Atrial Fibrilation

Posted By  CCF CARDIO MD - MTR on February 23, 1998 at 11:40:01:

In Reply to: Atrial Fibrilation posted by Robert A Sandford on February 22, 1998 at 23:54:39:

: I went into AFib on Nov. 21st 1997 and was put on lanoxin and coumadin at that time. I had a mitral valve replaced with a mechanical valve (Carbomedics) on January 21st at the Cleveland Clinic Florida. All went much better than I expected; great doctors and minimally invasive procedure. I am on the same medication, feel great, lifting light weights, been walking 3 miles a day for the last 2 weeks, but still in AFib.
  Heart rate mid fifties resting and up to 80 after a brisk walk (mid fifties has been my norm for over 20 years). I hope to start running soon.
  Should I be considering Cardioversion or let better than well enough alone????

[CCF Cardio MD - MTR]

_
Dear Robert, I'm pleased to hear that you had such a good result from your mitral valve
surgery.  Your atrial fibrillation developed prior to your surgery so I presume it was due
to mitral valve disease that lead to your surgery.  When the mitral valve leaks or is
narrowed, the left atrium (the heart chamber above the mitral valve that receives blood
from the lungs) dilates and this stimulates atrial fibrillation as the electrical fibers
of the heart are stretched.  When the left atrium is very large, it is difficult to convert
someone from atrial fib to normal sinus rhythym.  I don't know the size of your left
atrium but it may be that your doctors felt that medications would be unlikely to convert
you from atrial fib to sinus rhythym.  Also, about one-third of patients who undergo
open heart surgery develop atrial fib in the post-operative period.  Our practice here
in post-operative atrial fib is to start medications to control the rhythym and then do
electrical conversion to sinus rhythym the next day if the medications don't work. However, for chronic afib, we still
don't know whether controlling the heart rate vs. aggressive electrical conversion is
better.  Thus, the answer to your question would depend on the size of your left atrium,
what therapies were tried in the past, and how you would tolerate some of the medications
that control the heart rhythym.  However, you sound like you're doing great now so it may be
that you should avoid cardioversion.  Perhaps you could discuss this further with your
cardiologist.
Information provided in the Heart Forum is for general purposes only.  Specific diagnoses
and therapies can only be provided by your physician.