A 60-Year-Old Woman With Atrial Fibrillation

DR REYNOLDS: Mrs B is a 60-year-old retired teacher with atrial fibrillation (AF). She is married and has 2 daughters. She lives near Boston and has commercial health insurance.

In December 2000, Mrs B experienced several self-limited episodes of palpitations and throat tightness. A stress test was negative for anginal symptoms or ischemic electrocardiogram changes at a high workload; a thyroid-stimulating hormone test was within normal limits. In May 2001, she experienced a severe episode of palpitations and was sent to a local emergency department where she was found to be in AF with a moderate ventricular response. She was treated with intravenous diltiazem and spontaneously converted to sinus rhythm. She was referred to a cardiologist, who recommended aspirin and use of a β-blocker as needed to control palpitations. An echocardiogram showed a mildly enlarged left atrium, but was otherwise normal. A Holter monitor showed nonsustained runs of atrial tachycardia, but no AF.