From the great Hospital Medicine Quick Hits blog:

This was in NEJM this week--I like the concept of "lenient" atrial fibrillation control as easier to achieve and no worse for patients than strict control of heart rate.  Looks like 110 is the new speed limit in atrial fibrillation.

Seemingly big news today in cardiology: patients with hard-to-control atrial fibrillation were better off getting a catheter ablation than trying different medical therapy.

Unexpected development: a small study reports good efficacy of a cage-like device implanted in the hearts of patients with atrial fibrillation. Right now we give people a medicine coumadin to prevent strokes from atrial fibrillation (a common heart arrhythmia). A company has introduced a device that evidently accomplishes the same goal. Complications were up around 7% which is more toxic than coumadin which has about a 1% per year serious bleed risk (about the same as aspirin). The Reuter's article calls coumadin "notoriously difficult to manage " as if it were some sort of villain.

I'm sorry to ask a profound question but what exactly is fish oil? Is it an antiarrhythmic or is it a cholesterol drug?

The word on the street is that patients who take fish oil have better cardiac outcomes not because of the effects on cholesterol or triglycerides but because of prevention of cardiac arrhythmias.  But in 2008 a meta-analysis came out in BMJ that throws cold water on that concept at least in retrospective studies.

A prospective study OMEGA is evidently finished recruiting and hopefully will publish soon.

A common irregular and often rapid heart rhythm is known as atrial fibrillation or A Fib. Roughly 2.2 million Americans are suffering from some form of heart rhythm disorder. In atrial fibrillation the heart's two small upper chambers (the atria) vibrate irregularly instead of beating effectively. Blood is also not pumped fully out of them so it may clot more readily. A patient can suffer a stroke if a fragment of clotted blood in the atria leaves the heart and lodges in an artery in the brain. Doctors have known for years about the link between atrial fibrillation and strokes.

Device works better than drugs for atrial fibrillation

Patients who take bisphosphonates for osteoporosis could face higher risks of serious atrial fibrillation (AF) or irregular heartbeats claim a new study. The study presented at the 74th annual international scientific assembly of the American College of Chest Physicians (ACCP) or “CHEST 2008” shows that people using alendronate or zoledronic acid two common medications to slow or prevent the development of osteoporosis had significantly greater chances of encountering serious AF including hospitalization or death when compared with placebo.

A new study by Canadian researchers found that only about forty percent of the patients who had atrial fibrillation which is a risk factor for stroke were taking warfarin a well known and effective anti clotting drug. Even those who were taking the drug in 75 percent of those studied were not taking enough of it to actively prevent a stroke.Further 25 percent more patients were taking a drug that was less effective than warfarin. "These are missed opportunities for stroke prevention " said Dr. David J.

Gene discovered in hereditary atrial fibrillation Mutations in atrial natriuretic peptide found in 11 family members.