize in the emergency department several times per month. More aggressive treatment may involve radiofrequency ablation. This is a non-surgical procedure in which a cardiologist inserts a catheter with an electrode attached at the tip. The physician then destroys carefully selected heart muscle cells that give off electrical signals stimulating the abnormal heart rhythm. By stopping these extra impulses, the heart’s rhythm is restored to normality. Implantable cardioverter defibrillators. Some patients may require an implantable pacemaker and implantable cardioverter defibrillator (ICD). This device is placed under the skin, on the wall of the chest, with wires going into the heart. When a low heart rate is detected, the pacemaker will increase the heart rate. If a heart arrhythmia occurs, a shock will be delivered to the heart muscle to correct the problem. Some concern has been expressed about the safety of people with ICDs driving. However, a new multi-center study released in the December 4, 2007 issue of Journal of the American College of Cardiology revealed that of the 1,200 people studied over a two year period, there was no detectable increase in ICD shocks delivered to the heart while driving. Further, no accidents resulted due a shock being delivered to the patient while on the road. What the study did discover is that there was an increase in ICD shocks delivered to the heart 30 minutes after driving. The results suggest there may be increased stress associated with driving, which may lead to an increased adrenaline release and a resulting heart arrhythmia. Common sense is important for patients with ICDs. Individuals who receive ICD shocks quite frequently are in poor health and, for safety reasons, should not drive. When an ICD is first inserted, patients must not drive for a period of one week. In addition, if a patient receives a shock, they should wait one week prior to driving again. Of course, if an ICD patient does not feel well, they should not drive. These decisions should be made in consultation with the treating cardiologist. Atrial fibrillation is a fairly common problem with several treatment options. A healthy lifestyle can be maintained with this condition as long as measures are taken to prevent strokes and the patient routinely visits his/her physician to monitor the condition. |
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