Does Absence (of AF) Make the Heart Grow Fonder?

摘要

I am seeing Mrs. A. in the Pacemaker Clinic with Dr. R, an inquisitive second year Cardiology fellow. Mrs. A. is a 78-year-old hypertensive woman who received a pacemaker for sinus node dysfunction 3 years ago. In past visits, interrogation of her atrial-based pacemaker showed brief periods of mode switching (< 10 min/episode) that explained her symptoms of palpitations. These arrhythmias were monitored but not treated. Two years ago she had persistent symptoms requiring her to come to the emergency room. An ECG showed atrial fibrillation (AF) with a ventricular response of 120 bpm. She was admitted, received iv diltiazem, and converted to sinus rhythm within 3 hours. An echocardio-gram showed normal ventricular function. She was given an oral calcium blocker and warfarin. She does not complain of palpitations and has no bleeding problems. Her INR is consistently in the 2-3 range. Today, her pacemaker interrogation shows that over the last 6 months she has had 13 mode switch episodes, all under 10 minutes in duration. She does not like the monthly INR checks and asks if she could stop warfarin and use aspirin for stroke prevention. Dr. R thinks this is a good idea#