Some Observations About Atrial Fibrillation

Abstract

Richard I. Shader, MD As I walked out of the theater one evening, an elderly man next to me slumped to the ground. I spotted and called over a nearby usher, and together we eased him into a chair. White haired and probably in his 70s, he said he had suddenly felt faint but was otherwise okay. I checked his pulse, and it was rapid, weak, and irregularly irregular. It seemed likely that he was experiencing an episode of atrial fibrillation (AFib). His wife, who was behind others when this happened, came rushing over. I asked her if he was known to have AFib. She replied that it was diagnosed a year before but that he was ignoring his physician’s advice to be further evaluated and treated because he only rarely felt palpitations. His age and sex are classic risk factors for AFib. Given the availability of databases derived from large population studies, many characteristics (in addition to being male and elderly) are now recognized as AFib risk factors. Table I, created from the cited references, lists some of the risk factors that appear to have valid associations with AFib. They are not listed in any specific order of magnitude because studies and populations are not comparable. Several people I know who have AFib have been told to avoid coffee and other caffeinated drinks. The idea of caffeine intake as a risk factor seemed to me to make common sense because of increases in heart rate via caffeine’s inhibitory effect on adenosine. However, this concern should only apply to caffeine-naive individuals because long-term ingestion is associated with tolerance to caffeine’s cardiovascular effects. Coffee drinkers who have AFib will be heartened by a recent article proclaiming the relative neutrality and even possible benefits of coffee consumption in many forms of heart disease (including arrhythmias) and stroke. Early recognition and treatment to improve any underlying or predisposing causes are essential. Once a diagnosis is established, agents to lower heart rate (eg, β-adrenergic receptor antagonists, popularly called βblockers) or to reestablish sinus rhythm (eg, sotalol) are typically used. These therapies may be combined, when indicated and safe, with proper anticoagulation. Thus, a regimen that involves rate and rhythm control and anticoagulation is usually central to the prevention of strokes and to reduce the likelihood of falls and their