DEAR DR. DONOHUE: I am a 72-year-old man with atrial fibrillation. My doctor has me on Coumadin and Toprol. I had electrical cardioversion done once, but the fibrillation returned. I would like your opinion of what would be the best treatment for me. – R.M.

ANSWER: Atrial fibrillation is a most common heart-rhythm disturbance. The upper heart chambers, the atria, are beating at a very rapid and erratic rate. That rhythm is passed on to the heart’s lower pumping chambers, the ventricles, and the result can spell trouble in a number of ways. For one, a fast, irregular heartbeat makes the heart a poor pump. For another, blood in the fibrillating atria stagnates and forms clots. Those clots can break loose and be carried to brain arteries, where they obstruct blood flow to the brain. The result is a stroke. This is the reason your doctor has you on Coumadin, a blood thinner: to prevent clots from forming.

To re-establish a more effective heartbeat, there are a number of options. One is to shock the heart, and that can sometimes bring about normal heart rhythm. It didn’t work for you.

A second approach is to try to abolish atrial fibrillation with medicines. That does not always work either.

A third course of action is to allow the atria to continue to fibrillate but slow down the heart rate so the heart can continue to pump effectively. That’s what the heart medicine you’re taking – Toprol – is doing, and this is the approach adopted for many people. It’s a treatment with few side effects.

Sometimes doctors try to eradicate atrial fibrillation by making scars in the atrial wall with a catheter inserted into the heart by way of a blood vessel. That technique is catheter ablation. The scars block the erratic atrial impulses from reaching the lower heart chambers. Heart surgeons effect the same result by making tiny incisions in the atria. The operation is called the maze procedure.

You and I have to leave it to your doctor to suggest which of the many options is best for you.

DEAR DR. DONOHUE: My husband and I have been married for two years. I knew he had herpes before our wedding. I have not caught it. We do not have relations when he has an outbreak, which is about three or four times a year. I am pregnant and am afraid I might catch the infection during pregnancy. How best can we handle this? – R.K.

ANSWER: The only absolutely sure way of not catching herpes is to abstain from sex during your pregnancy.

Condoms are partially effective in curtailing transmission, but you should not rely on them for full protection, especially during an outbreak. Though rare, herpes can be passed even when there is no outbreak.

Your husband should discuss with his doctor the advisability of taking a drug like Valtrex during these nine months. It has been demonstrated to greatly reduce the risk of transmission. It also reduces the number of outbreaks.

Herpes is a complicated problem. The herpes booklet answers some of the more commonly asked questions about it. Readers can obtain a copy by writing: Dr. Donohue – No. 1202, Box 527475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Four years ago, because of a high cholesterol count, my doctor gave me Lipitor. The readings have come down. I am 87. Another doctor told me it is a mistake for anyone over 80 to take statin medicines, as they cause liver damage. I fear to discontinue it. I would appreciate your advice. – H.S.

ANSWER: Statins – Lipitor, Mevacor, Zocor, Pravachol, Crestor and Lescol – are indicated for older people who are at high risk of artery hardening, heart attacks or strokes, or for older people who already have had a heart attack or stroke. For the elderly not at high risk, their use is open to question.

If you stay on Lipitor, your doctor can check on the state of your liver’s health, from time to time, with a simple blood test and stop the medicine if there is an indication of liver damage. Usually liver damage reverses after that.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.