From: djw@hodgkin.mc.duke.edu (David Wendt)
Newsgroups: sci.med
Subject: Re: Irregular Hearbeat -- Atrial Fibrillation
Date: 17 Dec 92 03:06:54 GMT
Organization: Duke University; Durham, N.C.

In article <liveipINN861@exodus.Eng.Sun.COM> vg@yaz.Eng.Sun.COM (Vineeta Gupta) writes:
>
>   Where can I read up more on this?
>   Is this treatable?
>   Can one do more than just take dylantin(?) everyday?
>   How can one prevent more of these incidences?
>   Lifestyle, diet changes .. do they help??
>   Does it get worse over time?
>
>   Please post or reply to vineeta.gupta@sun.com 

Any general cardiology text will have a section on rhythm disturbances.
(Braunwald, Hurst ..., also the text by Zipes and Jalife -- I believe the
title is cardiac electrophysiology from bench to bedside.  As to additional
current reading, a review of atrial fibrillation/flutter by Ed Pritchert
appeared several months ago in the New England Journal of Medicine.  The 
rhythm is certainly treatable, but as in most "illnesses", the potential
causes are multifactorial, and the success of treatment depends on the 
underlying cause.  Dylantin is an unusual choice for treatment of Afib, 
(contrary to protestations of the Dryfuss foundation which views Dylantin
as a treatment for almost all medical disorders), often patients are treated
with the so called class 1A drugs (procainamide, quinidine ...),or the 1C drugs
(flecanide and encanide), more recently, propafanone has gained popularity as
the side effects are less pronounced, and the efficacy (in some studies) better.
	Again prevention/prognosis/treatment, depends on the underlying cause.
A common presentation in young to middle aged patients is the "Holiday Heart
Syndrome".  A patient usually presents to the ER 24 to 48 hours after a long
weekend of partying and ETOH usage.  Withdrawal (even mild) is accompanied by
increased adrenergic activity, which may precipitate the rhythm in some.
Lifestyle change (i.e. avoid large amts of ETOH) and/or beta blockade
can be quite effective.
Other common causes include  thyroid disease (treat the thyroid), Valvular
incompetence (primary or secondary)...
	Many clinicians believe Afib becomes refractory when the Atrial size on
Echo is greater than 4.5 to 5 cm.  At that time the atrial sturcture has become 
distorted, any attempts at cardioversion (either electrical or pharmacologic)
are at best met with short term success.
	In addition to the palpitations and compromised exercise tolerence
experienced by some patients, a major concern is embolic stroke.  Although
studies are continuing, there is much data to support  anticoagulation therapy
in patients with chronic A fib.
	An additional aside, there are some centers at which surgical (the so
called corridor technique), and ablative aproaches are available.  these
should probably be considered investigational or reserved for complex
circumstances.
If you are in California, arrhythmia specialists include
Melvin Scheinmann at UCSF, and William Mandel at Cedars Siani I am sure there
are many other qualified specialists. Theroretically, any well trained
Cardiologist should be able to help or make a more selective referral.


					David J Wendt M.D.

Disclaimer: Please do not view the above as a medical reccomendation, seek
your own personal treatment from a competent physician, in an established
medical center. 
Newsgroups: sci.med