Still in AF but discharged from cardiologist

[JackyMac]

Last week I saw the cardiologist after an exercise tolerance test when I was NSR and then an echo cardiogram later when I was in AF.I had a private CV in February but by end of May AF was back.

He said I had an enlarged left atrium chamber but said there was nothing more he could do for me.

He seemed pretty pissed of for some reason, said an EP wouldn't help as it would be the same conclusion and I'd been in AF to long for ablation to work.

Should I get a second opinion or just accept that shortness of breath and AF is now my life sentence. I'm 75 but have been very active, especially running, which I can still do, but need to get breath back every 50 steps. Thank you

[CDreamer]

Hi - that’s a difficult one but your chances of having a successful ablation in your 70’s decreases and if you have a stretched atria because of running that would also decrease your chances of success - HOWEVER - I think it worth a consult with an EP. I have neighbours in the late 70’s and early 80’s who have recently had ablations which have worked for them although one is still in the blanking period.

Having said that, before you do anything I would do some reading around AF and athletes and consider if you intend to continue to run if you did have a successful ablation?

A lot more is now known about runners and AF so learn how to exercise safely and pushing yourself is known to stretch atria, a stretched atria causes AF. If you need to get your breath back every 50 steps then you need to walk - general rule of thumb for exercising in AF is you need to be able to walk and talk without getting breathless, otherwise you will do yourself more harm than good.

Lots of resources and I would recommend the Haywire Heart - Dr John Day or from his old blog site DrJohnM is probably one of the most prolific writers and commentators and has some down to earth advice - he is EP cardiologist, cyclist and runner

drjohnm.org/2022/07/places-...

Personally, I wouldn’t settle for what is one cardiologist’s opinion as my experience is that they are not the specialists in Arrythmias. It’s really what you know about yourself and how you want to live your life and what you would and would not settle for which is important.

You might also like to look at hybrid Mini-Maze if you are in persistent AF - do a search in the box as there have been many posts about this type of procedure which is still relatively new in the UK but this procedure has had a lot of interest.

[JackyMac in reply to CDreamer]

Thanks CDreamer . Ive been a runner all my life but the atrium stretch is fairly new. I didn't have it with my last echocardiogram. I will read up and follow all your advice.

[Jajarunner in reply to JackyMac]

Afib also causes an enlarged atrium. What came first chicken or egg. AF or exercise??

[Omniscient1 in reply to Jajarunner]

I also run in permanent afib. I think I'd be curious about why you need to stop every 50mteres. I don't think that's normal.

[Sixtyslidogirl in reply to JackyMac]

I am a runner with a moderately stretched atrium 34mm, which is on the border between light and moderate. This was after a couple of AF episodes in April & May this year (previously in Feb 2020, Sept 22, so v concerned about going into persistent. I have read Haywire Heart and also Afib cure. Haywire heart is good for letting you know what a mistake you made pushing yourself but less good on what you can do about it. The Afib cure gives you something to do. v keen on monitoring various biomarkers: the usual - weight, diet etc, I do my own blood tests via Thriva and am trying to get my inflammation down. Afib cure man says that by doing this you are giving an ablation a better chance of success should you go down that road. I think this is something runners can do as generally we are keen on stats! I am monitoring my heart pretty closely as for me ectopic beats are an indicator of how irritated my heart is. Also, I have been taking magnesium and over the last two months the number of ectopics has roughly halved. Difficult to say whether this is the magnesium or the other changes I have made (given up alcohol, caffeine, failed on cake). My (private) sport’s cardiologist advised cutting back 20% in volume and intensity. I can’t speak for running in actual AF. I couldn’t do it myself but hopefully you have some pointers as to what you can do to improve your situation.

I should add that I monitor with a Frontier X device which I pretty much wear all the time atm. You get an ECG trace from it but have to learn to recognise the arythmias. This may not be so relevant if you are in Afib all the time.

[JackyMac in reply to Sixtyslidogirl]

Thank you for your very helpful and interesting advice. I've ordered the Afib cure and I'm going to get a Thriva blood test.

[wilsond]

I'd certainly get a second opinion from an Electrophysiologist, the specialists in arrhythmia. You can ask fir referral from GP,or if you can run to it,I initial private self referral to one. Circa 200 pounds,then you can transfer to their nhs list .Cardiologist sounds very dismissive and certainly not the experts in the electrics of the heart.

Please don't just accept this!

[Jajarunner]

Second opinion. Sounds like he was having a bad day...😭

[BabsJ]

I had a similar experience with a cardiologist earlier this year. I have seen a cardiologist all my life because I have a hole in the heart and a murmur. I then started with A fib in 2011 and was pu on verapamil 40 ml and told me I was discharged. I could see someone about an ablation if I wanted. I am 70 years old. My daughter has been in touch with the hospital and I am now back on the list. We all need check ups with heart problems but especially as we get older as more problems can occur. Don't give up get back onto the hospital and get another cardiologist

[Ppiman]

An enlarged atrium is pretty common in older age, I gather, but is now thought to be not a natural consequence of aging but rather of something like AF or other heart issues. No one seems to be sure, either, whether the enlargement is a cause of or caused by AF or what the actual cause is, only that it is not simply age related.

Why you had such a poor response from a professional is unacceptable but maybe all too human given whatever led to it! Bad luck on that one. NHS doctors are all more or less peed off these days, it seems, thanks to a decade of bad support from the powers that be,

sciencedirect.com/science/a....

Steve

[KMRobbo]

Second opinion required IMO. What is there to lose?

[BaileyC57]

How many days have you been in AFIB? I am asking because I have been in AFIB for now 3 days straight! Hope mine goes back and it would give me a break from this!

[JackyMac in reply to BaileyC57]

I hope you go back to NSR as well. Nearly 3 months with this episode. I had my first cardioversion 3 years ago which lasted a year, the 2nd gave me 6 months respite and the last in Feb this year 3 months. Each time going back with one shock on lowest setting.

[Snowgirl65]

I'd say most definitely get a second opinion. My first cardiologist tsk-tsk'd at me when I suggested I should see an EP. Being in the US, he didn't want to lose my business!

[emv54]

Def second opinion! I'm also a runner/swimmer/paddler and (so far, phew) echocardiograms have all come back fine. But I'm super-aware of the issues around sustained aerobic exercise + afib and I'm committed to getting regular echoes — even though I can't access them on the NHS where I live unless I'm diagnosed with heart failure!

I also recommend reading The Haywire Heart... I learned a lot!

amazon.co.uk/Haywire-Heart-...

[JackyMac in reply to emv54]

Thank you. The title looks frightening! Like I should confine myself to my rocking chair and knitting. I'll get it though.