Does a heart still remodel if medications stop AF completely?

[OzRob]

I read a response to a recent post today where a member with recently diagnosed AF was tossing up whether they should continue with meds or get an ablation.

The response was yes, you should get an ablation, if you don't you will run the risk that your heart will remodel and the success rate for ablation is much lower.

I have a problem with this blanket response because the person posting the question was not asked if the meds were working by stopping the AF from occurring.

So my question is this: If you are on meds and you don't have any AF episodes or any other arrythmia at all will your heart still remodel?

I thought rogue signals bringing on AF were what remodels the heart? So is it fair to say that if the meds control the signals then your heart won't remodel?

I do understand that one day you may have a breakthrough of AF, is that then when you should be getting an ablation?

I was offered an ablation at the same time as starting a low dose of meds 10 months ago, 50mg Flecainide and 50mg of Diltiazem morning and night.

I have not had one blip in all that time and in very good health, in my case don't feel I am ready for an ablation.

Robert

[fra48]

I’ve asked this same question to my EP some time ago when presented with ablation option vs flecainide and his answer was a clear ‘No, if not in AF’

[CDreamer]

If it is AF which is causing the remodelling then of course if there is no AF = no remodelling with the proviso that the heart structure and valves are all healthy and functioning. Examples would be large atria caused by AF. Many posters report that when continued NSR the atria went back to normal.

Sometimes though it is heart structure which causes the AF, or faulty valves and so in some cases the heart structure will continue to change, exacerbating the AF - chicken or egg situation - that was my understanding. Is AF the cause or a symptom is the question? If AF is caused by cardiomyothpathy or fibrosis then that is a much trickier as ablation will not help and probably neither will drugs eventually.

As treatments tend to be offered to improve quality of life treatments can be a personal choice. As so many people struggle with medication or just cannot tolerate it at all, ablation with the promise of no need at all for medication is very appealing, was for me.

Replies are given in good faith and based on a posters’ personal knowledge and experiences and not normally on medical training, though there are quite a few medics who do post, and experiences are wide and varied so normally you will receive varied and often contradictory responses.

[Popepaul]

A nice succinct response from Fra48. I think that in essence there is a strong correlation between the quantity of AF burden and the the degree of deterioration in the structure and function of the heart, aprocess that is often referred to as remodelling.The passage of time and comorbidities can only accelerate this process.

I do believe that the opposite can occur if you remain in NSR and you have a healthy lifestyle with good diet sleep, exercise etc. These factors can improve the structure and functioning of the heart and this too is sometimes referred to as remodelling.

For many of us medications are a necessity and for most think that the benefits far out way the risks. Everything is a matter of degree.

Regards

[BobD Volunteer]

Surely that is a different question? I understood the first question to be "is it better to have an early ablation or continue on drugs " and of course with all drugs carrying risks surely it is better to attempt to stop the need for such drugs. It also pre-supposes that the drugs are actually controlling the AF which is sadly not always the case.

If one is lucky enough for the drugs to provided satisfactory control then one is left with a choice of accepting side effects or looking elsewhere for relief. (Ablation, WMM or similar) .

Do always remember though the words of Professor Richard Schilling "Any and all treatment for AF is only about quality of life" (symptom control). He went on to say that there was no difference in final outcome whichever path (rate or rhythm control or ablation) was chosen provided that rate was well controlled and anticoagulation given where appropriate . One could draw from this that rate was the most important thing to control but that is just my take.

Interesting thoughts though.

[waveylines in reply to BobD]

Well put Bob. And I guess there in lies the dilemma for many. I know my EP would not consider an ablation if the drugs are working effectively and are well tolerated ..... But every case has to be assessed on its own merits and on reflection of each person's health/needs. I think getting high quality knowledgeable medical advice on options, their pros and cons/risks is really important too. There isn't one single option that doesn't come without risks or downsides. It's being aware of what those are for you as an individual that is really important as well as the advantages.

[mav7 in reply to BobD]

Admin should post the final paragraph of the quote by Schilling permanently at the top of the forum.

Would be beneficial for all to know.

[AFCyclist]

Hi. Since I changed to 120mg Sotalol twice a day I have not had any AF for over a year. A significant change. A recent echocardiogram showed that my ejection fraction had improved from 35 to 50% but both atria were still somewhat dilated. I have been fit and healthy and cycling well. I should also say that over the past year I have also been taking low dose heart failure meds which may also have had an influence. Overall a significant improvement that has been confirmed by recent echo.

[mav7 in reply to AFCyclist]

May I ask if you are persistent or paroxsymal afib ?

I have been offered Sotalol is reason for asking.

[AFCyclist in reply to mav7]

Paroxsysmal. Often brought on by overdoing it on the bike, stress or alcohol.

[BenHall1]

Hi,

In your recent post you asked the question ...... So my question is this: If you are on meds and you don't have any AF episodes or any other arrythmia at all will your heart still remodel?

Have no idea, I haven't had an AF event for , well can't remember - 18 months at least up to 4 years,. Dunno. I do regard myself as now being AF free. Of course the other problem is my AF is paroxysmal and my consultant originally describe me as being an asymptomatic patient. So, maybe I'm not AF free everything is hidden because of these two features, who knows, particularly being asymptomatic.

All my medication has been daily and will be for life ........ so what !! I reckon - purely a bus drivers point of view, if it were to remodel it would have been done in the early years when I was around 65 to 69 years of age ......... now based on my last two ECG's my heart has changed (maybe remodeled ) but changed arising from aging ...( I'm now 79 ) not from medication. Based on these two ECG's and the differences ( which were not major ) I asked the guy doing the job what he thought of my heart .... he went all quiet while I stared at him - and then said, well it really has done alot of very hard work. I replied ... so would yours after 79 years !!

Long live my Warfarin and Nebivolol, Ramipril and Felodopine ... for as long as I have left. 😆

John

[BigDunc]

Hi Rob

I first started with AF around 18 years ago when I was in my late forties. Similar to you I was put 50mg of flecainide and experienced some breakthrough AF. My dose was increased to 100mg twice a day however at the same time I opted for an Ablation with the objective of being drug free.

I remained on 100mg post Ablation for around 6 months and had no episodes of AF. A couple of months after coming of Flecainide I went into AF. I went back onto Flecainide and remained free off AF for 13 years and life was relatively normal.

I was recently diagnosed with some coronary artery disease and had to come off Flecainide. My AF returned and I had a further Ablation that never worked

Hence I am a big fan of Flecainide and had little or no side effects. On reflection I rushed into having an Ablation and would only go for an Ablation if AF couldn’t be controlled with Flecainide. Be aware though that your arteries need to be clear before going on Flecainide. I had to have an angiogram before going on Flecainide and my current coronary artery disease is only mild and was taken of it.

Hope this helps

BigD