Severely enlarged left atrium

I was diagnosed with AFIB in 2016. In 2021, I had a transthoracic resting echocardiogram. The report showed the left atrium size was severely dilated. I was on Eliquis then and will always be on 5 mgs daily. My EP at the time never made much of the LAA enlargement other to say it would make an ablation there more difficult. My LAA was ablated in March of 2022. A watchman was implanted 9//22. My 3 month and 6 month’post watchman TTEs both should the severely enlarged LAA, Six month report stated “severely increased left atrial chamber size. Although there electrical P waves there is no A wave in mitral inflow, This is consistent with atrial stand still.” I had a CT Heart Morphology 12 month post watchman last week and a week later a transthoracic resting echocardiogram to check a mitral valve regurgitation issue. The TEE showed the mitral valve improved , but both showed the LAA remained the same.

Within the last few weeks I have started having frequent premature atrial contractions. From what I have read these are usually benign IF the heart structure is normal. Obviously mine is not normal. I am extremely concerned about this. I had a telemed visit today with my EP and his PA and,of course, I brought all of this up. The major discussion was about the PACs. I was told the last weeks TEE looked good. I brought up the enlarged LAA, they did not. I was told to have the TEE repeated in a year.

This was all very upsetting to me and as I think about it I am wondering what questions I should have asked about this situation. I do not feel that I did a good job communicating my concerns to them. Any suggestions as to what I should be asking would be appreciated.

I am not clear on your report—in one place you mentioned “ The report showed the left atrium size was severely dilated” and in another “ TTEs both should the severely enlarged LAA”—so I am not clear which is enlarged, the LAA or the left atrium?

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Daisy
I am not clear on your report—in one place you mentioned “ The report showed the left atrium size was severely dilated” and in another “ TTEs both should the severely enlarged LAA”—so I am not clear which is enlarged, the LAA or the left atrium?

Good point, Daisy.
Post watchman procedures:
45 day TTE states: The left atrium is severely dilated.
6 month TTE: Severely increased left atrial chamber size. Although there electrical P waves there is no A wave in mitral inflow, This is consistent with atrial stand still”
12 month CT Heart Morphology: Enhancement of the excluded left atrial appendage is seen. Cardiac Chambers: There is biatrial enlargement, with the left atrial measuring 5.0 cm in maximum AP dimension.
Last weeks TEE: left atrium size is severely dilated

My point remains, though….PACs are not benign when the heart structure is not sound, I am hoping folks have something to share about that.

Thanks, Daisy

Okay, thank you for clarifying. Your left atrium is dilated, not your LAA. A dilated left atrium is common among people with afib, but I've never heard of a dilated left atrial appendage (LAA).

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Carey
Okay, thank you for clarifying. Your left atrium is dilated, not your LAA. A dilated left atrium is common among people with afib, but I've never heard of a dilated left atrial appendage (LAA).

I changed the post title to reflect this accurately. Carey, do you have any suggestions as to what I should be asking my EP about this? This is “ new territory” for me and I need to be careful what I read about PACs that are not benign. As you know, my mind goes into over-thinking/anxiety mode! At this time, I will have a 7 day heart monitor in 6 months and a TTE repeated in a year. I asked about magnesium supplementation. They are getting back to me about this because when I had the magnesium lab in September, the level was a 4, the top on the normal range. My GFR in September was a 67, but during the last few years it has fallen under 60.

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Pixie
My GFR in September was a 67, but during the last few years it has fallen under 60.

My understanding is fructose is not great for the kidney. Also if you have cardio metabolic issues, working on those may be helpful. I've read about folks who've stopped GFR decline (not reversed it), but didn't save the details in memory as it is not my issue. If interested, I could try to come up with more resources for details.

If your mitral valve regurgitation is better, you don’t have high blood pressure and your Afib is resolved, seems like the left atrial dilation could improve. I had severe mitral valve regurgitation and Afib, and after getting those “fixed,” my level of left atrial dilation has improved. The mitral valve regurgitation needs an eye on it though as the trend is to repair it sooner rather than later.

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Pixie
As you know, my mind goes into over-thinking/anxiety mode!

And that's exactly what it's doing now. Your doctors aren't alarmed about the PACs because there's no reason to be. Unless you're experiencing thousands per day or they're causing symptoms, they present no threat to you. They're just an annoyance. If you're reading something that says otherwise, point me to it; I'd like to see what it says. You can ask him about trying some meds to see if that will stop them or at least reduce the number. The usual meds are all the same as for afib. Maybe try something mild like Multaq. I wouldn't go for a heavy hitter just to stop PACs. And, of course, you can always get a consult with Natale to see if a touch-up ablation would be worthwhile.

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GeorgeN


My understanding is fructose is not great for the kidney. Also if you have cardio metabolic issues, working on those may be helpful. I've read about folks who've stopped GFR decline (not reversed it), but didn't save the details in memory as it is not my issue. If interested, I could try to come up with more resources for details.

Thank you for this information, George. As usual, I always appreciate the thorough information you provide on this form. I don’t want to impose on you so it is not necessary for you to look for information on the GFR decline. If, however, anything comes to your mind, please let me know. Thanks.

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Pixie
Thank you for this information, George. As usual, I always appreciate the thorough information you provide on this form. I don’t want to impose on you so it is not necessary for you to look for information on the GFR decline. If, however, anything comes to your mind, please let me know. Thanks.

Here are a few places to start.

Richard Johnson MD, nephrologist researcher at UC Health. His list of publications is on the website linked to his name. Three lecture series on the topic; one two three His most recent lay book. Peter Attia Podcasts. I think the first two in this list are full sessions. Johnson's 2023 presentation in Denver. One of Johnson's points is that there is more to the story than fructose we consume, there are other pathways in the body where fructose is created.

Toronto nephrologist, Jason Fung, MD. Can fasting help reverse kidney disease? Study paper discussed. They used a fasting mimicking diet (FMD) in the study. Commercial FMD food can be ordered here. This post analyzes the calorie and carb/protein/fat macronutrient profile of the commercial FMD as well provides links to DIY options. A search on kidney disease on Fung's site.

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GeorgeN

Here are a few places to start.

Richard Johnson MD, nephrologist researcher at UC Health. His list of publications is on the website linked to his name. Three lecture series on the topic; one two three His most recent lay book. Peter Attia Podcasts. I think the first two in this list are full sessions. Johnson's 2023 presentation in Denver. One of Johnson's points is that there is more to the story than fructose we consume, there are other pathways in the body where fructose is created.

Toronto nephrologist, Jason Fung, MD. Can fasting help reverse kidney disease? Study paper discussed. They used a fasting mimicking diet (FMD) in the study. Commercial FMD food can be ordered here. This post analyzes the calorie and carb/protein/fat macronutrient profile of the commercial FMD as well provides links to DIY options. A search on kidney disease on Fung's site.

As usual, great information, George. Thank you.