Mitral valve repair now in continuous a fib after PE

I cannot address your specific question, sorry, but you mentioned atrial enlargement. This is typically caused by either hypertension or excessive regurgitation, or backflow through the mitral valve, generally meaning prolapse. The scarring of the annulus would be a prime indicator of 'stretching' the supporting tissue.

Atrial enlargement, apart from those precursors I just mentioned, is also common with those who have atrial fibrillation. I'm guessing a 12 lead ECG would have revealed if you were in persistent or permanent AF. However, in the early phase, the paroxysmal phase, AF comes and goes, and generally people are issued a monitoring wearable for up to a couple of weeks to try to catch intermittent arrhythmias like AF is in its initial stages. But, any significant and measurable enlargement signifies that you have been subject to the mechanism of enlargement for some time, many weeks.

If it helps, there is a lot of evidence that a repaired heart returned to NSR regularly and consistently will reverse some of the enlargement. In some cases, the left atrium reduces almost completely. This would be best for your iffy mitral valve, and if they can repair it or replace it (and I can see why the open-heart surgery would be indicated), I don't see why you shouldn't be able to scrape back a good measure of your previous levels of activity. You WILL almost certainly need cardio rehab to get there, or at least several sessions of it to learn how to get yourself back.

Thank you for your response. I had an echo in Dec 2025 and I have never been in a fib proximal or continuous until the pulmonary embolism event in France. I had a cardioversion last week. I got out of a fib for 3 days then it returned full on again. I had the MValve repair because of regurgitation. Now 15 years later I have moderate stenosis and moderate L atrium dilution. I’m sure the PE along with the structural damage that already existed and was noted in Dec 2025 (but wasn’t shared with me until Feb 2026) contributed to the continuous a fib. I’m an athlete and worked out at least 2-4 hours a day. Tennis, long distance cycling, skate skiing, Xc skiing, advanced downhill skier, weight training etc. . I did it all. I can’t give it up. I’m still doing 2-3 hours a day but my heart rate is 98-180bpm and can even go up to 140 with walking. I am now walking and have cancelled all tennis and skiing, doing Pilates and some weights but feeling anxious and devastated at my lifestyle change. What I really need to know is if I am best to try to repair the MV now or later when the stenosis progresses. I think now. But I’ve been told by one surgeon that I will end up worse with a new pig valve due to my previous repair and scarring. He said do not have surgery. My original surgeon, now 82, says operate but has not told me what to expect and he said he has to do a sternotomy on my skinny chest. I have no fat on my body at all for coverage of the wire. We had a short video call and I sent him questions. No response. Currently I am reaching out to several surgeons across Canada for consults. But the health care system here is broken. My cardiologist of 20 years retired and I was given someone who is dismissive of my questions in December 2025. I have 3 graduate degrees in public health and med science but I’m not a cardiologist and still questioning what to do to get out of a fib given the enlarged atrium. I see the dismissive cardiologist on April fools day! He did a transesophageal echo last week before the cardioversion so I hope that sheds some light and leads to a plan. I’m also on metoprolol and apixaban (eloquis) for life. Never on a drug before for anything. I do not feel capable of deleting all my favourite activities and social connections to substitute these activities for reading and Netflix and walking. I know I’ll have to find a highly skilled surgeon
for debridement of the valve hopefully by minimally invasive cardiac surgery, if that is even possible. . Will I be better off mindful watching for further stenosis and dilution of L atrium or have surgery now? Guess I need more consults as my previous surgeon is 82 and retiring in July. He wanted to operate in May but do I want an 82 year old operating on me even though he is world famous and has done 3000 mv repairs with 1000 resulting in scarring and stenosis like me? Anyway, it’s complicated I know. But surely there must be others in a similar situation who have had debridement …..opening up the mitral. valve causing retraction of the L atrium and returning to NSR ? Sorry this is soooo long. I’m obviously very anxious currently. .

@activegal I have had two ablations, seven months apart, both done by the same gentleman electrophysiologist surgeon. He is Dr. Paul Novak, who was the top Canadian cardiology student in Canada in 2002...I think it was. He sealed around my pulmonary veins properly the second time around and I am free of the dreaded AF since Valentine's Day 2023. Pulse Cardiology is probably spread as a corporation across much of Canada, and he is a member last I saw. He is in Victoria doing ablations in Royal Jubilee Hospital.
Novak would almost certainly want any ischemia or valvular defects corrected before he attempts an ablation, and I would guess that most EPs worth their salt are the same. Fix the important stuff first, and then we can deal with symptomology and quality of life....which is really all an ablation can do for you; it doesn't cure of fix the underlying cardiomyopathy or rogue signaling cells, but it can dam them with scar tissue, which is what an ablation does, thus preventing the signals from spreading out into the broader endothelium which is how the wave propagates and causes the contractions.

I can sympathize with your circumstances as a formerly highly symptomatic sufferer of AF. I wouldn't wish it on anyone I know, nor on anyone I don't. It is nasty and intrusive. But, it's not lethal.

78 year old female here. I had mitral valve repair at Cleveland Clinic 19 years ago. Perfect repair in that there was no leakage post surgery. But- now I am told that my newly diagnosed non-sustained ventricular tachycardia is the result of scar tissue from the surgery. The electrical impulses can’t travel through the heart on a normal path due to the scarring impeding that path.
I’m wondering if the scar removal you suggest would result in a long term favorable result, knowing that another scar would, in time, replace it.
Not very helpful, I know. Nobody had suggested scar removal as a treatment option.

@wcuro I hope I don't tread on any toes, but I have to speak up because what you say you have been told, about the scar tissue, or what you think you understand about what was said to you, is not in keeping with my understanding. Before I go on, I have no medical training.

When an electrophysiologist ablates the endothelial lining of the left atrium to stop the heart from fibrillating, he does create lesions which will ultimately heal, but they spread out a bit and create, if done properly and thoroughly, a complete circle of scarring around the affecting focus or entry point....usually around the pulmonary vein ostia. Later, there will be other re-entrants, but those develop with time and are found on the coronary sinus, in the left atrial appendage, in the septum, and so on....

The scarring is indeed impervious to the signals that need to travel through/over the endothelial lining. The wave propagation of energy travels over the endothelial lining and makes the myocytes under them contract...which is what we need the atrium to do.

You say you were told that scarring that took place years ago, by design, is now working against your heart's purpose of launching needed signals? How can this be? Why didn't scarring placed where it is currently located not cause tachycardia within days or weeks of the valve repair? Something doesn't add up.....to my uneducated mind.

Again, I'm not a physician, and I'm just trying to marry up what I understand about scar tissue and its effect on endothelial transmission, and how scarring around a valve repair could possibly cause tachycardia many years later. It sounds to me like both of us, you and I, need more understanding and a more comprehensive explanation. From there, your question just expressed in your post above mine should become more obviously replied to.

@gloaming It is possible that I misunderstood the explanation for my NSVT, but I doubt it. My ablation didn’t give any other answer and the docs were unable to stimulate my heart to exhibit VT during the procedure.
The explanation for NSVT was quite simply stated without medical jargon. Dr Marchlinski( Penn electrophysiologist of high repute) also said that the heart remodels as a result of scar tissue.
I think I’ll copy your response and see what he has to say. Interesting stuff. I always appreciate your thoughtful responses. @gloaming, is it too late for a medical career for you? I think I know the answer.

My Toronto based surgeon who is now 82 and retiring this summer is world famous….Dr Tirone David. He says he has done 3000 mitral valve repairs and 1000 scarred like mine and from the sounds of it, yours too. There is no way to predict who will have scarring and who won’t have excessive scarring. And maybe the annulus ring size is also an issue. Anyway, for my research to date it appears you can have a remodelling and they can remove the scarred annulus. But, it is very delicate and tricky surgery to remove the scarring and calcification. The easiest solution is to pop in a biological valve. The hardest is to remodel but no guarantees. They need to get in and see what’s there. A transesophageal echo should give a better picture of the extent of scarring. Scarring won’t be an issue with a pig valve but that will last only 10 years. I’m told I need a sternotomy but my surgeon is old school and probably not trained in minimally invasive cardiac surgery (mics). I suspect I won’t get out of continuous a fib till they fix the blockage! You may be in the same state. I’m looking for second opinions currently and my heath benefits will cover that from the Cleveland Clinic. But I’d have to mortgage my home to pay for surgery in the US. I’m looking at mitral valve experts at the Ottawa Heart Centre for consultation. I won’t stop searching till I get answers. I live in Nova Scotia and it’s limited when it comes to medical expertise given that the province has under 1 million population. So, I suggest you contact the CC and ask about debridement or remodelling. The valve may have calcified enough now that you don’t even need a ring anymore. But of course each case is different. My scarring is on top of the annulus. Keep asking questions and always look for a few opinions.

@gloaming
The scar tissue is on the annulus ring placed in the mitral valve. This scarring can be moderate or severe and occlude the valve opening therefore forcing the L atrium to work much harder to push the blood through. This action strains the L atrium causing it to dilate ….. that can return to normal after the blockage….. scarring is cleared. My understanding is that a fib can result and is sustained by the extra work the heart is doing to attempt to move blood into the ventricles. I’m still working on figuring it all out but I don’t see how one can get and stay out of a fib with this underlying root problem.

Backup plan, get another valuable opinion:
Have your test results reviewed, especially your latest echo: Send them to the great cardiac surgeon, Dr. Byron Boulton. Set up a consultation visit, perhaps by phone. He is Director of the WakeMed Structural Heart Program at WakeMed in Raleigh, NC. Phone (919) 231-6333. I had a serious regurgitation/mitral valve problem and AFIB (all caused by a gum/dental infection after questionable dental work). He repaired my mitral valve, did an LAAC, and did an ablation to cure my AFIB. That was almost 4 years ago. I am as fine as wine, off all meds too, except for 4 amoxicillin before dental visits. I am a soon-to-be 82-year-old male, just a kid. So of course, get the right doctor, it's as much an art as a science.
Regards,
Sagan

Thank you.. good to know there are many excellent surgeons in many parts of the US and Canada. I also had the mitral valve repaired for regurgitation and everything was amazing for 15 years until now. About one third of those repaired persons get a build up of scar tissue around that mitral valve annulus. So the opposite problem to that which was originally fixed. I’m an athlete . So atrial fib cramps my style a lot. Anyway, it’s a matter of figuring out what to do now. Hopefully I’ll get some answers soon but I figure it will involve a scalpel.