What is the age cutoff and other exclusion criteria for ablations?

Hi Riverpark;
I feel for you-it’s horrible to have to wait for answers.
I have a bovine mitral implant, history of mitral valve prolapse/regurgitation and various arrhythmias. Not AFIB, apparently but PVCs, pacs,nsvt from surgery scarring, svt, etc.
I’m 69 and active. I’ve also had two ventricular ablations, one at Mayo in Rochester. That one was partially successful; the source of errant signals was very hard to reach. I was on flecainide for awhile; they had to keep upping the dose until finally it quit working. It made me constipated but not like I had the flu. I was put on amiodarone, which I stopped in 2022 with my cardiologist’s approval due to side effects. I’ve been able to maintain on metoprolol since then.
My experience with my own echos is that they can vary year to year. In 2023, mine showed mild ventricular hypertrophy which I was told not to worry about. In 2024, however, left ventricle was reported as normal in size and nothing said about hypertrophy.
In 2023, the right atrium was described as mildly dilated, in 2024 it was “normal”. However, the left atrium was said to be mildly dilated in 2024.
My ejection fraction was estimated in 2022 as 55-60%, then 60-65% in 2023, now 55-60%.
Was anything said about your valve function? My implant was described as mild-moderately leaking back in 2020, then mild or trace in 2022 and 2023 back to mild- moderate in 2024. Mild stenosis was mentioned in 2023 but not 2024.
I’ve also been told by technicians that results can vary depending on who is reading/interpreting, or the angle they’re viewing.
I’ve been told arrhythmias, valve leakage, and even sleep apnea can enlarge heart chambers.
Hopefully this was helpful to you. I know how it is to wait
Try to call Mon and get some answers.
Please keep us posted.

Ps-I should have added “mild Concentric ventricular hypertrophy”

Hi Phoenix,

I can’t overstate how much I appreciate you taking the time to reply to my comments. You’re absolutely right about difficulty for me waiting for answers, so it was truly kind and thoughtful of you to share your experiences with me as you did. I’m headed out right now, but I wanted to quickly thank you and will reply more fully later. Thanks again! John, Sacramento

You’re totally welcome. If what I went through helps someone, then it had a purpose.
Ask any question you want; if I can answer them, I will.
Debbie
Knoxville

I’m fine for now, but definitely appreciate and will keep in mind your kind offer to take questions. Thanks, Debbie!

I am not familiar with the first condition, concentric hypertrophy, but you might find this helpful"
https://academic.oup.com/ajh/article/34/6/581/6265586
I am more familiar with left atrial hypertrophy/enlargement. Essentially, enlargement is in response to a stressor, usually blood pressure against the inner walls of the vessel in question...in this case the atrium. For AF, it's the left atrium. The enlargement is due to backpressure from the mitral valve that is closed due to even greater pressure on its other side by the more powerful musculature of the left ventricle.
https://www.ncbi.nlm.nih.gov/books/NBK553096/
What you should keep in mind is that the dilation of your left atrium is evident when imaged, and that it is almost certainly due to your atrial fibrillation (AF). Further, your left ventricle has mild expansion/thickening of its walls. This might be due to frequent AF, but it could also be due to hypertension systemically. If your hypertension is 'borderline', essentially low, then metoprolol can help to mitigate that. So, metoprolol has two things going for it: regulating your heart rate when you ARE fibrillation, but also generally keeping stress off your left ventricle due to mild hypertension. Note that I'm not saying you do have hypertension, only that,...IF... it is the explanation for your ventricular hypertrophy, metoprolol generally helps to reduce it.

Is any of this of major concern? I would suggest that it isn't urgent right now, but the changes do indicate a progression of your heart's general condition. If AF goes on too long, it can lead to deposition of collagen and fibrosis in the substrate of the heart (in the muscle tissue), which makes it stiffer. A stiff muscle has to work harder to make itself change length or shape in order to function properly. As anyone who builds muscle knows, when you make a muscle work harder, it adapts by making more muscle tissue. In the heart's case, it means larger myocytes, which means more volume of the tissue of the ventricle...thickening. In turn, wall thickening can lead to mitral valve prolapse, and even eventually to heart failure (not really 'failure', more like insufficiency...inadequacy).

I would ask you to take away this: the longer a heart experiences an arrythmia like AF, the more difficult it is to treat it. For example, you already have age working against you (or so you were told initially, but your lifestyle held a trump card....great!). You should really consult an electrophysiologist, ideally in person, get him/her to know you, and then you can go directly to that person when things get worse or change...bypassing the person who feels age ought to present a limit for treatment. But what I would ask you to think about, please, is that you can greatly slow the progression of your heart's disordered state by treatment, including an ablation. Ablations work wonders for many people, and if they work, they can prolong life by 10-20 years, even longer if there's no further deterioration. AF begets AF. Stem the AF and you can enjoy your life worry-free.

Hi Gloaming,

Wow, I am stunned by the comprehensive information you have sent in answer to my questions, and by the kindness that you and others show by taking the time and energy to make these kinds of replies. This is very helpful, indeed, and I truly appreciate it!

The age 70 cutoff for an ablation is quite arbitrary. It is a minimally invasive procedure, and there is no age limit, per a google search.
I am 74 and had an ablation a month ago.

I'm 76 and had 2 ablations procedures within 27 days, the 1st one with 4 ablations and the 2nd with 2.

I don't understand the 70 year age cutoff for cardiac ablation? I could not find any mention of an age limit on the internet. Very curious. I suggest you investigate further.