Cardiologist or EP?

I am seeing an EP, as opposed to a cardiologist, and the difference between the cardiologist's advice and the EP's advice is remarkable. Regarding exercise, the cardiologist told me to keep my heart rate under 80% of my max rate. Taking this advice, while exercising, I was constantly checking my heart rate and stressing while exercising. The EP told me it was fine to exercise at my max heart rate. If I go into afib, he said just stop exercising. I play ice hockey. Since I am on an anticoagulant, the cardiologist told me to sell my equipment, and stop playing hockey. When I told the EP that I stopped playing hockey, he asked me several questions: Do you wear a helmet? Answer - yes. Do you play with a bunch of old men? Answer - yes. Do you check (body contact)? Answer - no. He looked at me and said "play hockey. If you get hit with a puck, you might bruise a little more, you might take longer to heal, but you won't die." I have been playing hockey for 50 years so I know how to avoid dangerous situations while playing. Another difference in advice. The cardiologist told me to go to the ER if I go into afib and it continues for two hours. My EP told me that since I was anticoaugulated, I could wait up to 48 hours to see if I convert, assuming that I am not experiencing any other unusual symptoms like chest pain. Finally, the cardiologist wanted me to come to his office every 3 months. He would do an EKG and tell me that I am in NSR. After my first appointment with my EP, I did a follow-up in 6 months. After the follow-up, I have a yearly appointment, unless I go into afib and do not convert. Luckily, I have been in NSR for over a year. Of course, this advice was given to me and was geared to my particular condition. But I can say that dealing with a doctor (EP) who is well versed in afib and anticaugulation removed a lot of stress that I personally experienced because of afib. I hope this response helps.

Hello, Cowlady1. The first thing to know is that the cardiologist and the electrophysiologist are two different specialties.  The cardiologist deals with the "plumbing" of the heart and the electrophysiologist (who is also a cardiologist) deals with the "electrical" functioning of the heart.  So we say the cardiologist is the "plumber" and the electrophysiologist is the "electrician".Many people are in the care of both a cardiologist and an electrophysiologist....and as in your case, sometimes the recommendations they make for treatment may not be the same.  However, if you have been diagnosed with an arrhythmia, then it is best to be in the care of an electrophysiologist who can evaluate your case and prescribe medications and/or procedures that may work best for you.  Sometimes it is a period of trial and error as a-fib affects each of us differently and what works for one will not work for another.  Probably an electrophysiologist would monitor you in some way so any periods of arrhythmia (even some  you may not feel) can be detected.  Since  your cardiologist does not seem very concerned, perhaps you should see an electrophysiologist to be sure any problem is handled as it should be.  How long you will be taking medications will depend on many factors that will be determined by your diagnosis and response to treatment.  Glad to have you join in our community and hope you will let us know how you are doing.Best wishes to you,Jean(My A-Fib Experience Community Leader)

I’ve never seen a cardiologist only an EP and judging from some of the comments on this site the EPs are better equipped to offer updated advice. Good luck.

Hi MIC.  Re: exercising at max heart rate.  I don't feel comfotable with your EP's advice that that is fine.  Common sense tells me not to red line your bpm at a continuous rate while exercising.  Hitting your peak\\max rate is perhaps ok in a burst of speed skating but not to stay there.  Time to back off I would think.  I'm a daily biker and bike a bpm target of about 80-85 % max heart rate.  When I see myself going over that threshold, I simply back off.  For those of you Affibers that are unfamiliar with your max heart rate, there are a number of formulas but the easy one is to subtract your age from 220 and the result is your max heart rate for exercise.  Bob

Bob, I am 100% in agreement with your advice. I also take indoor cycling classes. I go to 90% to 95% of my max then I drop down immediately. Before I had my first afib incident, I would stay at 90% to 95% for an hour class, 7 to 10 hours a week. I believe that my excessive exercise caused my afib. I think it was my heart telling me to slow down. Thanks for your concern. Excellent advice. MIC

I see both a cardiologist and a EP. I also see a Vascular Surgeon. I have two heart conditions, Afib and a blockage in my carotid artery.  The Vascular Surgeon did an angiogram last year to determine the extent of the blockage after an ultrasound indicated 70% blockage. It turned out to be only a 50% blockage but once a year I see each of my three doctors just to be on the safe side.

Cowlady1,​Hello. I have been seeing both specialties (cardiologist and electrophysiologist). In layman's terms, here are the services they provide for me: ​--Cardiologist - Provided care since diagnosed with AFiB - 2007; cares primarily for all aspects about the heart and its systems, except electrical issues as noted below;​--Electrophysiologist (EO) -  Provided care since the need for a pacemaker was determined (2015);​  --EP: A specialist - focuses on the heart's "electrical issues" (heartbeat rate; pauses, if an issue; pacemakers; and so forth);Both specialists are doing a fine job; it is very comforting to have both providing guidance as a team; they both share notes andconfer about my situation as needed.Hope this helps you find your best path for AFiB care.​OUMike

I have seen both and also read both online.  As a general statement I think EPs treat afib more agressively, are more apt to recommend a surgical procedure (ablation, watchman,etc), and put you on thinners. Cardiologists more conservative, less likely to recommend surgery, and more likely to recommend (or at least entertain) lifestyle changes and look for triggers. Before even doing an in depth history, my EP asked me if I had ever considered ablation. Not so coincidentally there was an ablation presentation loaded on his computer screen! My cardiologist, on the other hand, views ablation only as a patient driven decision if other treatments are unsatisfactory. He also ws less dogmatic about thinners. Getting input from both are fine but I would lean more on a cardiologist well versed in afib for a more objective and rounded approach. Jim

Re exerciseHeres an interesting study with regard to doing high intensity interval training with AFib.   Seems to help.http://circ.ahajournals.org/content/133/5/466.long

Thanks to all for your great insights.   I do plan to see an EP....Wishing you a great day.Cowlady aka Regina