Bush is Not Alone

May 07, 1991

George Bush is not the only one to experience an abnormal heartbeat due to atrial fibrillation. The ailment is fairly common, doctors say, striking 1.5 million to 2 million Americans a year.

And while the president's doctors describe his arrhythmia as "benign," atrial fibrillation sometimes has serious consequences. Characterized in medical literature as "rapid, random contractions of the upper chambers of the heart, resulting in a totally irregular, often rapid heart rate," atrial fibrillation can be caused by infection, heart disease, or even ordinary stress. It is far less likely to cause permanent damage than a problem in the lower chambers, but it can cause strokes in some cases.

That's because the more troublesome cases damage heart valves and cause blood clots, which can travel to the brain. Doctors treat patients suffering abnormal heart rhythms with drugs, or where that fails, by installing pacemakers. An estimated 75,000 people suffer strokes caused by atrial fibrillation in the United States each year, according to the New England Journal of Medicine. Those strokes, about 15 percent of the 500,000 strokes a year, are often more damaging than the fibrillation.

For some severe cases, a newer, surgical technique is available. Although drugs or a pacemaker can keep the heart's lower chambers pumping normally, the upper chambers can stay out of sync. This produces the clots, mostly in an appendage that develops on the left atrium. Keeping these clots at bay with blood thinners subjects the patient to other dangers, such as excessive bleeding. Dr. James L. Cox of Washington University in St. Louis has devised an operation that interrupts the electrical chaos causing atrial fibrillation, thus forcing the heart back into a normal rhythm.

This "maze" operation consists of four slashes in the upper heart wall, breaking certain electrical connections and forcing current to flow in a single direction. One of the cuts excises the clot-forming appendage. It has been tried with success on 20 patients at St. Louis' Barnes Hospital and at the Cleveland Clinic. Recent research at New York's Mount Sinai Medical Center indicates that aspirin, already widely prescribed to prevent heart attacks, can cut in half the risk of strokes caused by less severe cases of arrhythmia.

Naturally, a specialist's advice is a critical ingredient. President Bush, who has the best of doctors at his side at a moment's notice, had his heart rhythm restored with medication and left the hospital yesterday without resorting to surgery. Many healthy people would, too, if they consult their physicians as soon as they feel irregular heartbeats developing.

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