A Fib

  I was recently diagnosed with A Fib and as I think about it I've had it for a long time (>1 yr).  I'm asymptomatic so I was not aware of there being problem.  Last week my Dr. electrocartioverted me and it lasted for two days.  I'm taking coumadin and just started on Cardizem.  The Dr. suggested that I may want to try one more conversion using Cordarone I'm not so sure I should because the chances of the A Fib reoccuring are great.
  So, I'm perplexed as to what to do, rate control or rhythem control.
  My attitude is that I shouldn't be in a hurry to do anything, just try to control my rate until the answers come to me.  My resting rate has never been bad 70-90 bpm, but, it goes up rapidly with any excersize.  The Cardizem doesn't seem to do much (180 mg twice/day).  Should I try other medications to see how they work for me?
  I've also been thinking about getting another opinion, but I think I know what will be said.  Do you think this is a good idea?
  I haven't seen anything mentioned about smoking and A Fib.  I enjoy an occational cigar but have stopped for now. I would like to go back to at least one vice, what would be your advice?
  One last question:  If I can tolorate excersize is there anything wrong with doing it? (esp sex)
  Thanks for responding, Sandy N

[CCF Cardio MD - MTR]

_
Dear Sandy, thank you for your question.  Atrial fibrillation is a common cardiac problem and your question addresses a dilemma in the management of afib.  This dilemma centers around how aggressively should sinus rhythm be restored.  As long as coumadin is taken, the risk of stroke is very small so the benefits of maintaining sinus rhythm center around the long-term hemodynamic benefits.  Over time, afib may weaken the heart muscle since the atria and the ventricles are not contracting in uniform fashion.  But, treatment with antiarrhythmic medications like cordarone can be problematic since these medications have  a high incidence of side effects.   Currently, there is a large-scale clinical trial being conducted that is examining what the best strategy is to treat afib: rate control vs. conversion to sinus rhythm with medications.   For you, beta blockers may control your heart rate better than cardizem.  Also, all forms of tobacco, even cigars, are harmful and are not recommended.  Finally, exercise is fine as long as your heart rate doesn't get too fast.  You certainly are entitled to a second opinion , but I'm not sure another cardiologist will do anything differently since your treatment so far has been standard.  
I hope you find this information useful.  Good luck!  Feel free to write back with additional questions.  Information provided in the heart forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.  
If you would like to make an appointment at the Cleveland Clinic, then call 1-800-CCF-CARE and ask for Desk F-25 or Desk F-15.  The Cleveland Clinic Heart Center website (www.ccf.org/heartcenter) contains a directory of the cardiology staff that can be used to make appointments and to select a cardiologist best suited to evaluate your cardiac condition.