Suggest Treatment For Atrial Fibrillation

Posted on Mon, 13 Apr 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 13 Apr 2015 Answered on

Tue, 5 May 2015 Last reviewed on

Question : Hello,

This is a question regarding my Father. He's 78 years old and had a heart attack a little over 3 years ago. He has done very well since then.
About 4 months ago, an atrial fibrillation episode began, that lasted for the next 3 months. His doctor increased the dosage of metoprolol and amiodarone he was taking and the a-fib finally resolved itself about a month ago. Soon after he returned to a normal sinus rhythm, he had a MUGA test. Every MUGA test he has had since the heart attack has shown a progressively higher EF percentage -- except for this most recent one. About 9 months ago, his EF was 43%. The EF with this most recent test was 31%. We're meeting with his cardiologist on Tuesday and I believe he is going to bring up the subject of a pacemaker for my Dad.

My question is this. Is it possible that this most recent EF of 31% is the result of my Dad's heart being physiologically "out-of-shape"? While his heart was in a-fib rythym for 3+ months, he didn't have as much energy as he normally does, and he wasn't able to exercise as regularly as he would have liked to. Since returning to a normal rhythm, he has begun exercising regularly again and feels much better. So what I'm wondering, is if it's fair to compare the previous 43% EF when he was very cardiovascularly fit, to a 31% EF measured when he was NOT as cardiovascularly fit? And, if he were to "get back into the same shape" he was, and had another MUGA test, would that show an EF comparable to the previous 43%?.

Also, he has already been scheduled for an electrophysiology study several weeks from now. Could you please speculate about what might be learned during that test?

Thank you.

XXXX

Answered by Dr. Ilir Sharka (2 hours later)

Brief Answer:
Your suggestions are quite right.

Detailed Answer:

Hello XXXX!

Thank you for asking on HCM!

I passed carefully through your Dad's medical history, and I would like to explain, that you are right when connect LV EF further lowering to the recently occurring atrial fibrillation.

The prior myocardial infarction has affected your dad's cardiac function producing ischemic cardiomyopathy. This is reflected by a low LV EF of about 43% till 9 months ago. All this picture is the result of LV myocardial remodelling, that is triggered by the prior myocardial injury (prior MI).

Recently, the clinical scenario is enriched by the three months duration of atrial fibrillation. It is well known that the presence of atrial fibrillation in a previously compromised cardiac function does imply a further negative contribution on cardiac performance (getting to a lower LV EF). This is in part a consequence of the loss of atrial contribution to LV filling and hence to LV systolic performance (EF), and in part to what is elegantly called tachycardiomyopathy (that is a LV EF progressive worsening during the presence of a relatively long and persistently uncontrolled tachyarrhythmia).

So I think that the 3 months duration of a-fib could have influenced to a certain degree to the developement of tachycardiomyopathy (which is reflected even with what you termed "physiologically "out-of-shape").

There exist chances of at least partial LV EF regaining after normal sinus rhythm restoration, but a very important clue is to look after the primary etiological cause, too. That is coronary artery disease.

Hope to have been helpful.

Greetings! Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Prasad