ANNOUNCER: An irregular heartbeat or atrial fibrillation means the heart's upper chamber beats at an irregular rate than when it's in sinus rhythm.
NANETTE KASS WENGER, MD: Sinus rhythm is the normal rhythm of the heart. It means that the heart beats absolutely regularly and typically the rate is between 60 and 100 beats per minute. Importantly, when you have sinus rhythm, the usual things that cause you to need a faster heart rate—exercise, fever and so forth—allow your heart to speed up. The things that cause you to be able to handle a slow heart rate—sleep, resting—allow your heart to slow down.
ANNOUNCER: For those diagnosed with an irregular heartbeat, one of the first questions asked is whether to remain in atrial fibrillation or have sinus rhythm restored. Many experts feel the answer can vary depending on the patient.
NANETTE KASS WENGER, MD: There is no right or wrong answer. It's different for different patients. Some of the recent research studies have shown that if you can tolerate the atrial fibrillation well and have no problems with the medications used for its management, then atrial fibrillation may be fine for you.
If atrial fibrillation causes symptoms, if you have palpitations, if it seems to adversely affect your heart function, if it limits your exercise tolerance, then probably you will do well in sinus rhythm. But this is something that you decide in partnership with your treating physician.
JACQUELINE NOONAN, MD: Being in sinus rhythm would be the best, but sometimes it's very difficult to make the heart go from atrial fibrillation into sinus rhythm. It's very important that the heart rate itself be reduced from a very rapid rate to a more normal rate. That can be done with medicine that will slow the heart rate, even though you're still in atrial fibrillation. But some of the drugs you have to take may cause more harm than good. It's not always possible to convert with drugs alone back to sinus rhythm.
ERIC MICHELSON, MD: At the present time, studies suggest that for many individuals who are only minimally symptomatic, it may be sufficient for such patients to be managed with an anticoagulant, a blood thinner, to reduce the risk of stroke, a drug to help keep the heart rate sufficiently slow so that you're asymptomatic to the extent possible, and only for those patients for whom atrial fibrillation is either highly symptomatic, or they have other medical conditions that make it more compelling. For those patients, we do try then to restore sinus rhythm.
ADOLPH M. HUTTER, JR., MD: Both options have been studied against each other in randomized trials, and both are equally as good for the patient. So you can stay in atrial fibrillation, have the same outcome in terms of your quality of life, your risk of a stroke, risk of death. Staying in atrial fibrillation is just as good as trying to get back into normal rhythm.
The options for a person with atrial fibrillation are to remain in atrial fibrillation or to restore sinus rhythm. This decision may depend on several factors and should be based on the individual person's needs.