I’m 39/f and I have paroxysmal afib since 2021 I have had (3 ablations, a cardioversion and tried all meds) without any changes. I recently had my yearly echo.. my ejection fraction is 56%.. while still considered good in has dropped. My concern is it has been dropping. Last year April it was 70%, Feb it was 63% and now it’s 56%. My dr won’t be in until next week to go over my echo results. Should I be concerned? I am on only Eliquis right now.
Ps. I live in the United States
Hi,
I can only offer limited comfort, I guess. I'm an 80 y/old male, paroxysmal AF diagnosed in Jan 2010 aged 65. My limited records tell me that my Echo in Oct 2020 my EF was 68%. Two years later, in Nov 2022 it had dropped to 60%. I haven't had an Echo since then so I do not know what it is at the moment and I've had no cardiac issues that would justify the expense to the UK NHS of another Echo.
I would add, that I'm not particularly healthy and have led a fortunate life, but I certainly haven't looked after myself particularly well over the decades.
John
You are asking a complex question best put to your doctor but here are my thoughts which I hope may be helpful.
If you are now in persistent AF with no other underlying issues and know that the cause of your EF dropping off and given your youth, in your shoes I would be considering looking at treatments such as the Hybrid Maze such as the Wolf Maze Procedure which quite a few of our regular contributors have undergone with great success. I am tagging MummyLuv who had the procedure in the UK and has written extensively about her experiences.
I would also caution that the reading from an echocardiogram can be quite subjective, dependent upon the operator and the machine. To make comparisons it is best done with same machine/same operator.
I wondered how symptomatic you are and if you can feel a difference in your body from the declining EF? I would imagine, no medical or personal experience here, that if EF continues to decline you may do, my understanding is that 56% is a more than acceptable level if you have no symptoms but the decline may not be acceptable - if it is treatable.
I’m still only paroxysmal. I have a pfo and an atrial septal aneurysm. My understanding is my afib can’t be fixed.
It can for many but not all.
This is my 3 ep.. I have accepted the fact that it can’t be fixed and just go in for monitoring every year.
The way I looked at it after rounds of ablations, cardioversions, and drugs, is that my afib couldn’t be cured, but it could be fixed. I chose the mechanical route.
I still have afib, but it is irrelevant to my stroke risk, causes no untoward symptoms, and requires no drugs. That is because I have a Watchman and a pacemaker.
Errant cells in my atria still fire away in odd patterns, but with a Watchman, there’s no place for stagnant blood to pool and form clots due to irregular blood flow, and with the pacemaker and AV node ablation, my ventricles beat regularly and have no idea what those erratic cells in my atria are doing.
Afib, while still with me, is no longer a clear and present danger, nor even a nuisance.
Just sharing my experience. I do, however, believe that left atrial appendage closure is going to become a first-line treatment of choice in the future for afib, superseding lifelong dependence on blood thinners, which carry more risks (notably, bleeding) than a Watchman longterm. Good luck!
Also, my ejection fraction is at a steady 55. I’m 83 and my EP is fine with it. I believe all’s well as long as it doesn’t fall into the 40’s or 30’s.
afib can’t be fixed.
Is this due to the atrial septal aneurysm ? Seems a possibility.
May want to google "ejection fraction". There are meds available to increase which your doctor may discuss the need at this time. Would not worry, seems you are receiving good care. Best to You !
Your EF is still normal. I understand the dropping concept - mine is also dropping - but it doesn’t happen over night so waiting a well is perfectly fine. People out there are living with an EF below 20. Wait until you see the doctor and don’t stress.
EF is very difficult to establish. It is a visual estimate, done by the cardiologist during an echo of your heart. 56 is considered quite normal by most of them.
Bad luck on those failed ablations. Goodness me - you must be fed up. So far as I know, an EF of anything over 50% is considered normal, but that 70% is on the high side of normal. AF induces a kind of reversible heart failure only when it causes a long-term tachycardia which has not been controlled (say by a beta blocker).
I think the echocardiogram is not the most accurate measure of EF and that there are many variables to account for. I can understand your fears and only the specialist will be able to assuage them, but I expect all is well and that what you have is a reduced EF from the persistent AF.
Steve
I have had an EF of just above or below 25 for 5 years, which briefly went down to 4 when I was in hospital at the beginning of last year. I am still playing tennis 5 times a week, running up stairs, going on long walks etc. Obviously get yourself checked out but I wouldn’t worry too much. My cardiologist says that what you can do and how you feel is far more important than the EF, which is just a number and can go up or down a lot between Echos. The drug Entresto is supposed to be the best these days to improve EF but I had to come off it after a few days as I had too many side effects.
Poor you! I was well into my 70s before PAF arrived following a virus but mine is very well controlled with Flecainide as an echocardiogram showed my heart was structurally sound. It may well add to my fatigue and tummy troubles but fortunately my husband takes care of me pretty well and my brain is still working. Losing that would be far worse. As you are taking an anticoagulant, ( seem to remember that’s what the Eliquis is) you are not at risk of stroke. So don’t worry!
Should you be concerned? Well, as others have pointed out, your EF is in normal range and Echocardiogram readings can vary with the operator. The falling EF level is not ideal. But you will be talking to your doctor, and hopefully s/he will give an opinion.
When EFs fall below 50, there is a blood test . A BNP test measures the amount of a hormone called B-type natriuretic peptide in your blood. The heart produces BNP, and higher levels indicate that your heart isn't working properly. But you aren't at that stage.
My EF was a 35. I was given a triple lead Pacemaker and medication and the last reading was 50. So hopefully it will continue to improve.
The drugs that treat these reduced EF conditions are Entresto which ohas been mentioned, there is also Dapaglaflozin (Forxiga) and various diuretics as well as Bisoprolol.
I'm slightly puzzled you had a cardioversion for paroxysmal AF. I understood that was only a treatment for persistent AF?
There are many possible causes of the declining ejection fraction including AF-related effects (repeat episodes can weaken the heart muscle), post-ablation changes (you do not say when you had your latest ablation), medication effects or ischaemia (blockages can affect heart performance). At the end of the day this will have to be investigated. They may want to do a cardiac MRI, repeat echo, Holter test and/or stress test. You could give the cardiologist’s secretary a ring and ask her if it’s ok to wait a week before the appointment. I’m not medically qualified but I would have thought it is.
Decreased keft ventricul ejection fraction
Afib
How do I know it's afib ?
Flu/ cold and Afib 
Paroxysmal Afib
