"Remodelling" of the heart

A member has lately said that the MDs have advised him to go for an ablation as soon as possible (he is in his 50-ties) in the course to prevent "remodelling" of the heart. I do believe in their good intention, but am puzzled if that really is so.

The normal heart operation is with the coooperation of the atria and the ventricles, in the way we all know too well. In the phase where the ventricles push the blood in the circulatory system they supply, the atria collect the blood comming to the heart and serve as temporrary storage for the blood. When the ventricles have finished their part of the cyclus, the atria contract, with the aim to fill the ventricles as quickly as possible and to prepare them for the next pushing the blood out (it is in particular important when the HR is increased and there is very short time at disposal for filling the ventricles).

Now, imagine the situation in which the atria start fibrillating and are not able to fill the ventricles as it should be! The way the ventricles get filled, is via the dillatation of the ventricles and "sucking" the blood in, with the help of the created underpressure in the chambers. This way of functioning is all but "normal" and it is no wonder that the efficiency of pumping the blood is poorer than usual, so the patients suffer on reduced blood circulation (the symptoms are too well known to all of us).

There is some time necessary for the heart to adjust to the new way of functioning, without the cooperation of the atria. In some people, this switching to the new working regime is easy and smooth, so they never notice when they switch to AF and back, in NSR (my case, fortunatelly). But, some people seem to have problems with this switching and, once in AF, they feel terrible symptoms.

I suspect that, with the time, a remodelling of the heart does happen, in the way that it really gets used to the new way of working, has more efficiency and the symptoms subside. We have had many people here, stating that, after being for some time in PERMANENT AF, their symptoms get milder or none, and they have far less trouble with AF. Is an early ablation really the right solution...? After 15 years of being regularelly in AF at night, my heart is still without any structural changes. Many members have reported the same.

Then, if the heart works with problems when in AF, is the advise of the MDs, that the exercisse, when in AF, is allowed or even recommended, the right one. When exercissing, the HR goes up, and the working condittions for the heart in the new working regime are worsened. Personally, despite being an exercisse addict, like many of you, I never undergo increased physical load when in AF, with the increased HR. Would advise this to others too.

Not playing a smart guy, just trying to understand. Maybe it helps to someone... Sorry about my English, hope you will understand.

[BobD Volunteer]

Your are confusing mechanical function with electrical. When we talk about remodelling what we mean is that the rogue electrical pathways which direct the electrical triggers become the norm.

Think of a river. A bend in the river by the nature of hydrodynamics creates a larger bend and if that bend comes back on itself to create a U shaped bend then sometimes the river breaks through the base cutting off the U and leaving an ox bow lake (google it). Just such happens with the atrial electical signals meaning that the rogue signals become the norm and normal steady cocntraction is not possible.

Maybe not the greatest analogy but I hope you get the idea.

[Hidden in reply to BobD]

No, Bob, I was looking at the function of the heart as the whole, regarding the way it is able to work in new circumstances. The rogue signals come as the consequence of too high demands put before the heart. If the control system demands too high HR, the heart can not follow it and the wrong signals get generated from the heart itself, fighting to survive. Have you ever slaughter the chicken? I did, many times. When the body is in chrises, the uncontrolled signals get generated with all the uncontrolled movements of the body. For my own purposes, I named AF "the syndrom of dying heart". Whenever the demand gets lower, the rogue signals disappear and the heart reverts to normal.

We know that, even after several ablations, AF tends to get back, sooner or later. The rogue signals find the way to get back. The question I was discussing was "Can the way of functioning get remodeled, so that, despite all the rogue signals, the heart can continue to work with satisfactory results. My answer is, YES, it can adjust and stop making troubles to the patient. People have reported here to have far less problems after some time spent in permanent AF (the heart gets trained to work differently and gets better and better at it).

The other thing I proposed, and has been also confirmed by sveral patients, is that the slow running hearts (HR 40+ at rest, 80-90 when in AF) has more chance of working succesfully in such regime. Such people have almost no symptoms (I count to such patients - had some insignificant symptoms at the beginning of my AF journey, but absolutely no symptoms now, 15 years later). The heart has learned to work different way and it is lucky circumstance that it is possible at all.

[Paulbounce]

All I will add is that this will turn out to be a very interesting thread I think. Now I know why I became a member of HU because of the knowledge and input here. I am going to follow this thread and will be interested to read all the replies when others chime in. You may be in for a busy day Nesko if you answer all the replies

Have a great weekend all.

Paul

[Hidden in reply to Paulbounce]

Thank you so much, Paul! I had the impression that nobody is interested...

[Paulbounce in reply to Hidden]

Heh Nesko. I think you maybe proven wrong there!

Cheers Paul

[Tomred in reply to Hidden]

very interesting

[Singwell]

What's the main point you want to make here? That the word 'remodeling' is inaccurate? I'm not clear from your OP. I always understood that the word was about a behaviour I.e. the tendency for the electrical signals to misfire, rather than meaning a morphological change.

I liked Bob's analogy - helpful.

[Hidden in reply to Singwell]

If the ablation is advised to be done early, than the remodeling takes the time and is related to structural changes. The electric signals "remodel" instantly, whenever you switch to AF. Bob has the problem to understand too...

[Singwell in reply to Hidden]

Which structural changes are we talking about with earlier ablation? I had mine done within 3 years.

[Ossie7]

Hi Nesko, I am not at all scientifically minded so can’t answer factually . However , from my own personal experience I have always been told by top cardiologists and EP, s that ‘ AF begets AF ‘ and more lately I was told ‘ NSR begets NSR ‘ . With that in mind I feel that the nerve pathway remodelling definitely occurs sooner rather than later .

I had to wait 6 months in aggressive persistent AF for my first cardioversion , since then had 3 more and 2 ablations and every episode I get is more aggressive than the last and persistent . Hence , I’m more with Bob’s electrical impulse remodelling theory . Structurally I feel the heart would weaken and lead to heart failure over time , as the L atria expands and enlarged over time and is less effective at working as a pump . I met a lady in my last a and e visit who had developed CCF with fluid in her feet, and abdomen as well as lungs after 2 years of persistent AF that wasn’t picked up over covid .

[Hidden in reply to Ossie7]

Hi, Ossie7!

"AF begets AF" is not correct, but the MDs and EPs have no better answer, since they do not understand what is going on with arrhythmia. If they did, there would be an precise explanation about AF and other arrhythmia, and there would be the cure, not stumbling in the dark.

It is not only about cardiac arrhythmia, but about somewhere 30 syndromes and disease, where they have no understanding and no answers. Look at the first page in the "HealingWell" forum (USA) and you will know what I mean. From Asthma, to Alzheimers disease, they are clueless. I have offered a chewing gum for the brain. Take it or leave it, as you like. Been to Australia in 1990! Wonderful land, great people! All the best! P.

[Ossie7]

All the best to you as well Nesko x

[Keano99]

My EP, the very experienced Prof Gill, of London Bridge Hospital, advised my heart would go “baggy” over 5/10 years if I stayed in AF. My left atria would stretch and expand over time, so I decided to opt for ablation. I’ve also read about clinical trials which conclude left atria diameter is proportional to the length of time you would stay in NSR after an ablation.

[Hidden in reply to Keano99]

Not sure that your last sentence is correct. If the atria would stretch when in AF, why would the diameter be peoportional to the length of the period you remain in NSR...?

Some day, when the truth about arrhythmia surfaces, you will laugh how little MDs knew about it, but still suggested the "cure". Money is a very strong motivation. In UK, the value of ablation intervention is somewhere about 16.000 pounds. In USA, the value is measured in tens of thousands of Dollars.

[RussJun55]

You may be interested in this abstract's characterization of "remodeling". pubmed.ncbi.nlm.nih.gov/246...

[Hidden in reply to RussJun55]

Thank you! Was interesting to read!

[Singwell]

It is true there's no clear aetiology for AF though we do know it's frequently partnered with other conditions that cause a new behaviour to forming the electrical system. The myocutes of the heart are known to be very sensitive to imbalances elsewhere e.g. BP thyroid disorder, blood sugar and cholesterol levels. That there's no clear aetiology discovered as yet does not make our medics incompetent- it means we do not yet know. Personally I'm thankful for what we DO know so far and that there are QOL options to allow us to enjoy our lives.

[SeanJax]

remodeling of the heart means Afib begets Afib and it causes more fibrosis to the atriums . All this fibrosis is a potential rogue source to ablate instead of the pulmonary veins alone. It would be difficult for the ep to ablate all of the rogue sources since it requires an extensive mapping and as soon as they miss one of the rogue sources your Afib will come back. That is the reason behind the recommendations and decide to have an ablation is strictly your decision.

[ChasMartin]

I was just reading a study in my research about ablation and such, that they talked about how the actual nerves literally branch out further and remodel over time. If you think about this, it makes total sense why the longer you wait the more difficult ablation is. The less branches that need to be cut off, the better.

[Hidden]

Such a good thing, to see that there are others with the similar opinion as me. Here a comment of PAF62, to some other post, two days ago:

"I avoided an ablation around 20 years ago, and a friend had one at the same time. He’s now in not such a great state, I’ve changed my diet and exercise regime and achieved far more than any of his ablations seem to have managed to do.

I was 23 when diagnosed, 5 years ago I was told I was in permanent AF. My father had it, died at 86 of plain old age. My 33 year old daughter has it too, so evidently hereditary. Tried meds because the docs told me I absolutely needed them, but they made me soooo much worse, each one worse than the previous one. Round 4 and I said no. I’ll risk it. “You’ll likely shorten your life” I was told. Better short than unable to function as I was on meds!!

So fast forward 18 months, and I’ve never felt better. Still in AF, but heart beat has slowed to a testing of 60-80 depending on the day. Still irregular but I workout 4 times a week, eat and drink sensibly and can now give my supposed cardiologist the 🖕🏼

My friend on the other hand has been forced into retirement, against his will, but it has become too dangerous for him to continue working.

I’m glad of my choice!"

[CDreamer in reply to Hidden]

It sounds as though your AF symptoms did not impede your life too much, had you been very symptomatic with very high heart rate I wonder if you would have taken the same view? My understanding was that all treatment for AF was to improve QOL - I couldn’t function with AF - I couldn’t walk up the slightest incline - now I can. I agree about the meds though!

There is still much we don’t know about what we don’t know.

[Hidden in reply to CDreamer]

Frankly, CD, my problem is not AF, but this forum... I have tried several times to go away, or at least to read and not to comment, but no use... I come here many times a day, every day, from 6 a.m. to 10 p.m. And... I can tell you that everything is there, in people's posts, you only have to know how to read between the lines.

My symptoms were mild at the age of 55, when it all started. If I had not bumped into this forum, I probably would never know that I am AF sufferer, since now my symptoms are completely gone. Such a nice thing, this AF! Imagine SVT, or something still worse!

[CDreamer in reply to Hidden]

Positive thinking 👍

Wonder what’s between my lines?😱

[Hidden in reply to CDreamer]

This post is "old", so not many will come to read it. So, I will try to be sincere. I rarely read your comments because of the length. I know, I know, my posts and comments are also long... Your comments are real contribution, and your attitudes are different from other people who comment regularly. Not long ago, somebody has pointed to it, in the same way as me. This forum is "lively", because of you, Bob, Jean, Buffafly and other regular and positive contributors. You are doing excellent job. I am also in "High BP forum", which has one post in a fortnight. So sad...

As for the reading between the lines, I wanted to say that there is a lot of information hidden in the data that people quote. For instance, somebody complains about the more and more frequent bouts of AF, but the quoted data suggest that it actually is SVT and that people are at higher risk than when in AF. I wrote about it, but nobody wants to believe it. I have no published papers about it, lol! Just look, to see what's coming...

[Hidden in reply to CDreamer]

CD, that's what I was talking about (newest post from marcyh, from yesterday):

"I had an ablation almost two years ago. It was wonderfully successful although I have had a couple of episodes since getting two Pfizers. However that has been much improved for most of this year.

However. I am noticing increasing atrial flutter - longer periods of a fast HR of over 100. Even, but fast and I get very short of breath, which was my nemesis with my AFib. I can hardly say two words together and because of the lightheadedness I have to sit or lie down for a while. "

marcyh is considering it to be atrial flutter, but it is actually Ventricular Tachy, with obviously unpleasant symptoms. And dangerous! We will have pandemic of such cases, it is for sure.

[CDreamer in reply to Hidden]

When we get into the complexities of VF, VT, NSVT, PVC, PAC & SVT I think we need to leave it to the experts to diagnose and as far as I can tell there is very substantial difference and very different changes to an ECG which identifies these very different arrythmias and more importantly their source. You cannot diagnose from how you feel. I have had NSVT, PVC & SVT and I really could not identify which was which by how I felt but I could get an indication from looking at an ECG. NSVT if persistent is not something to ignore and may need further investigations but neither is it immediately life threatening.

Are you implying that SVT is dangerous? My understanding is that VT could be dangerous, if sustained but that SVT is not. Are you implying that the cause is the ablation? If the ablation was for AF, which was my understanding in the post, then the ventricles would not have been ablated and so I’m sorry I cannot follow your reasoning. I am sure that during the recent virus we got so alarmed about heart conditions and the subsequent vaccines may have something to do with the increase in these reported arrythmias but cannot connect ablation for AF with VT - but then I’m not an expert, just someone trying to learn a bit more about my heart and how it behaves and what irritates it and how it can malfunction so I can do as much as I can to ensure that I do not require anymore interventions and still maintain a good QOL - as you seem to be doing.

You may find this very clear explanation about the difference between when to worry about VT and when not to be overly concerned helpful - from Dr Gupta helpful

youtu.be/5_wk3mXFNFM(Not working as expected?)

And sorry my post is so long, I just like clarity, but hope you will read through.

[Hidden in reply to CDreamer]

Thank you, CD!

As I said when I first mentioned that people will more and more have SVT instead of AF, I mentioned the knowledge which makes it possible to distinct them and to draw such conclusion.

Ablation has nothing to do with this problem, but the jabs do - they push the people in the region with bradycardia, PVCs and VT. Young men, dropping dead in the playing ground, die regularly from ventricular arrhythmia, leading quickly to SCA.

Thank you for your kind answers until now! I will not bother you with my idea anymore, they remain my problem, lol!