ablation and enlarged left atria


My boyfriend is slipping back into Afib after cardioversion six weeks ago.We saw his specialist today and asked about an ablation we were told because of the enlarged left atria the success rate wasn't very high and he'd need a second ablation.He has been on amiodarone which he had to come off due a pyschosis.Then went onto Bisoperol 10mg which totally flawed him he slept 20 hours in 24.everyday.After the cardioversion the Bisoperol was reduced to 7.5mg daily with 10mg Ramipril.daily.

Can any-one advise if they have been through an ablation with an enlarged left atria and the outcome.We forgot to ask whether an ablation can be partially successful.My boyfriend does not seem to be tolerating the tablets well.He's only 55.

Thank you.

16 Replies

  • I have had three ablations up to 2008 but been AF free since then. I think it true to say that ablation should be considered an on going treatment and that many people will need more than one procedure.

    I also understand that enlargement of the left atria is often a function of AF and that in many cases this may revert after successful ablation has stopped the AF.

    Hope that helps.


  • Thank you for your reply Bob.The cardiologist told us the left atrium will not go back to normal size.Yes I have heard enlarged left atrium and Afib go together.We are lucky because my boyfriend can get a referral to Wythenshawe hospital [a leading hospital for the heart in the northwest]. They have two EPs we have not seen one yet in the meantime my boyfriend remains under a local hospital that often transfer it's patients to Wythenshawe.

    I just hope when we get to see an EP then he will agree to an ablation as the tablets have barely kept the heart rate under control and the A Fib symptoms have still be there even when taking them and the cardioversion has not lasted more than a matter of weeks.

  • Don't take anything as gospel till you have seen an EP.


  • The left atria may get back to near normal if he is able to do moderate exercise. I was diagnosed with dilated cardiomyopathy and through exercise, cardioversion and amiodarone was able to get back to a normal heart size and NSR. for nearly 7 years. I considered ablation but so far haven't gone down this route because of the low success rate prognosis. But it seems that as time goes on the EP's are improving the success rate? Is he happy with his condition?


  • Lancen, thank you for this. I was going to add a comment for you at the end of my main reply but it shot up the screen and was gone!

    I had meant to ask my EP, when I next see him, if it was possible for the left atria to revert to its original size. And how would they know how big it was in the first place? I am still confused that they were surprised by what they found when they got into my heart despite all the preceding tests. There's a lesson to be learned there!

    Very best wishes.

  • My original diagnosis back in 2002 was DCM + AF but the cardiologist at Harefield couldn't say which caused which and gave a probable cause as a viral infection. He said that his rule of thumb was that if the enlargement was less than 50% then the heart could recover to normal size and recommended exercise + drug therapy to achieve this. I haven't gone down the ablation route as my AF doesn't significantly impact my lifestyle. If it did I would be more minded to try ablation.

    It's very much a personal decision which way to go

    Take care


  • That is so interesting, Lance. Thank you. If ablation becomes an option then I would recommend that you go for it! I'm so glad that I did. I did not want to regret not taking the opportunity!

    Best wishes.

  • As people will be sick of hearing, I had an ablation at the Liverpool Heart And Chest Hospital 3 weeks ago. They were surprised by what they found - enlarged left atria and scarring. 50% chance of success. Since then I have not felt my heart once, not once. I do realise that it is early days but I have my fingers crossed. There are 7 EPs in Liverpool. Dr Derrick Todd and Dr Richard Snowdon are my heroes!

    I too was on 10mg Bisoprolol and it wasn't good. I could hardly walk at times.

  • Jenny - you can tell us as many times as you like about your ablation and we'll never be sick of hearing about it - I feel much the same way when I bang on about warfarin on every thread going! I'm really pleased that things are going so well for you. Sue

  • Sue, you are kind. I have just been talking to a friend about the size and enlargement of the atria. She correctly pointed out that the EP would recognise that it was out of proportion with the rest of the heart.

    Repetition on the forum is always going to be necessary with new people joining all the time and it's all about helping each other. I'll always be grateful for the help that I received.

    Very best wishes.

  • Bob is right on this, go to an EP and one that has done many ablations and I'm sure you will get a lot further than you have so far.

  • hi, first AF is not the end of the world. It can be very troublesome, but do not despair.

    You dont say how long ago the AF was first diagnosed?

    But maybe with an enlarged Atria its been some time, as that is fairly normal.

    For my part, I am now 65, male, and AF was first diagnosed 15 years ago at age 50.

    But clear now that I had been in permanent AF for many years prior to diagnosis.

    Initially given Amiodarone, that worked a treat and stopped the AF within 2 weeks, felt as if I was 25 again.

    After a couple of years with no real other issues other than had to buy a good pair of sunglasses due to sun glare, I was taken off and given sotalol (similar to bisoprolol). AF returned and been in permanent AF ever since.

    Had 3 cardioversions, best lasted 3 days in NSR, worst about 12 hours.

    Last one I was put back onto Amiodarone for 4 months prior, but did not help stay in NSR after cardioversion. So wont bother with that anymore.

    Am now on Bisoprolol at 2.5mgs but does nothing for the AF at all, still 24/7 x 365.

    At best it controls heart rate but not rhythm.

    Also on Ramipril at 10mgs/day along with aspirin 75mg, and warfarin.

    I believe that my atria is also enlarged, but not so significantly at last EKG.

    You should ask how enlarged the atria is.

    The one thing about ablations is that the longer AF has been present the more difficult it is to stop, that applies to ablations and pills.

    Of course if an ablation works then great, cause no doubt that AF can itself be debilitating and pills do have side effects, like tiredness.

  • Did he see an EP cardiologist?

    It's quite common for persons with AF to have a dilated or enlarge left atria. I have the same issue. I've just had my 8th ablation and each one has delivered incremental improvement. For some people that's just what happens with AF.

    You could perhaps go and see an EP expert in AF and get an opinion.

    Good luck

  • 8th!!!' Could you tell us when you had the first one and indicate the intervals between each procedure? I noted that those people on the Liverpool trial are doing the 2nd after 6 weeks. Where are you treated? I am sure that Liverpool don't do as many as 8. I was told that a 2nd one was not an option due to the state of the atria. It will be pace and ablate if I need further treatment. I hope that they use the new Liverpool ultra sound method to save your groin !

  • Yes I have. My left atrium was enlarged. I have to have a second ablation in a few weeks time because Im in a study but after the first one 4 weeks ago at LHCH feel great! I was only put on Apixaban and Flecanide. So far so good. I've had the odd dodgy palpitation but things seem to be OK.

  • Thank you every-one for your replies.I'm usually away over night one night a week hence my delay in replying.I appreciate all your comments.My boyfriend is not under an EP but a cardiologist.However his cardiologist will consider ablation so I imagine he will be under one of the EPs at Wythenshawe eventually.They did 500 ablations last year not sure if that was one EP or a group of them.

    The AFib debiliates him totally,he's dizzy,constantly asleep and can barely walk far though he tries,he's breathless on walking upstairs.It was found on a heart trace in Jan this year.He has been admitted to hospital on regular occasions due to epilepsy previously so it would have shown up on heart tracing then I assume if he had been in constant Afib.

    He has been on Amiaradarone but he has a pyschosis on it so was taken off it and put on 10mg Bisoperol which barely controlled his heart rate even at rest.

    The cardiologist is trying to get his blood pressure under control .

    If my boyfriend has an ablation might it be partially successful,ie reduce the A fib attacks.

    All the best to you all.

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