Enlarged atrium and AF: I have been told... - AF Association

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Enlarged atrium and AF


I have been told, following echo, that I have an enlarged left atrium. My AF has been constant for past 3 months with bpm between 100 and 120. I am 4 weeks into Amiodarone with no nasty effects yet, but no benefits either, also Bisoprolol 10mg daily as well as warfarin. I am very down as I feel as if there is nowhere to go as have been told that cardioversion/ablation is unlikely to work because of the enlarged heart. Is there any else on the forum in a similar situation. I feel constantly exhausted, breathless and very depressed and feel there is only one direction this can go. Sorry to be so negative, but I just feel as if I have been diagnosed with a terminal illness. Fed up as can se no light at the end of the tunnel.

28 Replies

Hi I've got enlarged heart cadiopathy af and had 2 Cadioversions had a icd fitted on same medication as u n I'm in nsr at mo so don't dispair u Neva know

Don't give up hope I have enlarged left atrium and have had 7successful CVs and 1cryoblation that has been 80percent success just have to go for touch up my enlarged heart has also improved so pardon the pun take heart

Read all my posts as I had an enlarge left atrium.


Hi AmyRosie, it's a tough time when getting to grips with AF but it does improve. I had an enlarged left atrium and leaky valves and this shocked me as I thought I had an electrical issue and not a structural one. At the time I was told the issues were probably due to the AF and not heart disease. I've now had two cardio versions and three ablations - I'm not 'cured' but have gone from persistent to AF occasionally controlled by drugs with limited side effects. Last month I had another scan about 3 years since the last and everything had improved greatly. AF is not a terminal illness and things will improve for you. I'm really glad you are talking about your fears and concerns - keep doing so - to this forum, to your medical providers and to your friends and family.

So sorry to hear you are feeling so down. Do follow the link in the post by Jamila123 entitled 'Very interesting article' as it might give you some encouragement.

It seems so dismissive to say that cardioversion and ablation may not be effective and therefore there's no point in trying. Perhaps seeking a second opinion might be worthwhile. I wonder if it was a cardiologist or an electrophysiologist who made this discouraging comment? The former can know a lot less about AF than the latter.

Lots of us with AF have found ourselves in a dark tunnel which does have light at the end and most of us have or had enlargement of the left atrium. It can improve if AF is controlled.

Adjustments to medication might help with the exhaustion. As the article says, treatment of AF can be worse than the condition itself.

I have an enlarged left atrium and my cryo ablation worked perfectly. Pay for a private consultation with the top EP in your area to get the full story. There may be reasons why an ablation won't work but the enlarged atrium alone shouldn't be it.

Hi First time I have posted on here but have read threads regarding my condition and they have helped. I had permanent AF diagnosed when I walked into my local A&E with my heart thumping out of my chest and feeling dizzy. Was diagnosed AF and sent home on Bisoprolol and Apixaban. Back in again a week later with chest pains and admitted for a day. Was told I needed cardioversion and would receive an appointment to see the cardiologist at the rapid response unit. 6 weeks later I was still waiting for an appointment and my quality of life was terrible, no energy, couldn't breath, tiredness. I was told virtually that as I was "stable" on the meds my condition didn't warrant any urgency as there were people with worse conditions with me waiting! Sorry for the background but here is why I felt of use to you. Family persuaded me to go private and I saw a Cardiologist at the nearest BMI Hospital the day after. Echo showed that I had a mildly enlarged left atrium and a leaky valve and had the Cardioversion the next week. I walked out of the hospital and for the first time in 8 weeks could literally skip to my friends car. Since had follow up Echo and atrium has reduced slightly. I would certainly consider a private consultation. Afer paying for the consultation and cardioversion privately the cardiologist referred me to the NHS hospital he works with and I am now back under the NHS but the care is far superior. Its well work considering private or at least see another cardiologist at a different hospital. There is light at the end of the tunnel - please don't despair.


I think the first thing you need to do is change you doctor. It is not sensible to be so dismissive like this. Enlarged left atrium is common with AF and is often reversed if a successful ablation is carried out.

I feel that much of your fatigue is most likely due to the drugs you are taking as Bisoprolol is particularly likely to give your symptoms. If you have not already seen an electrophysiologist then please ask to be referred and maybe even pay for a first appointment as being fobbed off in this way is wrong.

@amyrosie If you have undiagnosed hypertension--this causes the left atrium to enlarge. If you have, at the beginning, undiagnosed atrial fibrillation, because at first you don't notice the symptoms and they are not there all the time, this enlarges the left atrium and also the wall thickness of the left ventrical. These changes are all your heart's efforts to adapt to the abnormal situation, to keep you alive and well. I had these situations at the beginning of this whole issue. I finally was diagnosed with hypertension and started taking bp meds, very successfully. As far as the afib goes, the pulmonary vein isolation radio frequency ablation worked very well for me---HOWEVER--this depends on the skill and experience of the electrophysiologist and his carefully chosen team and the skill and experience of the hospital and the ep lab. I had the 3rd best location for this in the entire USA and a very excellent (carefully chosen by me) doctor. I currently have to take a very low dose warfarin and very sub optimal (according to the pharma co,.) dose of sotalol ( an antiarrythmic and beta blocker drug). The dosage of the drug has alot to do with my genetics. I have some glitches (underfunctuioning) in the P450 cyp detox system whereby the detox pathways in the liver underfunction (the ones involved in removing warfarin from the body)--so the dose I need is smaller. Alsom the doctor gave me sotalol because it is detoxed through thekidney, which avoids this detox issue in the liver. All Rx. drugs (most of them) are xdetoxed through the P450 system. Another aspect that may be affecting you are the triggers for atrial fibrillation. If you consume any of these it can put you into afib or at least abnormal sinus rhythm : alcohol, sugar, salt, large macrolide antibiotics, quinolone antibiotics, chocolate, anything you are allergic to, processed foods of any kind, msg, aspartame, epinephrine, caffeine, asthma spray inhalers, bronchodilators,novacaine (contains epinephrine)-use carbocaine instead at the dentist, As far as the "abnormal" ekg and "abnormal" echo cardiogram, all abnormalities are not terribly clinically significant--and perfection is not part of the human conditoin anyway. I have had a successful ablation-- take 2 bp meds, 2 afib meds--- have an enlarged left atrium , annular mitral valve plaque,inverted T waves, and an elevated ST interval in the ekg. But my cardiac artery calcium score is zero, my bp, pulse pressure, heart rate recovery (from exercise), and mean arterial pressure are extremely optimal. This means that despite my deviations from perfection, my heart is functioning very well. Also the ejection fraction is about 65% ( % of blood leaving the left atrium and going to the rest of the body ) this is very good-it means no heart failure. The result of my ekg also says, lvh---left ventricularr hypertrophy--this just means that due to the late diagnosis of bp and the length of time I had afib with no symptioms my left atrium adapted by increasing the wall thickness and working harder--however-- this currently has no ill effect on me.

The other issue that may not be considered by your doctor and you are the imbalances and/ or deficiencies of things like amount of protein you eat, macro minerals, trace minerals, electrolytes, Co enzyme Q 10, especially magnesium, foods with potassium and magnesium, maintaining the extra cellular matrix such as collagens (ex. I use 1 tablespoon of collagen peptide powder in yogurt). reduced glutathione--which removes the extra fluid in the space between your lungs and it's surrounding tissue and also thereby lowers the viral load thatacumulates in this area); having enough ingredients for the mitochondria (energy factories in every cell) to produce atp (adenosine tri phosphate)-as in life. the ingredients are CoQ10, Magnesium, and T3 (active thyroid hormone). The Rx. meds you are taking deplete the body of many nutrients and this in itself can cause the problems for which you are taking those meds. Things that maintain the mitochondria further ( shilajit, nicotinamidxe riboside, magtein(magnesium L- threonate) are grreat for me and my afib . These are not any things I amtelling you to use as I am not qualified o to tell you what to take--as I am not your doctor or any doctor or scientist--I am just relATING WHAT I have found that improved my situation tremendously. These are things you can research on your own, as you have a computer,or you would not have found this site--and discuss with a doctor legitimate scientific info. It is good to have blood tests for, Free T4, Free T3, Total T4, Total T3, Reverse T3, thyroid antibodies, estradiol, free and total testosterone, progesterone,Red blood cell magnesium, Co Q10, B12,B6, folate,the genetic polymorphism test for 5MTHFReductase type 677; and the COMT gene--if you have these two genetic polymorphism you need reduced bio available B vitamins (like J Twin Lab B-Right and avoid epinephrine and meds that raise dopamine). To research these you can look at the genova diagnostics web sites-- or just research 5MTHFR 677 and the COMT gene--there is alot of info as these are clinically significant . The available set of all B's are also very necessary for the heart to have enough energy so you will not be short of breath. (reduced folate-5mthf, methylated form of B12, and the 5P5 form of B6 plus all the other B's) You can also research "extra cellular matrix and it's relation to heart function. You are correct in your confusion---YES afib is an electrical malfunction--but the longer it persists untreated, the more the architecture of your heart is changed by it. If left unstopped the afib will cause serous structural function problems, which you probab;y do not have yet. The same thing happens with untreated hypertension. Also if you have untreated hper or hypothyroidism either of these can cause afib and also a heart atack--so you should have a complete thyroid test panel. The same holds true for the specific nutrients CoQ10, red blood cell magnesium ( if the upper limit of the range is 6.5-your level should be there at 6.5 or 7 to assure you have enough magnesium in the cells and in the extra cellular space) DID your doctor test all these things??? Why can you not have an ablation?? I had one even though my ekg was , and still is permanently "abnormal".

I hope thqt if you get more information you can figure out what you and your doctor should do. Do you have an electorphysiologist with whomj you can get a good evaqluqawtion. Another web site with good information is called " uptodate.com" however you have to pay for a subscription ex. $50 including tax for one month. I found this site very helpful for info about all afib procedures and all afib and hypertenion medsw. An informed decisioni is always a good idea. Good luck.

nymima01 in reply to traveler65

Just wow! You have done research! TY for some valuable information!!

traveler65 in reply to nymima01

@nymima01 Hi It is not that I was just calmly sitting arund doing some research. I was in really bad condition when the afib was at it's worst and not being diagnosed and/or treated properly. It behooves you to know ahead of time something about drugs and different treatments, because some of the things that some doctors may diagnose or suggest as treatments may not be good for you. I was actually really scared about the whole situation, but tried to be calm and objective to find a solution. "uptodate.com" although you have to pay for it (by day, week or month) isreally informative as to drugs and procedures. And the genetic tests for 5MTHJFR, COMT, and the P450 detox system were taken by my husband and myself in 2007--as well as a ct scan (diagnostic-no symptoms) of the heart5--$450 at princeton Longeviity in Princeton NJ USA. WHY? because we knew afew people who were alleged;y very healthy, according to their doctors, but who died suddenly (undiagnosed heart issue). On this test my cAC WAS ZERO, BUT MY HUSBAND'S WAS 38 and in the Laft ascending artery otherwise called the widowmaker--you can see the documentary "the widowmaker" on netflix or a shorter version on Yu tube.-- HE WAS ACING A NUCLEAR STRESS TEST AND WORKING OUT AT THE GYM LIKE A 25 YEAR OLD ALTHOUGH HE WAS 52 AT THE TIME. cac is coronary calcium--He managed to stop the progression and is trying to remove it-- tiny bit of statins (less than would work by itself) and other substances based an various cardiologists research to remove coronary aRRTERY PLAQUE. wE TOOK THE OTHER GENETIC TESTS FOR THE ySAME REASON AND IT WAS HELPFUL FOR DELAyiNG WITH ANY HEALTH PROBLEMS AND AVOIDING SOME. As far as researchuing doctors and hospitals---don't you think you should--if yoyu have any freedom to get to the ones you find to be better. After all you are puttting your life inu their hands.

nymima01 in reply to traveler65

I totally agree. I write for my 91 yr old mother who has had afib for over 25 yrs. She is now at the point where her only alternatives are ablation or Amiodarone. She is maxed out on her metoprolol dosage (100 mgs 2x a day) and she was on Tikosyn and digoxin for 5 yrs and is now taken off both as her EP feels she became immune to them. She seems to be in afib almost every day, is NOW officially diagnosed with chf and has 3 bad valves. She is on Eliquis, losartan, Eliquis, synthroid (hypothyroidism) and Lasix. She has a pace maker to keep her heart beat from dropping lower than 60 beats a minute and she also suffers from tachycardia. She does NOT want an ablation, and is refusing Amiodarone. She has tried every diet known to man in order to find her triggers, and some have worked for a time, but the afib a always come back. She is resigned now and deals with afib now by doing breathing exercises and some yoga exercises. She is still of sound mind. Her health seemed good up until her latest diagnosis of chf and she seems breathless and more tired now. We are always on a quest to make her more comfortable, but modern medicine seems to be more geared towards those younger than my mother. It's not like we or rather SHE hasn't tried everything. Some of her attempts have been dangerous (supplements that did more harm than good) and I find that I am more conservative in my approach to her health - especially because of her age. I have done my research too and that is why I was impressed with your in-depth research. I feel there are not too many answers at this point for her because how many make it to 91 yrs old in otherwise seemingly good health? She is in a class by herself in the medical world.

@amyrosie By the way-- when my electrophysiologisdt saw me for an evaluation the first time--he said he thought I would need 3 ablations and lots of drugs and he was not sure this would even work--this was because my a fib was so out of control that I had about 5 different types of abnormall electrical activities going on a t the same time--my ekg looked truly scary-- I think some doctors that saw me got really scared!! My gp got so upset--she thought I wqas going to die in her office--did not say thqat but Her hands almost were shaking-she wanted to send me to the hospital--but I had already set up an apointment for the ablation with a good ep--so she just concentrated on keeping my inr in range to prevent a stroke or blood clot. As for the EP's assessment originally, I had already been taking bio identical hormone replacement, very good bp meds, and natural thyroid hormones, a very pure food diet various soft martial arts type activites like zen meditation, qi gong and tai chi etc., so I was already afew steps ahead. You should also be aware of the fact that extra electrical activity eminating from the pulmonry veins into the left atrium and xtending to the rezt of the heat is coming from tissue that was already there in the embryonic stage. the rest of your tendancy to have a higher heart rate and strange hear trhythms invole gentic tendacies for allergic or intolerant reactions to various substqances. The point here IS THAT SLTHOUGH THE EP SAID HE WAS NOT CERTAIN HIS PROCEDURES AND DRUGS WOULD WORK BECAUSE I APPEARED TO BE IN SUCH BAD SHAPE. IT WORKED VERY WELL AND I AM IN GREAT SHAPE.

Howe ver-- this is because after his very skillful surgery-- I followed a very helpful protocol of diet, supplements, activities etc. discovered by much reading aboutresearcha s to what I should do. This whole experience is a very daunting task for you especially as you are not feeling well--the doctor should not be telling you nothing will work-- he is really afraid to admit thaqt he does not not what will work. Recovery is more thqan just surgery and drugs.

@amyrosie if you can afford it see a private electrophysiologist for an evaluatoin or come to the usa and go to strong memorial electrophysiology lab in Rochester, New York. ( direct flight London to Rochester).-look them up on the web and pick one of their excellent ep's strong memorial will put you and a family member up in a nearby hotel.

amyrosie in reply to traveler65

Thank you traveler65 for taking the time to write these detailed responses to me and passing on this info based on your experience. I won't be coming to the US but have decided to see an EP, closer to home for a private consultation. I have only seen my GP (not very helpful) so far and had one appointment with a Cardiologist at the local hospital. I have been the name of an EP at a hospital, about 30 miles from here. (He was recommended by another GP I happened to see for an emergency appt while visiting my father in another town. He suffered from atrial flutter himself - a lesser condition I know). I have to do something as I can't shake off this feeling of gloom and despondency. Thanks once again.

skipabeat in reply to amyrosie

My situation is very similar to yours amyrosie and they are suggesting Amerodrone (not going to happen ) or AV-node ablation I am very excited about the ablation. I am getting a second opinion next week. What did you end up doing?

amyrosie in reply to skipabeat

Only just seen this post. I ended up taking Amiodarone. It worked really well, but have had to come off it as it gave me overactive thyroid - the symptoms are as bad as AF!! In limbo now - waiting for another hospital appt with Cardiologist. Still not seen an EP as I settled down on the Amiodarone, but back to square one now!! You will have had your ablation by now. I hope it has been successful x

I strongly agree with Bob. Don't be downcast and see if someone else will try cardioversion. The Amiodarone makes it more likely to work, I was told. If your INR with Warfarin is not stable (you don't say), consider Apixaban instead because you need to be in the correct INR range with Warfarin before cardioversion can take place.

Good luck!

amyrosie in reply to starry-eyes

Thanks starry-eyes - if you take apixaban how are your levels monitored with no blood tests?

starry-eyes in reply to amyrosie

No monitoring required. Works in a different way. Tablet twice a day.

Thank you all so much for your detailed replies and support. I think I will make an appointment to see an EP for a private consultation if my GP will not refer me, as I have already asked him and he said the protocol is that I should be referred by my Cardiologist. They don't make it easy do they, when you are feeling drained anyway. I have only had one appointment with a Cardiologist so far. I can't afford to have 'procedures' done privately but assume I can be referred back to the NHS. I have recently had an echocardiogram - would my private consultant be able to access this - different hospital - I am not sure how it all links together? Has anyone had a private initial consultation then been referred back to the NHS? Also any idea of the cost of a private consultation in the UK would be helpful? My INR is all over the place at the moment. It was 5.9 yesterday and got a call from the clinic to miss last nights dose (I was prescribed some buscopan last week, which they think sent it up). Starry-eyes, I note your advice about Apixaban but as you are not closely monitored (as with Warfarin which I have been taking for 2 months) how do you know you are on the right dose. Am new to all this therefore AF naïve!!! Can anyone recommend a good EP in the Cardiff area - perhaps at The Heath, An EP called Dr Barrie at Morriston Hospital has been recommended to me. Thanks yet again.

The Bisoprolol is probably affecting both your mood and energy levels. I was prescribed 2.5mgs daily 18 months ago and was immediately hit by bouts of depression and lethargy. The episodes of depression passed but the lethargy ( and craving for sugar!) persists. I'd expect 10mgs daily to be problematic. It's worth ensuring that your calcium (excites the heart and can trigger AF) intake is moderate and that your magnesium and selenium intakes are high enough. I take 300mgs of magnesium citrate per day and that both helps to reduce my AF issues (at the moment!) and anxiety levels. Stay reasonably active, keep your weight under control (can be a problem with Bisoprolol!) and try to get plenty of rest.

Walker1234 in reply to jimlad2

Hi I have been reading about magnesium and thought I would try some...asked the GP and she said oh NO ?? You can't take that...I am on apixaban and Slozem...just wondered if it does help

amyrosie in reply to jimlad2

thanks Jimlad

Hi amyrose, your story sounds a bit like mine and numerous others on this site. please try not to be to downhearted although I am a bit the same. Lets take heart( pardon the pun) from others positive comments. Today I have been for some pre checks for my first cardioversion which is tomorrow (yikes!!) I just hope to feel better generally. I felt very down with the results of my recent echo as I have been lucky enough to just have paroxysmal af for a lot of years but things have changed now! You will feel better in the future! Sending you lots of healing thoughts.


amyrosie in reply to caznear68

Hope all goes well today. Please report back how you get on. I know people on here have had it done quite a few times but still a bit nerve wracking the first time xx

I dont have much time now, so I will make this brief. Many of you have mentioned Potassium and Magnesium supplements and simply said, I am convinced that my AFIB (Hb was nearly 160 when I walked into the ER) was at least mostly caused by a deficiency in these important minerals. There was no doctor who told me this and they all in fact basically said it was unknown as to why it was happening, could be my leaky aortic valve.. but no definitive answers were given. My own research is how I found and tried this simple "fix". Its been 11 months with no AFIB and Im feeling great (although that stupid aortic valve is scheduled for replacement in April)... but I would try the supplements as they cant harm you at all. Good luck!!

With your doctor's agreement you could try decreasing the Bisoprolol, very slowly - by 1.25 grms at a time, with at least two weeks between each decrease. The AF may appear to get more unsettled after each decrease, and then will settle down - then you can try another decrease. But it must still prevent your heart rate going above 100.

If you can decrease it even a little you will probably feel a bit better.

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