Left atrial dilatation reversible?

Dear fellow Afibbers,

I have a mild enlargement of the left atrium. It´s 41 mm in diameter, which obviously is borderline. Some years ago the diameter was only 37mm so it has grown probably due to atrial fibrillation.

Now I´m on flecainide.

Is it correct, that, if the flecainide works and afib is supressed effectively, the left atrium can shrink to it´s normal size (below 41 mm) or is an dilatation of the left atrium irreversible?

Thank you.

Dirk

Hi Dirk,
First of all, 41cm LA diameter is perfectly fine for an ablation. Underscore the word 'mildly' dilated. They start to get more concerned when you are over 50cm to 55cm as making a successful ablation on one go around more problematic with dilation around that level and bigger.

Flec can help mainly if it is successful in preventing or minimizing breakthroughs such that reverse structural remodeling has a chance to work .. which it almost invariably will to some degree with a long term quiet heart.

Even AFIB activity once every month or two can be enough to prevent much positive reverse remodeling once that initial remodeling is well underway. Hence the wisdom of applying any and all tools necessary to maximize your NSR time and not get too complacent with what seems like a fairly modest level of paroxysmal AFIB activity over a long period of time.

Do everything you can from the supplemental and dietary fronts to insure good magnesium and potassium repletion etc etc, and dont be too procrastining for too long if and when you are still getting a fairly frequent pattern of breakthroughs to get a top quality ablation to help with much more NSR time, if and when the supplemental route isnt able to provide enough absence of the flippies.

Shannon

Dirk,
Same here mine was borderline at 4.1 cm when I got diagnosed grew to 4.4-4.6 cm a few years ago during 2 echos 1 year apart but I believe I was in AFIB both times. Then last year May after 13 months on Flec the reading was 3.0 cm but I was in NSR during that stress/echo test which was was excellent for my age. When I brought this up to Dr Natale he wasn't so sure the Flec did it. He thought the reading might have been off which even my cardiologist admitted might be possible but who knows until my next stress test. I asked him what he saw during the ablation he told nothing to worry about just mildly enlarged with not much Fibrosis. I was in and out of afib all week when I had to stop the Flec so I suspect the enlargement might be an atrial stretch which is temporary. In any event waiting too long is not in anyone's best interest IMO. I'll see what my report says.



Edited 1 time(s). Last edit at 06/03/2013 03:01PM by McHale.

Dear Shannon,

thanks so much for clarifying this for me.

I still have a lot to learn and I' m lookong forward to accumulate knowledge.

This board is extremely helpful.

Any more opinions are very welcome.



Edited 1 time(s). Last edit at 06/03/2013 02:50PM by Dirk.

l spent a significant amount of time in afib (two years plUs) prior to Starting TKOSYN and have been in NSR Since DEC 2011. was 60mm at that time and just had echo today. l am down to about 55 and holding. The EP Said flat out that I might continue to shrink and l might not. My ejection fraction is 60% he said. With my hypertension gone and HbAlc back to normal 1 may See improvement over the next year but "no guarantees".

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.