9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”
A-Fib is a progressive disease that, among other bad effects, tends to enlarge and stretch your left atrium. Because your left atrium is fibrillating or quivering rather than beating properly, it isn’t filling and emptying properly. Your left atrium has to work harder than normal and tends to stretch and dilate over time.
(An enlarged heart may also proceed or cause A-Fib. High blood pressure or other heart problems may enlarge your heart and lead to or trigger A-Fib.)
A normal left atrium measures around 2.0-4.0 cm. Some centers won’t do a Pulmonary Vein Ablation (Isolation) procedure if the left atrium is over 5.5 cm. Because the left atrium heart walls have been stretched thin in an enlarged heart, it is easier to puncture them when doing a left atrium ablation. Surgeons also are reluctant to operate on someone with an enlarged heart. (Some people, like Lance Armstrong and other athletes, have a naturally larger heart due to their levels of physical activity. The above rules would not apply to them.)
However, some centers do perform PVA(I)s on patients with an enlarged heart. Newer ablation techniques are less likely to puncture heart walls. (The author does not currently have a list of centers doing ablations on patients with an enlarged heart. But if you email me, I will try to find someone near you.
If you have A-Fib, you should have your left atrium measured to see if it is being enlarged. One of the benefits of a successful PVA(I) (besides curing A-Fib) is that it often reduces an enlarged left atrium.
¤ Pappone, C. et al. “Atrial electroanatomical remodeling after circumferential radiofrequency pulmonary vein ablation. Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation.” Circulation 2001;104:2539-2544.
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