Holter monitor results

I wore a holter monitor last week for 24 hours. I just received a call from my cardiologist's office saying he wants me to make an appointment to discuss the results. He said there were episodes of AFib and Rapid Ventricular Response . I told the receptionist that I had already made an appointment with an electrophysiologist in the same practice. She told me I could keep both cardiologists. My questions are :
1)How bad is the diagnosis of AFib with rvr?
2)Would it be wise to keep both cardiologists?
3) What is the treatment for this?
I knew I had paroxysmal AFib but I didn't know I had RVR. At the time that I was wearing the holter monitor my doctor had switched me from Atenolol to Diltiazem without weaning me off the Atenolol. My heart went crazy for those two days. Would that have something to do with the results? Or not? Any advice would be appreciated.

RVR stands for rapid ventricular rate, so all it means is your afib comes with a fast heart beat. That's extremely common and there's nothing particularly bad about it. It just means you're probably more symptomatic than someone without RVR. It also means you need to take rate control drugs such as atenolol and diltiazem.

The immediate treatment is keeping that rapid heart rate under control, and that's what the atenolol and diltiazem are for. Not sure why he switched you, but either drug should work. I'm sure he had you stop the atenolol before the Holter because he wanted to see your heart beat without having the rate suppressed. And yes, stopping the atenolol had a lot to do with your heart going crazy. You're probably in afib more often than you think, but the atenolol was keeping the rate down so you didn't experience many symptoms. Without it, you did.

You made no mention of an anticoagulant. Are you taking one? Whether or not you should be depends on your CHADS-Vasc score. You can calculate your score by clicking here. The purpose of an anticoagulant is to prevent stroke, which is the primary danger of afib, and if your score is higher than 2, you probably should be taking one.

As long as your heart rate doesn't remain above 100 for prolonged periods of time and your stroke risk is controlled, there really aren't any other dangers to afib. People with afib live just as long as people without.

Unless you have other cardiology issues, there's really no reason to keep two cardiologists. We like to think of general cardiologists as the plumbers of the cardiology world and electrophysiologists (EPs) as the electricians. Afib is an electrical problem, not a plumbing problem, so you really only need an EP unless there's more going on.

As far as long-term treatment goes, you have four choices:

1. Drug therapy. This involves taking a daily antiarrhythmic drug, of which there are several, and probably also a rate control drug like diltiazem or atenolol (metoprolol is more common).
2. Ablation. Current guidelines state that ablation is the accepted front line therapy for most patients.
3. Maze procedure. This is a surgical procedure, so it involves a lot more risk and recovery time than an ablation, and it may also require an ablation anyway.
4. Do nothing. Just take a rate control drug and an anticoagulant and live with it for life.

Thank you Carey for your detailed response. I was on Atenolol but I'd get an AFib episode every morning before my next dose.He said Diltiazem would work better since he didn't think the Atenolol was lasting long enough. Atenolol lowered my blood pressure and heart rate to low to increase the dose. He had me take my Atenolol on Tuesday then take my Diltiazem on Wednesday when I got the holter monitor. So no weaning off the Atenolol . Just right onto the diltiazem.(which I was on during the Holter monitor testing )
My heart rate during these episodes gets up to 175 bpm. I went to the ER last week because it felt different and wouldn't stop. Normally it stops in a couple minutes. They told me not to come back to the Er unless I was having chest pain and my blood pressure was over 200/110 .
Im on a daily dose of aspirin for now. I'll see what the cardiologist suggests on Monday .
I don't have any structural damage to my heart. At least I didn't several months ago. I had an echocardiogram and a nuclear stress test done. Both turned out ok except I have
a leaky mitral valve which is being monitored.
What antiarrhythmic control drug is best?
I would prefer an ablation ( which my new cardiologist performs) but I'd hate to make things worse if the ablation wasn't successful.
Thank you again ..

There is no antiarrhythmic drug that's "best." They all have their pluses and minuses and need to be tailored to the individual. But I would strongly recommend that you avoid amiodarone for anything other than short-term use until you get a second or third opinion from EPs.

You have a leaky mitral valve, so you do have a plumbing problem. Keep both cardiologists. Your current guy advises you on the valve, the EP advises you on the afib.

Before you head down the road to ablation, ask your new EP how many afib ablations they've done, how many they do per year. That's a singularly vital question you need answered before you even consider that option.