Dick Cheney's Atrial Fibrillation

Vice President Dick Cheney was diagnosed with atrial fibrillation yesterday morning. Within about 12 hours, doctors had restored him back to a normal rhythm.

The appropriate treatment of atrial fibrillation is very tricky. While it would be natural to assume that restoring and maintaining a normal heart rhythm is always the best thing to do, this turns out not to be the case. In fact, for many patients with chronic or persistent atrial fibrillation it is safer and more effective to let the arrhythmia persist, and take measures to control the heart rate and to prevent blood clots (with Coumadin).

In Mr. Cheney's case, the arrhythmia is not chronic - it apparently began suddenly, perhaps as recently as a few hours before he was diagnosed. In such cases it is usually best to restore a normal heart rhythm immediately (within 24 hours). With luck, the atrial fibrillation might not recur.

But especially for patients over the age of 65 (Mr. Cheney is 66) who have underlying heart disease, the odds that the atrial fibrillation will come back is well over 50%. If that happens, doctors may have to choose between using antiarrhythmic drugs to attempt to maintain a normal rhythm, or defaulting to rate-control measures.

Mr. Cheney's new heart problem is by no means unusual. Atrial fibrillation is a very common arrhythmia, and the same therapeutic questions he's facing now are also being faced by millions of other Americans.

You can read about the treatment of atrial fibrillation here.