Aa
Atrial dialation results unclear
I just had a cardioversion 12/11. A TEE was performed to rule out clots beforehand. The TEE show severe bi-atrial enlargement, and normal global systolic function in both Left and Right ventricles. The odd thing about this is a previous echo in April 2012 (when I was not in afib) showed a mild left atrial dialation and a normal right atrium size. Two years ago when I was in afib, I had a TEE before cardioversion, which showed the left and right atrium moderately dialated.
When i asked the nurse practioner who discharged me what all this meant, she said it did not make sense. When she learned I was in afib for the recent TEE and the one 2 years ago, she said that must be the reason for the difference. She gave me copies of all 3 to present to the cardiologist when I see him for followup January 7.
To say the least I am very concerned, as I had been told I had a mild dialation. After talking with the nurse I felt somewhat better, but am still concerned. I had been in afib for 5 days at the time of the TEE and cardioversion.
I'd appreciate any input -- thanks.
When i asked the nurse practioner who discharged me what all this meant, she said it did not make sense. When she learned I was in afib for the recent TEE and the one 2 years ago, she said that must be the reason for the difference. She gave me copies of all 3 to present to the cardiologist when I see him for followup January 7.
To say the least I am very concerned, as I had been told I had a mild dialation. After talking with the nurse I felt somewhat better, but am still concerned. I had been in afib for 5 days at the time of the TEE and cardioversion.
I'd appreciate any input -- thanks.
COMMUNITY LEADER
My AFib symptoms do not cause me any problems when I am not working hard physically - I still do yard work, including running a chainsaw on some large White Pine trees that came down in the "super storm" Sandy that hit New Jersey in late October.
The bottom line here is my history, heart's physical condition, and lack of severe symptoms from AFib make my doctors unwilling to try to stop the AFib, not even ablation. That is, with a low probability of success, a non-zero risk and symptoms that do not prevent me form physical activities most older people engage in (I was a runner before, even to age 67) computes to just control the HR (BB and CCB) and mitigate clot formation (warfarin). Use of a pacemaker has never been suggested in my case.
I have maintained a casual contact (short of being a volunteer) with the staff director at the heart institute where my surgery was done. On lamenting my AFib with him he outlined the same ablation options I have read about here many times and noted all are done in the institute, then he added if the symptoms justify the risk.... same bottom line.
My main problem now from not running for the past 5 years is it is hard to keep the weight off my mid-section. My appetite for food had not changed to match my lower level of physical activity.
God bless, and Merry Christmas
The bottom line here is my history, heart's physical condition, and lack of severe symptoms from AFib make my doctors unwilling to try to stop the AFib, not even ablation. That is, with a low probability of success, a non-zero risk and symptoms that do not prevent me form physical activities most older people engage in (I was a runner before, even to age 67) computes to just control the HR (BB and CCB) and mitigate clot formation (warfarin). Use of a pacemaker has never been suggested in my case.
I have maintained a casual contact (short of being a volunteer) with the staff director at the heart institute where my surgery was done. On lamenting my AFib with him he outlined the same ablation options I have read about here many times and noted all are done in the institute, then he added if the symptoms justify the risk.... same bottom line.
My main problem now from not running for the past 5 years is it is hard to keep the weight off my mid-section. My appetite for food had not changed to match my lower level of physical activity.
God bless, and Merry Christmas
No Jerry, regarding atrial fibrillation (and many other arrhythmias), I have a lot to learn from you! :-)
You are completely right that atrial fibrillation mostly affects left atrium. Uncontrolled contractions of the left atrium will cause this effect, and it usually affects right atrium to a much lesser degree.
As you are saying, a-fib can cause more a-fib because the left atrium gets restructured inappropriately. A-fib itself will not cause leaky valves, but enlarged atria can (in some cases, in some not) cause leaky valves. My dad, for example, is 70 y/o and has a severely enlarged left atrium. However his mitral valve is perfect and he has been in NSR all the time (except the mandatory a-fib after bypass surgery which went away a few days later). So I guess there is a random element as well. His PACs has increased lately, so unfortunately there is a chance he will develop a-fib sometime. I'm mildly concerned and checking his pulse weekly.
DeltaDawn: A-fib can be treated with one "light" fix and one major. With the light version, they ablate the area between the pulmonary veins and left atrium. The theory is that a-fib usually is initiated by PACs that origin from the pulmonary veins. So they are removing the spark, but the wood is still present. If the left atrium is very restructured, this often doesn't work, as other foci in the left atrium can be able to initiate a-fib on their own. Just as a dilated ventricle can produce "R on T PVCs" and initiate v-fib. A normal ventricle can't do that. But we all have some weird atrial tissue near the pulmonary veins that has this ability to initiate heart beats independently from the rest of the heart. Which is why we all can get short runs of a-fib but no healthy person get v-fib.
So, the major treatment is to physically restructure the left atrium through surgery. Known as a maze procedure. I'm sorry - I don't know what robotic afib surgery is. I wish you both a wonderful holiday! :-)
You are completely right that atrial fibrillation mostly affects left atrium. Uncontrolled contractions of the left atrium will cause this effect, and it usually affects right atrium to a much lesser degree.
As you are saying, a-fib can cause more a-fib because the left atrium gets restructured inappropriately. A-fib itself will not cause leaky valves, but enlarged atria can (in some cases, in some not) cause leaky valves. My dad, for example, is 70 y/o and has a severely enlarged left atrium. However his mitral valve is perfect and he has been in NSR all the time (except the mandatory a-fib after bypass surgery which went away a few days later). So I guess there is a random element as well. His PACs has increased lately, so unfortunately there is a chance he will develop a-fib sometime. I'm mildly concerned and checking his pulse weekly.
DeltaDawn: A-fib can be treated with one "light" fix and one major. With the light version, they ablate the area between the pulmonary veins and left atrium. The theory is that a-fib usually is initiated by PACs that origin from the pulmonary veins. So they are removing the spark, but the wood is still present. If the left atrium is very restructured, this often doesn't work, as other foci in the left atrium can be able to initiate a-fib on their own. Just as a dilated ventricle can produce "R on T PVCs" and initiate v-fib. A normal ventricle can't do that. But we all have some weird atrial tissue near the pulmonary veins that has this ability to initiate heart beats independently from the rest of the heart. Which is why we all can get short runs of a-fib but no healthy person get v-fib.
So, the major treatment is to physically restructure the left atrium through surgery. Known as a maze procedure. I'm sorry - I don't know what robotic afib surgery is. I wish you both a wonderful holiday! :-)
Thank you both for the input. I will keep you informed on what I learn at my January 7 appt. with the EP. Do you think I should request an echo before then, or wait and talk with him about it? Also, I have been hearing ads for Beaumont Hospital (near Detroit) regarding their new "robotic afib surgery." I'm wondering what's that's about.
Jerry, what meds do you take to keep your hear rate down while in permanent afib? Also, has anyone ever suggested destroying the AV node and putting in a permanent pacemaker with you?
I am comforted and somewhat more relaxed after hearing both of your input. I am, however, feeling like I knew what I was dealing with and what the progression might be and now I don't -- kind of unsettling. I feel pretty well this week and see my PCP tomorrow, so that's something. I didn't get any instruction on what my activities should be, but I'm thinking low key. Take care and hope you both have a wonderful holiday.
Jerry, what meds do you take to keep your hear rate down while in permanent afib? Also, has anyone ever suggested destroying the AV node and putting in a permanent pacemaker with you?
I am comforted and somewhat more relaxed after hearing both of your input. I am, however, feeling like I knew what I was dealing with and what the progression might be and now I don't -- kind of unsettling. I feel pretty well this week and see my PCP tomorrow, so that's something. I didn't get any instruction on what my activities should be, but I'm thinking low key. Take care and hope you both have a wonderful holiday.
COMMUNITY LEADER
Live and learn. I didn't know AFib causes "bi-atrial enlargement", assumed to be both left and right. I now an echocardiogram shows I have an enlarged left atrium, but the right is reported as normal. These echos were done while I was in AFib. Is there a difference in terminology here? I understand the fibrillation is in both atria, not just the left, still my echo shows normal size for the right.
Indeed, leaky valves can be involved. I in fact was diagnosed with a leaky mitral valve on my first echo after being diagnosed (via stethoscope and EKG) on my first visit to a cardiologist. I was never told the AFib might cause valve problems, but was told the leaky valve would cause enlargement of the left atrium and thus increase the chances of AFib.
Not sure this helps, but to conclude. After about 5 years with a known leaky valve and a couple of electrocardioversions which, with the help of Propafenone, keep me in NSR for most of the time my left atrium enlarged to the point (or the valve leaked to the point) that surgical correction was required. I have remained in permanent AFib since and the follow up echo always shows an enlarged left atrium, mostly normal right atrium... and during constant AFib - here my HR is near normal due to beta and calcium blocker, but the atria are in fib.
Please share with us anything more your learn about having your atria changing size, both up and down.
Good luck, I am not trying to dispute anything from Oslo, I'm am mostly a reader here.
Indeed, leaky valves can be involved. I in fact was diagnosed with a leaky mitral valve on my first echo after being diagnosed (via stethoscope and EKG) on my first visit to a cardiologist. I was never told the AFib might cause valve problems, but was told the leaky valve would cause enlargement of the left atrium and thus increase the chances of AFib.
Not sure this helps, but to conclude. After about 5 years with a known leaky valve and a couple of electrocardioversions which, with the help of Propafenone, keep me in NSR for most of the time my left atrium enlarged to the point (or the valve leaked to the point) that surgical correction was required. I have remained in permanent AFib since and the follow up echo always shows an enlarged left atrium, mostly normal right atrium... and during constant AFib - here my HR is near normal due to beta and calcium blocker, but the atria are in fib.
Please share with us anything more your learn about having your atria changing size, both up and down.
Good luck, I am not trying to dispute anything from Oslo, I'm am mostly a reader here.
First, a TEE is usually more accurate than a TTE to evaluate atria.
When you are in A-fib, you don't have any atrial systole (the atria don't contract), so the atria will more or less just stand still and gather blood, which will dilate them. I know this can cause chronic dilatation of the atria, but I don't know how large the acute effect is (the effect that will reverse when you are in sinus rhythm again).
We don't really "need" the atria for the heart to function and perform. The atria contribute to 10-25% of the pumping power, but we can live a long and happy life without this effect, just like everyone with chronic atrial fibrillation do. The main problem with dilated atria (except vulnerability for atrial fibrillation) is if the valves are affected and stretched, so they get leaky. This may affect ventricular performance. If your valves are OK, I wouldn't worry too much about this, but ask your doctor and do regular heart tests.
When you are in A-fib, you don't have any atrial systole (the atria don't contract), so the atria will more or less just stand still and gather blood, which will dilate them. I know this can cause chronic dilatation of the atria, but I don't know how large the acute effect is (the effect that will reverse when you are in sinus rhythm again).
We don't really "need" the atria for the heart to function and perform. The atria contribute to 10-25% of the pumping power, but we can live a long and happy life without this effect, just like everyone with chronic atrial fibrillation do. The main problem with dilated atria (except vulnerability for atrial fibrillation) is if the valves are affected and stretched, so they get leaky. This may affect ventricular performance. If your valves are OK, I wouldn't worry too much about this, but ask your doctor and do regular heart tests.
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