Afib/Pulmonary Hypertension

[mike25]

Hi,

I am a 31 year old male in otherwise good health (marathon runner and long-distance cyclist).  Last summer I an episode of afib about once a month for three months, each episode of around 4-8 hours duration.  An echo showed normal structure and function, but revealed an estimated pulmonary artery pressure of 49 mmHg.  In August during a follow-up appointment, an ekg suggested possible ventricular hypertrophy, so my cardiologist had me cut back on the athletic lifestyle to verify whether this was an artifact.  A repeat echo in January showed no evidence of hypertrophy; structure and function are normal, but the echo again showed elevated pulmonary pressures of around 35 mmHg.

I had a cxr that was unremarkable as well as a pft that exceeded predicted values in both capacity and diffusion measurements.  Liver and blood tests were all normal except for elevated bilirubin of 1.4.

I have had two episodes of afib since last summer, but both were extremely short-lived (15-30 minutes) and I was able to terminate the last episode by elevating my heart rate through exercise (a trick I read on the internet).  I also have very frequent PACs ranging from 1/10 sec to 1/5 min.

Question:  Should I follow up on the pulmonary hypertension?  My cardiologist doesn't feel that the measurements are significant.  Any other thoughts on my symptoms?  The afib episodes and the pacs don't bother me enough to warrant ablation at this time.  Thanks in advance!

[CCF-M.D.-CRC]

Dear mike,
I would have exactly opposite concerns: I wouldn't worry about the pulmonary pressures and would worry about the afib.  Mildly elevated pulmonary pressures by echocardiogram are common and in the absence of symptoms are an essentially normal finding.

Atrial fibrillation on the other hand is not normal and will only progress over time.  Three episodes in three months is not an insignificant finding and the more episodes you have the more likely you are to progress to chronic afib.   In the right hands afib ablation is becoming a routine procedure with high success rates and a fairly low complication rate.  There are however very few centers that are doing this right now so if you do decide to pursue ablation I would recommend going to major center such as Mayo, Duke or Cleveland Clinic.

[mike25]

Thanks, Doc.

Has anyone had experience with the afib ablation procedure, particularly at Cleveland?  I'm not going to be in the market until I have afib episodes more often, but I'm curious as to what the various experiences have been with results of the procedure.

[debra21784]

Dear Mike,
Iam in complete agreement with the doctor the atrial fib is the issue and a serious one at that.Have you had an ep study done?Most times an ablatation and ep study can be done at the same time.Unfortunately I did not have my ablatation done till after I suffered and survived a major stroke from atrial fib.The cardilogistI saw did not take my a fib seriously because of my young age (46)and felt the possibility of stroke was low.Well it wasn't.
There are 2 issues here.The first is till you decide on an ablatation or choose to treat the arrythmia medically you should be on some type of anticougulant therapy.Asprin is effective in people who have not experienced a stroke from atrial fib.If you are not on it do so .Secondly ,my ablatation was done at Hopkins and at that time they did an ablatation to control the rate my rate was going as high as 300 from a fib.
The ablatation is no worse then a cardiac cath done under sedation with discharge the same day.I was feeling fine by that evening other than some soreness at the puncture site and on my chest for a few days.
I would see a cardiologist at a major academic center who specializes in arrythmias and get a consult .It is well worth it and may knock out that risk factor for stroke and not require further medications.

[BlueGirl]

You need to to get this checked by a specialist.  I have pulmonary arterial hypertension or PH as some call it.  The pressure you describe are very serious.  The normal pumonary pressure should be under 25.  Your pressures are well over that and that is measured from an echo.  Echo pressures tend to be less that what your pressures really are.  The only way to get an accurate measurement and diagnosis is through a right heart catheterization.  Please pursue.  Pulmonary hypertension is constantly misdiagnosed.  The earlier you start treatment the better.  The symptoms you describe are soo familiar to me.  Please go to http://www.PHAssociation.org for more information and to help you find a specialist.