Irregular Heartbeat Can Be Nothing, or Serious

When former Democratic candidate presidential candidate Bill Bradley announced he had a heart condition known as atrial fibrillation, some people wondered about his ability to lead the nation. Bradley’s doctors said he was in excellent physical condition and that in his case, the condition--which causes an irregular heartbeat--was not a serious health hazard. (Former President Bush was treated earlier this year for the condition as well.) Health interviewed Dr. Bramah N. Singh, a cardiologist at the Veterans Administration hospital of West Los Angeles and professor of medicine at UCLA’s School of Medicine, to learn more about this heart-rhythm disorder that affects an estimated 2.2 million Americans.

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Question: What distinguishes an occasional hiccup in heartbeat from a real problem?

Answer: Atrial fibrillation is a disorder of the heart rhythm in which the upper chambers of the heart, called the atria, begin to beat at a rate of 300 to 600 beats per minute in an uncoordinated fashion. People with an occasional, short-lived palpitation shouldn’t worry unduly, especially if they have no heart disease. But if it comes and goes, or if it’s continuous for an hour or two, or several days, they need to see a doctor.

Q: Can you elaborate?

A: The most common symptoms are shortness of breath, palpitations, discomfort in the chest and dizziness especially if there is an underlying heart disease. If this disorder of heart rhythm goes on for a long period of time, it can be potentially dangerous, because the heart muscle can begin to get weak and ultimately fail. If the blood flow is retarded, clots can form in a heart chamber, which can lead to a stroke.

Q: So it can accompany other problems?

A: Most people with atrial fibrillation also have some kind of heart disease. But in about 5% to 10% of cases, atrial fibrillation is caused by an electrical disorder alone and the heart muscle is not compromised. We call this lone atrial fibrillation, and the prognosis for this is not necessarily unfavorable; it’s relatively easy to control.

Q: Are there any known risk factors?

A: People who have had heart attacks, high blood pressure, heart valve disease or some other forms of heart disease are more at risk. An overactive thyroid gland can contribute to atrial fibrillation, as can inflammatory diseases, such as pericarditis--an inflammation of the covering of the heart. Excessive intake of alcohol is also a risk factor.

Q: How can we limit our risk?

A: The most common cause today is high blood pressure, which can lead to heart attacks. . . Atrial fibrillation is also a disease associated with aging.

Q: Are there any types of activities that people shouldn’t undertake?

A: Smoking and excessive alcohol intake should be avoided. If they’re having symptoms, the prudent thing is let a doctor decide what is reasonable in terms of physical activity.

Q: What treatment is recommended?

A: If a person has heart disease on top of atrial fibrillation, we want to get control of the underlying causes first wherever possible. We need to lower the blood pressure, replace a heart valve if necessary, and control heart failure if this is present. Then we move to treating the atrial fibrillation, but almost invariably we need to slow the heart rhythm at the outset.

Q: What is the prognosis?

A: The best prognosis is for people with atrial fibrillation who have normal hearts and no heart disease. That can be fixed more easily. For those with underlying heart disease, it depends on the nature and severity of the disease.

Q: What is the hardest thing patients cope with?

A: The uncertainty of whether any form of therapy can work year in, year out.

Q: Where can readers go for more information?

A: Their own doctors are the best sources, because most of them know about this disorder and can refer them to specialists. Or they can call the American Heart Assn. at (213) 202-5019 or check its Web site at https://www.heartsource.org.