Ablation with enlarged left atrium?

Following 2 unsuccessful cardio versions, my EP cardiologist doesn’t want to perform an ablation [low success rate for PAF] & thinks medication should suit me best [cost possibly?]. I have an enlarged left atrium & permanent AF. Does anyone else have this prob & have you been told you can have an ablation or just stay on drugs. I am only 62 & would like to try the ablation first. He has also said that in the near future I would be a candidate for ablate & pace [scary I feel as I try to be very active, play golf etc]. Any help would be much appreciated.

19 Replies

  • I am 65 and had pace and ablate 3 years ago. It doesn't stop the af but does stop the symptoms. You will certainly be able to play golf etc. as the pacing is set to respond to what you are doing. Good luck


  • Thanks Eileen - it just seems such a final step to have pace & ablate. Think I will delay that obne for as long as Poss.


  • Chris, I had the p m fitted but if I become unwell again, they will then do the final ablation

  • I have an enlarged atrium at am 52. The way my doctor put it is the long term med use is for older people not for people like me 52 even 62. Ablations are worth it even if you can get off these damn meds for two years it will better your health then the long term side effects. MY EP is all for ablation. I go for my fourth on March 11. Shaking my head He told me those were the two choices and told me why he preerred the ablation. I totally trust him that ablation is the best choice and I know that I have good yeras outof them. THe first was five years, the second 1 year and the third two that is 8 years without these meds in my system. Mine TOTALLY stopped the afib with the ablation.

  • Many thanks babbawabba - I think I will push for an ablation when I go back on 10 March. Good luck on the 11th, fingers crossed etc.


  • Chris2014, I have PAF and my EP advised that the earlier an ablation is done the better the chances of ridding oneself for a couple of years the progress that comes with the PAF to full blown AF. I trust my man and will go with the ablation. I also have an enlarged left atrium I am 59. My understanding is that the further you go with AF the harder it gets to treat so early intervention is better.

  • Hi soozie - I have been living with permenant AF for well over a year. Prob is getting appointments! I am going to push for an ablation on 10th Match with the EP.


  • Where are you from Chris???

  • Hi Soozie - I come under Southampton which has excellent facilities I understand

  • Hi Chris, I was going to suggest a couple of good EPs but they are in Oz a bit far to travel :)

  • Just a bit!!

  • Hi Chris2014. I am 55 in a couple of months, and was told last October that as my left atrium was so enlarged, the risk of ablation was too great and they were going to continue to treat my permanent AF with meds only. I was very overweight but have taken steps to get that down (lost 4 stone now). Meds currently 10mg Bisoprolol, 2.5mg Ramipril, 120mg Diltiazem (twice a day), Furosemide and Warfarin. I'd go with the ablation & pace if offered.......... Good luck!

  • Thanks AlfieMum. I wish you success with the weight loss. I'm not overweight but also take Ramipril, Diltiazem , Furosemide Atorvastatin and Warfarin. Am thinking of pushing ahead with an ablation.


  • I originally was diagnosed with dilated cardiomyopathy (DCM) as well as AF. If you have an enlarged left atrium then probably this indicates DCM as well. I've had 5 cardioversions - all except the first worked initially, but eventually after weeks or in a couple of cases years I went back into AF. I have asked about having an ablation when I last saw an EP, but his advice was that there was only a 30% chance of success even after multiple ablations, and a 2% chance per ablation of being worse off than if I didn't have one (hence the requirement for a possible ablate and pace!). This advice may now have changed as the science of ablations has improved.

    You didn't indicate whether your cardioversions were initially successful. If they were not there is an internal cardioversion method which has a much higher chance of success and was used on my last 4 cardioversions all of which were initially successful.

    Generally the advice I have had from both EP and cardiologists is that the longer you have been in permanent AF, the less chance you have of ablations being successful.

    In my case as I seem to manage my AF quite well and can do reasonable exercise (including golf and gym) without too much trouble I have elected to stay in permanent AF as I felt it better to live with something I know rather than risk having to have a pacemaker - but it's clearly a personal decision.

    All the EP's and cardiologists I've seen say that staying in AF doesn't affect life expectancy versus any alternatives. They also indicated that I would have to stay on warfarin (or an alternative) for life whatever route I went down to reduce stroke risk and having an ablation wouldn't change the need to take drugs (currently as well as warfaring I am on ramipril, nebivolol and simvastatin.

    Drugs (amiodarone) worked for several years, but eventually I had to stop taking it due to eye complications, and the only alternative offered (dronedarone) proved not to be effective.

    In time my DCM has become less pronounced - it seems that exercise and drugs can considerably return the heart back to a more normal size.

    Hope this helps


  • Hi Excalibur. The first cardioversion worked for a few days. I then had to take Ameodarone for 5 months before a second cardioversion, which never worked. I have had permenant AF for over a year [in between various waits to see the cardiologist then eventually an EP]. The EP said that my chance of a successful ablate was only 20% alowing for the enlarged left atrium & PAF. I also have a small ASD [hole between atriums] & a leaking mitral valve - bit of a mess really especially as I have always been so fit & sporty. I am going back to see the EP on 10th March so will ask him to do an ablate & also to see if they can fix the ASD & valve too.

    I will only consider an ablate & pace if my quality of life becomes too bad as my understanding is that it doesn't cure the AF, only helps with the symptoms. Many thanks for your reply.


  • Hope the consultation on 10th goes well. 20% success rate doesn't sound too positive though. Have you asked him what the chance of a negative outcome I.e. worse than now is? The mitral valve seems more of an issue as I assume this could mean surgery - we all leak to some extent but I suppose it depends on how it affects the heart's pumping efficiency (ejection fraction).

    Hope you haveva positive meeting


  • Hi Lance

    Never thought of a 'negative' outcome. I will include this onto my list of questions for the 10th plus the ejection fraction which I have never heard of but will research as I want to be as fully informed about my condition as possible.



  • Chris, I have had cardioversions and 2 Ablations . In June had Pacemaker with the intention of pace and ablate, Up to now cross fingers I have been AF Free, because of this no ablate unless I have AF again. I now feel I have a quality of life, I was very symptomatic when in Af which was Paroxamal but often. I no longer have the horrendous nights when I often landed in A&e. In my case best thing I did was to have a PM

  • Thanks BStanding. My EP now thinks I have a leaking mitral valve as well, so am going for tests next month. He may recommend fixing it then see how I do but he has decided against pace & ablate/cardioversions for now.

    Thanks Chris

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