Enlarged Right Atrium

A friend of mine has been dealing with afib now for about a year. His heart rate is controlled around 80-90 BPM. However, the doctors are telling him his right atrium is enlarged and that being the case an ablation is out of the question. I don't think I have ever heard that before nor can I find reference here.

I've been encouraging him to seek out a new doctor for several months now and I think he is finally going to do that.

I know this is limited info but its all I have right now. I don't know of any other underlying issues that may be pushing the doctor to make this particular diagnosis. thoughts?

I'd encourage him to send his info to Natale to see if they have the same opinion on ablation...

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GeorgeN
I'd encourage him to send his info to Natale to see if they have the same opinion on ablation...

I have as well as encouraging him to come to this site and do some research and ask questions first hand.

So far as his right atrium I have gleaned over a couple studies and they all refer to the left atrium size may affect ablation outcomes but nothing about the right.

Hi Rocketrich,

First of all while a super enlarged left atria can increase the odds of needing a bit more work in order to seal the deal long term ... and a severely enlarged Left atria tends to start at 52mm across the widest part of the left atria in men ... and 47mm is considered severely enlarged for women The more elite operators rarely find an significantly enlarged left atria ( noted >/= 52mm in the left atria for men, and >/=47mm for women.

However, for the more elite EPs who are skilled at performing large number of persistent and LSPAF cases every week, rarely will they shy way from even a >60mm left atria as a barrier to starting and finishing an expert ablation process.

Again, you will get a dramatically different answer from the more typical ablationist's who limit their practices to mostly doing anatomical-only pre-ordained PVI-only .. or with maybe the LAPW (Left Atrial Posterior Wall iso) as well before, stopping and calling it a day..

Huge experience with the most challenging cases means everything!

Cheers!
Shannon



Edited 1 time(s). Last edit at 04/11/2019 03:40AM by Shannon.

Thanks for a more in depth perspective Shannon. I take it from your response that having an enlarged right atrium further reduces need for concern.

An enlarged right atria can impact the odds a bit, but again it typically isn't anything close to a deal breaker as it maybe for the average EP who mostly dabbles in ablation when a case comes along periodically.

Being highly discriminating in the choice of an Ablation EP is highly recommended, in our strict guidelines and we advise everyone to set a very high standard for the key choice made for whom to entrust one’s hearts’ care too during a cardiac ablation process. All things considered having a smaller left and right atria is more ideal than having either or both atria significantly enlarged.

However, for elite level EPs like Drs’. Natale, Rodney Horton, Luigi DiBiase, Pasquale Santangeli, Amin Al Ahmad, DJ Lakkireddy, and quite a few others around the US, (to name just a small few off the top of my head this morning), the size of the LA is primarily just another key data point to inform them of the likely degree of procedural detail and nature of the ablation process this patient’s heart will demand of their skill set in order to deliver the targeted final successful result of long-term freedom from all AT (i.e. atrial tachycardias of all definitions) in the least total amount of work required to achieve that goal. Keep in mind that what ever condition we bring to an EPs table is what they try to make the best off the situation since it one area the EP doesn’t control.

Hence, all the more reason not to settle for an ablation EP who you think ‘might be good enough’ .. try to partner with confidence in the man/woman who you feel sure can handle any degree of difficulty your heart might present to them during those few hours their table.

Having significant atrial enlargement in either atria can increase the steps needed for durable long term success, but rarely is it seen as a deal-breaker by the best ablation experts.

Shannon

And P.S. the above issue regarding enlarged atria size, that is most often the the result of long-term poorly controlled AFIB (followed, perhaps, by extreme chronic fitness and other CVD risk factors), is one of the very best incentives NOT to overly procrastinate in starting, and finishing, one’s expert ablation process when prior efforts at self-management of one’s AFIB has proven to be a mixed bag, at best. The longer one drags out the decision to get AFIB out of your life when it’s still a real
nuisance regardless of one’s effort, the greater the odds of increasing the complexity and stages of treatment needed to turn this ship around, and the fewer good choices among you’ll have among the top EPs to choose from.



Edited 2 time(s). Last edit at 04/11/2019 11:45AM by Shannon.

I don't think it's accurate to say it reduces concern. It's more accurate to say that it doesn't increase concern for a highly experienced EP.