Atrial Fibrillation

A 76-year-old retired, decorated police officer consulted his family physician because of palpitations 1 day in duration. He had been feeling well and physically active doing household chores and yard work: he was not taking any medications. Although uncomfortable because of the palpitations; he was not dyspneic and had no chest pains. On physical examination, his blood pressure was 130/75 mm Hg in the right arm, and the lungs were clear on auscultation. The point of maximal cardiac impulse was in the 5th intercostal space at the midclavicular line. The ventricular rate was 98 beats/min and very irregular. An electrocardiogram (ECG) confirmed the physician’s impression of a diagnosis of atrial fibrillation (AF). There were no acute repolarization changes (ST-T) and no abnormal Q waves. The jugular venous pulses were not elevated and there was no hepato-jugular reflux, thus eliminating the possibility of congestive heart failure. The patient was reassured that...