Does the size of the Left Atrium Determine if NSR can be Restored

If the left atrium gets too enlarged, can that prevent NSR from being Restored either with an ablation or Maze Surgery? Also, if Normal Sinus Rhythm were restored and the Left Atria is severely enlarged, does the Left Atria revert to a smaller or even normal size at some point?



Edited 3 time(s). Last edit at 03/07/2024 01:43AM by cornerbax.

No, it doesn't prevent NSR from being restored, but it can make it more difficult. An enlarged atrium tends to form fibrosis (scar tissue) and fibrosis promotes afib. So if you undergo an ablation and restore NSR to a heart with enlarged atria, the chances of new sources of afib appearing later are higher.

An enlarged atrium can reduce in size somewhat once the things causing the enlargement are removed. Those things could be prolonged, strenuous exercise such as endurance sports, weight lifting with heavy weights, hypertension, and chronic stress.

Hey Carey, happy Holidays to you! Thanks again for the response and great info. If you recollect I have MVP with Severe Mitral Regurgitation. My EF is 50%, my Left Ventricle is very mildly dilated, and my Right Atria and ventricle are normal. After this journey I finally have minimally
Invasive robotic surgery scheduled for June. My EP doesn't think anything will get worse at least not significantly by June. I will also have a Maze Procedure done at the same time.My EP estimates an 80% chance The Maze will allow NSR with no ablation needed later. With that said, I had my annual physical today and gave my PCP the updates on my heart and he said he wonders if my Left Atria which is Severely Enlarged will revert back to a smaller or normal size. He said if it doesn't and it's too stretched he didn't think NSR would be Restored. I know he isn't a cardiologist but that statement got me a little concerned. My Left Atria is 6.5cm as of my last echo. What are your thoughts on this? I am thinking
my EP who is a specialist and said 80% likelihood in my case NSR would be restored would be more credible.



Edited 1 time(s). Last edit at 03/07/2024 01:07AM by cornerbax.

FWIW. my left atria was quite enlarged after almost 4 month of permanent AF in 2015. Got into NSR after that (except for occasional episodes which didn't last long).
About a year ago or so i had another echo and was told that my left atria is only very slightly enlarged, almost normal size.

@Joe

thank you that is great info and news! My Left Atria is 6.5cm and states severely enlarged on my echo. Do you know what size your Left Atria was? I have Severe Mitral Regurgitation and Afib hitting me with a 1-2 Punch. The two issues combined are putting a serious workload on my Left Atria. My AfIB has been diagnosed as Valvular Afib, meaning it is a direct cause from the Severe Mitral Regurgitation from my Mitral Valve Prolapse. It's a little scary on this surgery but I am in great hands and it has to get done sooner than later. From my understanding, if my Left Ventricle and/or Ejection Fraction get worse it can be a much bigger problem. On another note, are you sure you had "Permanent"Afib? I'm thinking you mean "Persistent Afib" as from what I understand permanent Afib means no ablations, medications, exercise or lifestyle will revert someone to NSR.



Edited 1 time(s). Last edit at 03/07/2024 01:11AM by cornerbax.

Quote
cornerbax
What are your thoughts on this? I am thinking
My EP who is a specialist and said 80% likelihood
In my case NSR would be restored would
Be more credible.

My thoughts are don't listen to doctors' opinions on ablations if they're not EPs. Seriously, just don't because few of them know what they're talking about but they're not shy about sharing their opinions on the matter. I've heard all sorts of nonsensical stuff come out of doctors' mouths about afib and ablations, and that includes general cardiologists. So listen to EPs only.


I'd forgotten about your MVP, so there's the most likely reason for the enlargement and the afib. Get the afib fixed and the MVP fixed and I would imagine you will see the atrium shrink and the EF improve.

Thanks, Carey. I had read tons of people with Severely enlarged Left Atria who have had Successful ablation or Maze Procedures. I was a little stunned when my PCP mentioned if my Left Atria doesn't shrink I won't go back into sinus rhythm. Just two weeks ago my EP (highly rated and head of the EP Dept) estimated a 75-80% success rate of the maze procedure along with the Mitral Valve Surgery. He said worst case scenario is I would need to correct Afib down the line or possible aflutter with an ablation but I have a 75-80% chance to stay in NSR.

This all while he was reviewing my latest echo and medical records while talking to me. So yeah, definitely a very incorrect assessment on my PCPs part, thankfully.



Edited 2 time(s). Last edit at 03/07/2024 01:13AM by cornerbax.