Ablation and severely dilated left atrium.

[Ecki]

Does anyone know if I will be able to have an ablation, as my LA is severely dilated. My cardiologist thinks that an EP may not be willing to a late me because of this. I've put myself on a strict diet as I've read that losing weight can help to reduce the amount of Atrial dilation. I had an echo in Sept which showed LA diameter of 5.2 cm, then MRI scan on 1st October which showed diameter of 6.2, so it's either increased enormously in a couple of weeks or the MRI is more accurate. I'm worried that I won't be able to have an ablation because of this. Any advice? Thanks

[BobD Volunteer]

I'm not sure diet will help other than helping the AF which has likely caused the dilation but always worthwhile. Don't try and second guess the EP. He/she will know what is possible.

[CDreamer]

Well done if you can lose weight, it will help your general health and can reduce the AF burden.

If you were in AF when the echocardiogram was done then getting an accurate measurement is all down to technician expertise and interpretation so I would say the MRI will be more accurate.

[Hidden]

3 things cause an enlarged atrium, being in AF, being overweight and high blood pressure. It can also be caused by sleep apnea. If you can tackle those things it can reduce over time, but you have to treat underlying causes aggressively.

All the best

Andy

[VioletG]

I have also been told that I have a severely dilated LA, and have been wondering the same thing about ablation. I will be asking my EP about this at my appointment this Friday. I have never had high BP and have only had a handful of afib episodes. However, weight has been an issue, so I am in the process of getting it off, and feel better for that. As others have said, it is good for overall general health. I will update with what information I get from EP regarding whether ablation is possible in this type of case.

[Ecki in reply to VioletG]

Thank you, I'll be very interested to know your EP's opinion. I was diagnosed with high BP over 20 years ago, but it's been well controlled with medication. I've had 2 episodes of Atrial flutter and one of Atrial fibrillation, which was triggered by reflux disease, after GP told me to stop my medication for reflux. I also have an issue with weight, and am getting it down. I came across an Australian study from 2015, where the participants were obese and had dilated LA and AF. They found that those who lost more than 15kg in a year had significantly reduced the amount of dilation of their atria. I'm hoping this will happen with me.

[VioletG in reply to Ecki]

I met with my EP today. I too have had only a handful of episodes of Afib. Even so, he feels I should consider having an ablation, and these are the reasons he gave. I list them here in case any of them might apply to you:

1) I am not asymptomatic during the episodes that I have had, in other words they make me feel quite awful. Some people barely notice them.

2) He said that any episodes, including ones I might not have been aware of, create more scarring of the heart, and an ablation, earlier than later, has a better chance of a positive outcome - right away, and for 5 to 10 years or more. He seemed to think it was better to ablate now, than wait for more episodes to happen.

3) I am not a candidate for drugs typically used for Afib, because they are all used for slowing the heart down, and I already have a slow heart (bradycardia).

4) While an ablation is not risk free, it is less than 1% for complications.

5) I have lost 35 pounds over the last year, so my BMI is now less than 30. He said there was a recent significant study in California, of 3,000 men and women, that showed the success rate of ablations and the relation to BMI. A BMI score 30 to 35 is "good" results, but less than 30 is "very good". (I think 35 to 40 was "so-so" and over 40 was not very successful at all.)

5) When I asked if my severely dilated left atrium presented a problem for an ablation procedure, he said no, that they have the technology to deal with that.

I am in the US and my EP is at the Cleveland Clinic (which has been rated the #1 hospital/clinic for cardiology in this country for over ten years). I am apprehensive and nervous about an ablation, but I think I must rely on this EP's advice, and go ahead with it. I will have to wait at least 2 months for the procedure. In the meantime I am on the anticoagulant Eliquis (Apixaban), for stroke protection. (I have had no side effects of any kind on it.)

It is great that you are losing weight too! I already feel better just knowing the scale is going in the right direction. I hope this info helps.

Best regards!

[Ecki in reply to VioletG]

Thank you for this information. It's really encouraging. I had a cardioversion a month ago and I've got a follow up appointment with my cardiologist next week. I'm going to take a copy of your reply in case I need to argue the case for referring me to an EP. Well done on losing so much weight, that's really impressive. I've lost 18 lbs since the beginning of August, still got lots to go but I keep thinking of my dilated atria every time I'm tempted to eat things I shouldn't. I'm in the UK, so I expect there'll be a long wait to see an EP, let alone have an ablation. I know it's scary but I was so debilitated when I was in AF, I really couldn't do anything and felt dreadful. I've been told the AF will definitely return but I'm hoping an ablation may keep it away longer. Hope all goes well with yours.

[AIW58]

My friend has a dilated LA but that is from having an ASD (hole in the heart septum) as a child. She now has a significant AF burden. Her EP initially wouldn't consider an ablation but is now offering her a go as the technique has developed over the years and none of the meds control her symptomatic, frequent AF. She's not certain whether to go for it because there are additional risks but she can't function when she's in AF so between a rock and hard place really.

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