Atrial Fibrillation and Heart Failure

I did not have that conversation, but what he and I discussed would have led him to understand that I had done my homework and was fairly conversant with the problem and its treatment.

The heart's substrate has become disordered when someone develops an arrhythmia. It cannot be reversed...at least not that I have ever read or seen in amazing news. It can be controlled to an extent, but the point is that the disorder is progressive....slow or fast, or middlin', it progresses.

It gets worse if the arrhythmia is not controlled, and it can accelerate. If the arrhythmia persists, and becomes permanent, the entire time it is in arrhythmia is time where the heart remodels itself. Collagen gets deposited in the substrate and fibrosis appears there as well. In time, the mitral valve is going to sag or lose its tone and you'll get mitral valve stenosis. Note that this is predicted as likely, not absolutely in all cases.
https://www.ahajournals.org/doi/full/10.1161/JAHA.123.032215
Here, below, they discuss the results of a study where they measured EF and enlargement in patients, some who were cardioverted early and stayed in apparent NSR for five years, and the others were in and out of AF. The latter had much more enlargement, and those who were successful at staying in NSR even had some modest reduction (they use the term 'reverted') in atrial size...bonus!
https://pubmed.ncbi.nlm.nih.gov/15860382/
Note, also, that hypertension is mentioned. If the patient is in NSR, but still largely hypertensive, then atrial enlargement is going to be much more prevalent.

I couldn't find a study hazarding an estimate of the probability that any one heart will succumb to heart failure when in AF and left there long enough. My guess, if you insist, is that it's close to 80%.

My paroxysmal afib has not progressed in 10 years, knock on wood. But once persistent or permanent as @gloaming says, remodeling occurs as @glomaing describes. My mother had congestive heart failure with her permanent afib. She lived to 96, very short of breath for many years.

Hi - in Jan.2021, I had heart failure [35% EF] with A-fib and PE; so I researched Cardiac Rehab. My insurance would not pay for any rehab so I crafted my own using data from well-respected institutions [UCSF; Mayo Clinic; etc.] I recovered within a month - doing well at four months.

cardiacrehab.ucsf.edu/cardiac-rehabilitation-and-wellness-center

http://www.mayoclinic.org/departments-centers/cardiac-rehabilitation-program/overview/ovc-20442302

My mom had similar history as yours. She died at 92 with congestive heart failure. She was dx with AFIB in her mid-60s, but I don't know how much of the time she was actually in AFIB. It bugs me that the EP I'm about to fire seemed to be ok with leaving me stay in AFIB and not offer cardioversion until I asked for it.

Thanks for the journal article links, gloaming.

Hi
Heart Rate left uncontrolled can do further damage to your heart.

Beta Blockers didn't control H/R. Metoprolol 186 avge H/R Day with pauses - 47avg bpm Night.
Bisoprolol 156, no breathless and no pauses at night. 47bpm Night.

After 2 years 3 months as above left uncontrolled H/R My echo shows severely dilated left atrium. Venticles working well including systollic. At 76 a wee bit of leakage from valve and some regurgitation.

CCB Calcium Channel Blocker saved me H/R controlled under 100.
Diltiazem 120 CD Morning and controls BP too. A very safe anti-arrhymic Med. Dame satructural so no Cardioversion, Ablation, Anti-Arrhymic Med like Flec...

No more BB Bisoprolol or any other BB.

With persistent the forward treatment is 'give up on sorting rhythm BUT MOST IMPORTANT in rapid H/Rate ids to control H/R which in turn helps the Rhythm.

Happier now but please if you are taking both a BB and a CCB SEPARATE them by Day and Night. AND better CCB and BB at night as BP is higher early morning.

cheri JOY. (Tuckie). 76 now in NZ