Heart remodelling ?

[Andyb7612]

Hi everyone ...I have a question here for anyone that might have done any research on this subject and it is as follows...I keep reading that a fib remodels the electrical pathways of a heart as it progresses...but then I have also read that if nsr is kept for over four days consistently that the remodelling can start to reverse itself... my question is , if that's correct ,, then why when people have successful treatments from medication, abalation , etc , does this not happen to them 🤔 ..

[BobD Volunteer]

It frequently does . People with enlarged atria often find they return wholey or partially to normal after sucsessful ablation.

[Andyb7612 in reply to BobD]

Thanks for the reply Bob. I wonder if the same applies to successful medication treatment if nsr is maintained over a long period of time ...

[Visigoth in reply to Andyb7612]

I’ve been wondering exactly the same myself. Someone posted an article on this a few days ago but I can’t for the life of me find it!

[Singwell in reply to Andyb7612]

I've a memory of my arrhythmia nurse telling me about this when I was deliberating ablation #2. I think she mentioned the Potassium Channel Blocker mafs as having a good track record in remodelling. Hope I've got that right.

[rosyG]

it does, as bob says. If the treatment were successful people wouldn't know re modelling hadn't occurred as they wouldn't have sufficient tests etc, Best to assume it does reverse. That's why athletes detrain to stop AF and muscle returns to normal

[Andyb7612 in reply to rosyG]

Yes its all very interesting ..so if medication works to stop the af and keeps a person in nsr as well ..is it the same for the person on meds then does there heart reverse the remodelling as well ?

[Slidingdoors99 in reply to Andyb7612]

Hi! I recently asked the cardio unit here and I really don’t think they knew the answer! I have requested another echo but this could be months away, especially as now (unfortunately) my EP has requested a heart MRI…

[Andyb7612 in reply to Slidingdoors99]

It might not take as long as you think for your echo , Blackpool hospital organised one for me and it only took around 3 weeks if I remember correctly...

[Slidingdoors99 in reply to Andyb7612]

Thank you, but…😔 I asked over 2 months ago and no news as yet. Very overstretched here in the S.West I think.

[Andyb7612 in reply to Slidingdoors99]

Yes I think it's the same everywhere I'm afraid ..Good luck though I hope you hear back from them soon...

[Slidingdoors99 in reply to Andyb7612]

Thank you Andy!

[mjames1]

Really good question.

This recent paper, linked below, suggests both surgical and drug interventions (category 1) can reverse remodel compared to a second category where SR was not restored and where remodeling occurred.

Of interest is that there was no change in remodeling in the third category where NSR was restored spontaneously and the heart tested at one year. But that might be explained by the fact that this group had a better baseline to begin with which makes some sense. Or that this group had more effective lifestyle interventions. Hard to know since no data on this given.

That said, I couldn't find much else specific to reverse remodeling with drugs alone, other than a "uh huh" when I asked my ep nurse if Flecainide could reverse remodel. Hopefully more studies will follow on this.

But overall, in the old debate of rhythm versus rate control, this study chalks one more for rhythm control.

acc.org/latest-in-cardiolog...

Jim

[Andyb7612 in reply to mjames1]

Yes definatley interesting that Jim.. I shall have a look at the video later this evening when ive a little more time ..cheers

[KMRobbo]

Who says that the reversal of the remodelling does not happen to people who have had successful ablations??

[Andyb7612 in reply to KMRobbo]

I'm not sure.., but on this site alone I read of people that have had abalations that have been successful for a certain length of time only for the afib to return at a later date , so does that mean the heart didn't manage to reverse the remodeling process for them after maintaining nsr for a length of time ? therefore that was my question ..

[KMRobbo]

I dont think it is so simple as you describe. I am not medically trained but will write what I THINK I understand in my simple perception:My thoughts are that initially the Afib was caused by something ( I actually don't know what caused mine I had no recognised triggers nor co morbitities).

This could be a multitude of things: heart damage, high blood pressure, genetic succsepibilty, over excercise in terms of athletes and sportsmen, excessive use of alcohol. And probably many more reasons.

I think that the high blood pressure and the excessive endurance exercise are actually remodelling the heart themselves and causing sites that generate the afib. So if these are treated by RF ablation but the the root cause, of the high blood pressure or the over excercise are not addressed then other initiating sites will develop and Afib will return. If the sportman stops being one, or the high blood pressure is reduced maybe it wont??

However other initiators for the afib come from outside the heart, and that must have been the case for me as I had a PVI cryoablation and have not had afib since. The rogue signals from outside were prevented from reaching my heart.

If this was the only source of the AFib, then so long as these signals do not manage to pass over the ablation scars I will not have afib. If they do breakthrough I expect I will get it again.

But that is not to do with remodelling. ( incidentally my EP told me they don't understand what causes the rogue signals from the pulmonary veins, they just know if they block them the afib usually stops ).

However it is much more complex: in my AFib my echocardiogramne showed I had slight Left VENTRICULAR hypertophy - enlarged ventricle) and a slightly enlarged atria after having had attacks of afib for 3 years. If this had been left to continue then I could have had remodelling and generated initiating sites inside my heart in addition to the rogue signals from outside.

So it's best not to be in Afib as this causes the remodelling. ( ie stay in rhythm - Afib begets Afib).

But if the cause of the AFib is not addressed then you will also get more Afib. ( ie the high BP or the excessive endurance excercising).

So it's not a matter of remodelling not being reversed as much as not removing the root cause of the AFib in the first place. If you dont AFib will return.

Happy to be corrected by the more knowledgeable if I am stating anything incorrectly.

[Andyb7612 in reply to KMRobbo]

Thanks for the reply.. I think you could pretty much be spot on there with your views on the subject..

[Towne]

Ive just read a very interesting book 'The Haywire Heart'(Case Mandrola Zinn) and understand that AF causes 'stretch' of the atria due to blood back pressure which over time causes fibrosis (minute scarring of cardiac cells) which can eventually disrupt electrical signal flow through the heart tissue which in turn promotes further susceptibility to AF - But if AF can be terminated (eliminating the underlying causes and/ or meds/ablation) then the atria again overtime will eventually return to normal due to no further stretching/fibrosis occurs- thus hopefully breaking the cycle.

[Andyb7612 in reply to Towne]

Hi thanks for the reply...that does sound very realistic enough although I am not medically trained and far from being an expert , it is encouraging to hear its possible anyway...

[Bunnyuk]

Thanks for this thread. I've been trying to find out about just this. I really want to understand what's going on, and break the download spiral of "afib beats afib " and the supposed inevitability of its progression (which ive been told will happen by my afib nurse!). I'm determined and convinced there must be a way to encourage the heart to heal, to remodeling the electrical pathways .

[Andyb7612 in reply to Bunnyuk]

Yes it would be nice to think there is a chance for it to reverse the remodeling...that's interesting as well as my cardiologist says not everyone does progress with the afib just most people do...