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uncontrolled atrial fib with cardiomyopathy

My  58 year old spouse is on the max dosage of amiodorone, takes digoxin and a whole list of other things....the right atrium is enlarged and he was diagnosed 4-5 years ago....usually, when fib occurs, he can get back in rhythym with exercise.....recently he went into fib during exercise, and it sometimes lasts for 3-4 days, where it used to be a number of hours or part of a day.  We did do a conversion when first diagnosed but it did not "hold".
My questions:
He drinks alot of coffee....how much is too much?
He drinks alcohol daily....usually brandy or whiskey....I do not know the actual amount....I know NO alcohol is the recommendation....when do I "report" him to his cardiologist?  He won't let me come to the appts.
I believe he is depressed.....he will not deal with that.  Can it worsen the condition?
When is it time to visit Cleveland for ablation?  He states he will not even consider it until he's in fib more than 50%....I think he is approaching that.  We've talked with  an electrocardiophysiologist here...what my spouse needs is complex, involving many "firing" sites.
His mother has atrial fib, his dad died of a massive heart attack at 55.
He is type A.
He is on cholesterol meds.
I have done as much reading as I can and understand what can happen in the future....but what kind of reduction in life span could this mean?
Both brothers, younger and older, are hugely overweight, have drinking problems and hypertension.  My husband is six feet, about 230 pounds....we are careful with what we eat and he works out regularly, usually kayaking or on an elliptical. His younger sister is grossly overweight and has diabetes.
This is a source of great concern for me.....he will be angry with me if I contact his doc.
Thank you so much for any help you can give me,
One very worried wife
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230125 tn?1193369457
1. there is no answer to the how much coffee questions.  Coffee affects some people and not others.  That is more up to the individual.

2. Unless he is an alcoholic and needs to abstain from alcohol, for a male, one to two drinks per day is acceptable.   a drink is defined as 12 ounces of beer, 4 ounces of wine, once of harder drinks like whisky.

3. Depression can affect prognosis with heart failure.  I positive outlooks goes a long way.

4. Atrial fib ablations in the setting of heart failure is not as successful as atrial fib in a structurally normal heart.  It is possible that they his heart is too sick or that the pressures are too high for an afib ablation.  The only way to know is to talk to your electrophysiologist about it or visit the Cleveland Clinic and get their opinion.  If you live far away, I bleive there is a way to solicit e-consults or consults via email

5. Atrial fib does increase the risk of cardiovascular events but it is unlikely to be a modifiable risk factor.  I would focus on things you can change like high blood pressure, diet, weight, exercise, etc.

I hope this helps.
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