Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your current concern and would like to explain that the episodes of atrial arrhythmia may really be frightening, especially when they are recurrent, but you should know that those scarce episodic atrial arrhythmias could not harm or threaten your life, when your cardiac function and structure is quite normal (normal echo and stress test).

When such episodes of atrial arrhythmia recur, then a potential triggering factor should be sought, such as thyroid dysfunction, electrolytes imbalance, chronic pulmonary disorder, drug abuse, etc..

When any of the above factors is localized and isolated, if the arrhythmia occurs again, further clinical investigations are necessary.

Now, returning to your actual clinical scenario, as those bouts of palpitations (cardiac arrhythmia) are very rare, the most appropriate strategy for detecting (registering) and carefully reviewing is to implant a subcutaneous loop recorder, which is maintained much more longer than a standard Holter monitoring.

In such way, it would be possible to reconfirm recurrences of atrial tachycardia or any other potential arrhythmic events and conclude the most appropriate therapeutic strategy.

If after reviewing the data from loop recorder, important cardiac arrhythmia is concluded then an invasive electrophysiologic study and cardiac ablation would be a rational decision for addressing this issue (as atrial tachycardia is not rarely resistant to medical therapy).

Anyway, you shouldn't worry about it, because as I mentioned, no life-threatening complications seem to be obvious (rare episodes of atrial tachycardia in a structurally normal heart).

You just need to perform some medical tests as follows:

- complete blood count for anemia
- thyroid hormone levels for possible dysfunction
- blood electrolytes level for possible imbalances
- chest X ray study and pulmonary function tests if necessary.

You should discuss with your doctor on the above mentioned issues!

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

You should know that thyroid dysfunction may lead to cardiac arrhythmias, whichever it be, hypo or hyperthyroidism.

Coming to this point, I would recommend repeat your cardiac ultrasound, as two years, is a rather long period and changes may have occurred (myxedematous heart).

Besides, I would advice you to follow the investigating strategy of the loop recorder.

Regarding cardiac ablation, I would explain that it could be necessary if recurrent episodes of cardiac arrhythmia are present, BUT, first secondary causes that may trigger the arrhythmia (including thyroid dysfunction) should be excluded.

When performed by experienced hands, cardiac ablation may be performed and re-performed (if necessary) in a safe way.

Hope to have been helpful!

Greetings,

Dr. Iliri

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Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

It is likely that your arrhythmic events are quite rare as your Holter has revealed nothing.

That is why I recommended endorsing a loop recorder.

I don't think that during this period any significant changes in your ultrasound may have occurred. But as your thyroid function is not in a steady state, it would be wise to exclude any adverse implications of your thyroid gland over the heart. So, it would make sense to discuss with your doctor again and consider performing a new cardiac ultrasound.

I would be happy to review your test results, as soon as you could upload them for another professional opinion.

Wishing you a pleasant weekend!

Regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I understand your concern and would explain that your situation is not so concerning.

In my opinion the episodes of arrhythmia are related to thyroid hormone imbalance.

You should know that the thyroid hormones are very important for a normal cardiac function. A thyroid dysfunction (hypothyroidism or hyperthyroidism) can lead to several cardiac problems, starting from cardiac arrhythmia to changes in the heart structure and even heart failure.

I think that a better management of your thyroid hormone levels, will help to significantly reduce these episodes of arrhythmia.

Coming to this point, as your thyroid function has not been in a good balance lately (according to your latest performed TSH levels) a new cardiac ultrasound would be rational, just to be sure that everything is OK, and this hormonal imbalance has not lead to any structural heart changes.

From the other hand the loop monitoring is a test more helpful then Holter, because you can hold it for a longer time and activate it by pressing a button in the moment that you experience palpitations, and it can register your heart rate at the moment. From the other hand these ECG registrations can be sent to your doctor (by phone) in a short time and he can examine them in a few minutes after your episode and examine the type of arrhythmia.

Hope to have clarified some of your uncertainties!

Wishing all the best,

Dr. Iliri

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