Questions...

[clanmags]

I saw my EP privately on Wednesday because I was worried that my first NHS appointment at the cardiology unit seemed a long way off. I'm so glad I saw the EP first because he has already requested a cardio version for me when I arrive at the cardio unit on 22nd September. I have now been in persistent AF for six months. The EP informed me that my heart is weakened...either by the virus that put me into AF or by the fact that my heart rate has been high for so long. He says he won't know if there's a problem with my heart until I am in sinus mode. This upset me greatly as I believe I should have had a cardio version as soon as I was diagnosed. I was surprised that the EP said an ablation is not recommended at the moment as it's a risky procedure. He has put me on a beta blocker which I have been taking since Thursday with no sign, yet, that my heart rate has gone down. I should have asked more questions than I did but I couldn't think straight at the time! I have two questions that someone might be able to answer. Since the sinus node has been 'switched off' does it really matter that the heart is beating from other areas ie; does this peculiar beating, in itself, cause the heart to weaken or is it the fact that the beats are too fast that causes a weakness? Also, if my heart gets back to (almost) normal, can my heart recover from its weakness? I do hope so!

Maggie

[Beancounter Volunteer]

Hi Maggie

Well please bear in mind that I am not medically trained at all, but the "weakness" you refer to is probably an enlargement of the left atria, and this is very common in AF sometimes also called cardiomyopathy. Now I can't be certain of this as obviously it clould be other things, but this is the most common.

I agree with your EP that a cardioversion should be the next step to get you back into sinus (NSR Normal sinus rhythm) but I disagree that your sinus node has been "switched off". I think he was trying to describe something to you about your AF.

And that is that in AF the sinus node is by-passed by the atria and the signals sent to the ventria to beat differently, by different paths. but this is reversible depending the on the length of time you have been in persistent AF and some other factors such as age (you're not old enought to worry) cardiomopathy itself, and any other underlying heart problems (you will have to wait and see about those)

But once you are back in NSR the atrial enlargment does begin to go down, it never gets back to "normal" but it does reduce.

Lastly I will let others talk about ablation as I have never had one, but I doubt many of them would describe the procedure as "risky"

Be well

Ian

[Hidden]

Hi Maggie......I agree with Ian which in itself is unusual...I jest!!!

I'm certainly not qualified to comment on medical issues relating to the function of the heart. Ablation, as most of us are aware, carries risk, but I'm surprised your EP implied that it is a risky procedure, may be the degree of risk depends on the overall condition of the heart. My EP made me very aware of the risks but he also put those risks into context. It is good that he has organised a cardioversion as it is important to see if you can be brought back into sinus rhythm and perhaps an echocardiogram will be carried out to determine the condition of your heart. The important thing is that "things" are happening so lets all be hopeful for a good outcome, best wishes, John

[BobD Volunteer]

Just to add to what Ian has said Maggie, unless you have had an AV node ablation, nothing has been switched off. Yes enlarged atrium can reverse once NSR is established and heart rate is controlled .

A cardioversion in itself can be as dangerous as ablation some might say and of course in order for it to be done a patient needs either to have only just gone into AF or been on anticoagulation for a period (probably two or three months) with a stable INR between 2 and 3. Not doing this risks a serious stroke although in emergency a TOE can be done to check for any clots within the heart, (Trans Oesphageal Echocardiogram, they put an ultra sound device down your throat to look into the heart.) My experience is that local hospitals do not like doing DCCVs. I must assume that you are already anticoagulated.

I am not quite sure what he means about not knowing till you are in NSR? An echocardiogram, CT Scan or even MRI are not dependent on such . It may be that he would prefer not to do these until you are.

Regarding ablation again I think his reasoning may be that he would prefer a) to be able to see an echo survey to see if there is any structural damage and b) see if cardioversion CAN return you to NSR before considering this option. This would be the normal process.

[clanmags]

Thank you so much for your replies, all. I am now feeling much better and not so worried as I have been. Yes, I have been anti-coagulated for three months (it will be four by the time the cardio version is done) and being checked once a week in readiness. I'll let you know how I get on. Once again, I am so grateful for this site and all the lovely that people that provide advice and encouragement.

Maggie