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A-fib and large atrial diameter a poor prognostic sign?

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  • A-fib and large atrial diameter a poor prognostic sign?

    I have come across a couple of recent articles which draw some connections between disease proression and young age of onset of atrial fibrillation and large left atrial size. One of these articles is by Woo et al (2005), which BJ Maron also provides an editorial on. They look at myectomy survival rates and suggest that in their study, those who don't do so well are usually those with a number of characteristics, including the ones listed above.

    There is also another article, 'Impact of Atrial Fibrillation on the clinical course of HCM' (2001), co-authored by BJ Maron which seems to support this. Does anything about this connection?

    One of the implications is that for those who fall into certain chategories, aggressive therapeutic approaches are needed. I presume this would mean surgically treating the a-fib (if possible) and, if not already done, having a myectomy in certain cases.

    Take care,

    Paul
    Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

  • #2
    Paul, I know Lisa will act as quickly as she can to address these issues for you, but she is moving full speed ahead with the Annual HCMA Conference next wkend. The good news, is that Dr. Maron will be there and I know there will be much discussion on A Fib. So, I know you will get many posts to this message, but I think you'll get even better info after next wkend.

    I know it would be a bit much for you to travel this year, but the conf is always in NJ and always the first wkend in June. Maybe next year?

    Linda

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    • #3
      Paul, you have raised important question I got yet no answer.

      Young patients with permanent a-fib and very enlarged atria seems to require aggressive therapeutic approaches [By aggressive I also mean surgical, since catheter approaches seem to have very limited application with very enlarged atrium]. However, what I've read is that surgical treatment of a-fib (and atrium reduction) is almost always only done if there is need for another heart operation, namely valve repair or replacement. Thus, in general, it seems that the doctors will not propose a surgical treatment of a-fib even with a bad HCM prognosis.

      But why not? Is the risk of this intervention higher than all the risks associated with a-fib and the HCM progression (heart dilatation I guess!)?

      or there is yet not much experience with surgical treatment of a-fib (and atrium reduction) in HCM patients?

      Fausto

      PS I will be looking forward to receiving news from the Annual HCMA Conference. Next year, I will try to participate.

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      • #4
        Hi Fausto,

        These are good questions. Perhaps the annual meeting will produce some answers.? I spoke today with one of only a few cardiothoracic surgeons in Australia who perform minimally invasive robotic surgery for atrial fibrillation. He said his team do the Maze procedure, but that for me a reoperation would carry more risks (I have just had a myectomy).

        He also pointed out that the extensive Maze procedure produces considerable scaring on the left atrium. This is bad for people with HCM, particularly those who rely heavily on the left atrium for cardiac function.

        His advice was that, should I have a recuring problem with a-fib, that I should undergo PVI, which does not damage the atrium a great deal (and is less invasive). Of course, successful outcomes in the HCM population are less. All very interesting stuff.

        Paul
        Age 38, dad of two young children, dx 1996, myectomy March 2005, a-fib issues, due for ICD soon.

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