is it likely that AF will diminish with additional weight loss

[Scot__0__0]

  I am a 32 year old male who has lost 100 pounds since August 98, my current weight is 447. (I am continuing to lose weight) In August I underwent electrocardioversion for an episode of  AF. (I had been in AF for + or - 72 hours prior to the procedure) At that time a TEE was done and I was told that I had dilated cardiomyopathy (all four chambers) and my EF was estimated to be 45% . The consulting cardiologist and electrophysiologist both told me that persons of my size almost always have some degree of heart enlargement. I was  told by one cardilogist  that the heart enlargement would likely decrease with substantial weight loss. While the other cardiologist's diagnostic impression was that it would not decrease. The cardioversion was successful, yet approximately once per month I experience a bout of AF. These episodes last anywhere from 10 minutes to 2 hours. I also have hypertension and elevated cholesterol levels. Otherwise I am healthy and active. My medication regime includes Mavik, Toprol, Cardura, Diazide, Rhythmol, Coumadin, and  Aspirin. In August I increased my activity level. At that point, due to shortness of breath and fatigue,  it was difficult for me to walk 1/4 of a mile without rest. I am now able to walk as far as like without experiencing breathlessness (However, I continue to be limited by some leg and back pain when attempting to walk long distances). My questions are as follows:
  1) Is it likely that the episodes of AF will diminish with continued weightloss?
  2) In your opinion which cardiologist is correct? Will my heart size decrease with continued weightloss?
  3) Is it likely that my EF will return to normal with continued weightloss?
  4) Generally speaking, what is the prognosis for someone with my particular pathology?
  5) How frequently should a TEE be completed?
  Thank you for your time.
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Dear Scott
You are morbidly obese - a level of being overweight that is a danger to your cardiovascular and overall health. That is reason enough for you to try to lose a substantial amount of weight. With a substantial amount of weight loss, your heart should start returning to normal size over time. If the heart size decreases, there is a good chance that the episodes of atrial fibrillation will decrease in frequency. Along with the heart size decreasing, the EF should start to normalize, again with time. With smaller degrees of weight loss, it is unlikely that your heart will reverse its structural changes. Thus, in a sense, both your cardiologists are correct. However, do not be discouraged - any amount of weight loss will benefit your health. Regarding your prognosis, it is very good if you can continue losing large amounts of weight. If not, I suspect you will develop serious cardiovascular and orthopedic problems, especially as you get older. You should ask your cardiologist about the TEE question. Personally, I only perform tests if the results will change what I do. In your case, I would not perform a TEE just to take a look, because if your TEE remains abnormal or gets worse, I would tell you to lose weight, but even if it were completely normal I would still tell you to lose weight.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.