AFib

[jeanette1952]

I am a 64 year old female.  I had my first AFib episode on 5/31/2014. Two years later on June 17, 2016 I had my second and a small third one a month later.  I was hospitalized for the first two. They performed a stress test on 6/17/2016.  Stress test findings were: "There does not appear to be any increase in lung uptake.  Review of the images shows no evidence of significant decreased tracer uptake suggesting ischemia. Review of the gated images shows the right ventricle to be normal in size, wall motion and wall thickening. Ejection fraction at 71%. IMPRESSION: Normal gated Lexiscan Tc-99m scan without any overt evidence of ischemia. ECG portion of the study was negative for ischemia. Left ventricular function is normal with an ejection fraction of 71%".

Echo results performed in sinus rhythm on 6/17/2016:   1.  LV ejection fraction is estimated to be 55-60%.  2.  Doppler filling pattern indicates no diastolic dysfunction.  3.  Mild to moderate thickening/calcification of anterior and posterior mitral leaflets.  4.  Calculated mitral valve area by pressure 1/2 time is 3.06 cm.  5. Moderately decreased mitral posterior leaflet mobility.  6.  Mild mitral stenosis ... mean gradient 5 mmHG.  7. Mild-moderately left dilated left atrium (4.30 cm).  8.  Mild mitral valve regurgitation.  9.  Mild mitral annular calcification.  10.  Mild to moderate tricuspid regurgitation.  11. Mild pulmonary hypertension.

How do these findings affect my AFib? Will the dilated left atrium cause eventual heart failure? Does it increase in size with every episode? Am I a candidate for ablation with these mitral valve issues? I am scared now to do anything...don't know when next one will hit. I have lived with extreme anxiety all my life. I just want to find some peace with this. I don't see the cardiologist until November. I am on metoprolol and warfarin (also an 81 mg aspirin). I want the ablation if at all possible. Thanking anyone who responds in advance.  Just an after thought...I had a knee replacement on 5/10/2016.    

[researcher09]

Jeanette,  your left atrium diameter is well within the normal range so that is not a concern.  The other things mentioned looks normal too.  The medications you are taking for your knee replacement may need to be weaned off depending on what they are for an ablation procedure.  The most important thing is to choose a high volume center or doctor to do your AF ablation.  You may be able to find some references for your area on the lone AF forum as well as other helpful comments.

[jeanette1952]

Thanks for your response.  I no longer take meds for knee replacement...not for a month now. My main concern is whether or not they will consider an ablation with some of the mitral issues and will the left atrium continue on a downward spiral with each AFib episode. The first episode was like 8 hrs. the second was about four hours and the third was about 2 hours.  
  

[researcher09]

It is still considered paroxysmal because you self converted to NSR.  The odds for a successful procedure is higher for paroxysmal AF so you do want to catch it now instead of waiting for it to get worse, ie persistent or long term persistent.  Exercise, diet and stress are modifiable factors that can help some with AF.  Most people will need to get the AF ablation eventually just so they can exercise and get stress relief and get their life back. Heart failure is not a concern since you are paroxysmal and you have only minor issues with valves and no ischemic disease.  If there were major leakage, your ejection fraction would be lower and your measurements are normal.