WASHINGTON -- Doctors found cause for elation and concern when President Bush's heartbeat finally settled into a normal pattern after two long episodes of atrial fibrillation.
The fact that drugs alone could produce and maintain normal rhythm for a number of hours makes it unlikely that the president will need an electrical shock to reset his heart. But the fact that the president's irregular heart rhythm was unusually resistant to medicines raises the odds that the rhythm will recur and that he will need drug therapy for months, maybe longer.
"It still appears to be a benign condition, but the rhythm is more resistant than one would like," said Dr. Valentin Fuster, chief of cardiology at Mount Sinai Medical Center in New York.
"That means this is probably not a freak one-time incident and the president may have a predisposition to the rhythm. So there is more of a chance it will persist or happen again," Fuster said.
When the president returned to the White House yesterday morning, he still had atrial fibrillation. It disappeared within 45 minutes of his return. White House physicians continued to check his condition with a heart monitor in the Oval Office.
Although Dr. Bruce Lloyd, the Navy car diologist caring for the president, said that he had treated patients who had their first onset of atrial fibrillation with frequent return check-ups, other experts said that patients wavering between rhythms would more commonly be kept in a hospital.
But by placing cardiac monitors in the Oval Office, doctors have taken the essentials of a hospital to the president's home.
"I think we would have discharged him today under any circumstances," said Dr. Allan M. Ross, head of cardiology at George Washington University Hospital, a consultant on the case. But he added, "We are blessed with a situation where the White House Medical Unit is close by and very well equipped."
About three-quarters of patients with their first onset of atrial fibrillation can be successfully treated with drugs. Atrial fibrillation, a common condition, occurs when the top chambers of the heart, the atria, begin to twitch randomly, causing the muscular pumping chambers to beat too rapidly and reducing the heart's efficiency.
Patients with new atrial fibrillation frequently switch in and out of the rhythm before the bout ends permanently.