Sorry for the long post here, but a lot to say
I saw my EP last Thursday, which is the first time because up until now I have seen a registrar each time I went, and he was very pleasant, and as he read my notes, I said persistent asymptomatic AF, he looked and said “how do you know you are asymptompatic” which to be honest knocked me back, so I said well I get no episodes, and generally manage to get on with my very busy life, and he said “Breathlessness?” I said yes, especially when walking up hills, and he asked “Exercise?” and I said I used to play badminton for two hours twice (sometimes 3 times) a week, but now that was much harder and I ran out of breath very early on. He also was worried about my sleep apnea, beacuse for the last couple of years I get that at least twice a week.
He said, that in persistent AF the BEST I can expect is that the heart is working at 70% normal, that’s because the Ventricles are simply not getting the right signals to pump properly. So it’s hardly surprising that I feel so tired (or all of us)
He then looked at my echocardiogram from nearly 18 months ago now and said “That’s a large enlargement of the left Atria, and I wouldn’t be surprised if it wasn’t even bigger now” I’m going to book you in for another to check, and also I want you to wear a 24 hours halter and do the things that make you breathless. He said, I think you may be shocked by seeing what your heart rate is doing when this happens, and at night your heart might be getting very slow, which does not help the sleep apnea”
I have to admit to being more than a bit taken aback, I have been merrily coasting along thinking I was one of the lucky ones. But he explained that I have simply got used to being in AF and I literally might not remember what it’s like to be in NSR.
OK options, well he mentioned 2, Amiodarone for 6 months and then a CV, but he’s not a fan due to the potential side effects and he says, it only tells us you can go back into NSR it won’t keep you there. Or surgical ablation, he said catheter ablation will almost certainly not work for me, having been persistent too long and surgical has a higher rate of success (?) and they would do a left atrial appendage exclusion at the same time to reduce my risk of stroke.
So I go back in December and he will chat over this again, I am still a little stunned so forgive me and not sure what to think, I will probably seek a second opinion, but my EP is highly regarded and likely to be right. So it looks like the Beancounter may have to have an ablation after all, but the more challenging thoracoscopic ablation, a joint operation between the Cardiologist and the EPs. Haven’t yet discussed if this will be “mini Maze” or another form, and I am very much still learning about this.
So this time, be well Ian.