Q: I had MVR in 1993 in Helsinki. Since then I have been on Marevan and Digoxin. In between I had Cardorone for some years. Now I have irregular (AF) and fast heart beats and cardiologists have said that this situation will continue life long as my left atrium is large (6.2 cm). Presently I am on Inedral (60 mg/day), Marevan (5 mg/day; INR-2.2) and Digoxin (0.25 mg/day). My question is that will this situation continue life long or can it be cured with medication?

A:Atrial fibrillation is a common problem in patients with mitral vave disease. It is well tolerated and drugs like Inderal or Diltiazem in proper doses are good to control the ventricular rate. Anticoagulant, which is required for valve replacement patients, is also to be continued to prevent clot formation in the left atrium. This arrhythmia in your setting is often a permanent feature and rate control is a very good way of managing it.