The heart is equipped with a  clock called the sinus node.  This clock regulates how fast the heart beats.  It is so versatile that it is able to run the heart faster when the person is exerting or run the heart slower when a person is asleep.  Unfortunately, this clock has a high frequency of wearing out with age.  Diabetes, hypertension, heart strain, or simply being older than age 65 is associated with the clock short-circuiting.  Then instead of having a rhythmic beat, the clock has a continuous sparking and the upper chambers of the heart cease to actively beat.  Instead, the upper chambers of the heart simply quiver and there is no effective boosting of the ventricles of the heart.  Note that the ventricles are the primary pumps and they will continue to beat but most frequently too fast or too slow and incompletely filled.

 Recently, a gentleman came to the hospital because he was more short of breath than usual.  He had been doing well at Thanksgiving carrying on normal activity but by Christmas he recognized that he was so short of breath that he could no longer carry on his normal activity.  He came to the clinic and it was found that his heart was in atrial fibrillation.  In this gentleman’s case, his heart was beating much too slowly, only 40 beats per minute.  This is much too slow to meet the body’s need for blood. In this case, the gentleman needed a pacemaker in order to speed up the rate at which the heart beat.

 In another situation a middle aged gentleman had had recurrent episodes of atrial fibrillation.  In the recent snowstorm he shoveled more snow than his heart would tolerate and he went into atrial fibrillation with a heart rate of 130 beats per minute.  When this occurs, the heart does not have time to fill up so he needed something to slow his heart down.  A single direct current electric shock was able to re-establish his normal rhythm and get the clock going the right way again.  Then his heart rate slowed down to its normal level.  He will continue to use a medication to try to prevent the recurrence of the atrial fibrillation.

 In the past, the thrust of care for patients with atrial fibrillation was to try to re-establish a normal rhythm.  Recent studies have shown that there are many times it is better to leave the atrial fibrillation alone and simply control the rate of the heart beat using medications.  This is an appropriate strategy in many patients who have atrial fibrillation but are not disabled by it.  If the person finds that they are disabled and feel very bad when in atrial fibrillation trying to re-establish a normal sinus rhythm is appropriate care.

 The most important part of caring for atrial fibrillation is the prevention of strokes from blood clots that form in the inactive atria of the heart when they are fibrillating.  Thus the most important part of caring for individuals who have atrial fibrillation is provision of anticoagulation to prevent blood clots.  There is a medication called Warfarin that slows the rate of blood coagulation and prevents blood clots from forming.  The risk factors that should alert a person with atrial fibrillation that they need to be anticoagulated include an age greater than 65, hypertension, diabetes, heart failure, abnormalities of the heart valves or a previous stroke.  Individuals with these  risk factors and a history of atrial fibrillation have a prohibitive incidence of blood clots causing future disability.  Careful control of anticoagulation with Warfarin and blood tests to monitor the warfarin effect are critical for the person’s long term care.  This can be done through your local clinics.

 Atrial fibrillation is very complex medical condition and as shown by the two individuals above, treatments can be very different.  Your local clinics are the place to start in treating this condition.  Referral on to an internal medicine specialist or a cardiologist may be indicated depending on the complexity of the problem but care should begin in your local clinics.