Two CryoAblations by Dr. Kerwin, Problems with Pradaxa, Difficult Recovery Period, Lung Damage, Dealing with the Fear that A-Fib May Return
By Anthony Bladon, 2012, Santa Barbara, CA
What I wish they’d told me about ablation for A-Fib
To give these comments some context, I’m very pleased with the eventual outcome of my ablations for A-Fib (two cryoablations, done by Dr. W. Kerwin at Cedars-Sinai/UCLA, see www.cryoablation.com). As of this writing, two and a half years after first diagnosis, I am two years without arrhythmia. I feel like a new man! But at least for me – and probably for you, since you are researching on this site – more advance information is always better than none.
1. Cryoablation (like RF ablation) may not work the first time!
Of course they do tell you that, but you always imagine and hope you will get lucky. Four weeks after my first ablation, arrhythmia returned (paroxysmal, lasting a few hours at a time) and the EKG confirmed it. I was shattered. I had done everything right. So what next, another ablation? It didn’t take me long to prepare psychologically for another 6 hours on the table, but it did take a while physically! They can’t just wheel you in again the next day. So I had to endure two more months of A-Fib until I had regained enough strength for a second procedure. Those two months couldn’t have gone fast enough.
2. After the procedure, your heart will be in bottom gear for a long time!
As an active, fit 68-year-old with none of the CHADS2 risk factors, I naively thought I’d be back on the bike in a few days. No way! After a couple of weeks I could walk a flat mile per day at 2 mph. I could climb stairs 3 or 4 at a time with a half-minute’s rest each time. It’s an interesting illusion. After this procedure I had no pain and no visible wound (not counting the nicks in the groin), so there’s no insistent reminder that I was an invalid! So I felt I could do much more. But it’s unwise to do so. My heart rate became unstable, in sinus but missing a beat quite often, when I tried to exercise beyond “bottom gear”. For example, sweeping the yard. The doctors said “Take it easy,” but didn’t elaborate that this might mean spending 12 hours a day in bed and taking very, very gentle exercise indeed.
3. Pradaxa may not be the new wonder drug!
Both before my first ablation procedure and after it, I experienced light-headedness with slight right-side limitations (grip weak, toes needed flexing to maintain circulation). It was pretty mild, rarely requiring me to feel like lying down. It always occurred at rest. I was taking 150 mg daily of the anticoagulant Pradaxa and no other drug the entire time. Before the ablation procedure, doctors were inclined to attribute these symptoms to A-Fib. But after the procedure, A-Fib was no longer a possible explanation. After about 10 of these episodes, I stopped Pradaxa and switched to Coumadin. Bingo! Light-headedness diminished daily until by day 4 after stopping Pradaxa, it was completely gone. Phew.
The problem with this side effect of Pradaxa (which I firmly believe it was) is not that the effects were hard to tolerate. No, they were pretty mild and non-intrusive in my daily life. The problem was of course that light-headedness (etc.) is a classic indicator of TIA or a precursor to stroke—so it’s Really Scary! And, what’s more, that’s the very outcome that Pradaxa is supposed to be guarding against! So until I stopped taking Pradaxa, I was a nervous wreck for 2 months, and all kinds of additional tests were initiated (carotid scan, etc.), unnecessarily as it turned out.
4. They may catheterize your urethra for the ablation procedure. When you urinate the first few times, there’s some blood, and it hurts!
It’s a long procedure (5-6 hours), so it’s understandable that your bladder needs to be managed. But hey, why the trauma? I still don’t really know. However, it got better within a day.
5. Minor lung damage can easily occur — and last a while!
My second ablation procedure took more like 7 hours. The doctor was being “more aggressive” this time. But when you are flat on your back for that length of time, the lungs take a beating. So I woke up coughing blood, and deep breaths were rather painful. Make sure they crank your bed up a little from horizontal, it made a big difference! They diagnosed Atelectasis which sounded less dramatic than the everyday term for it, collapsed lung. It took a full 6 weeks (yes) for the lung to fully heal. Fortunately, progress was gradual and measurable, using the incentive inhaler device they gave me.
6. After ablation, there may be periods of irregular heartbeat. And all kinds of other minor recovery symptoms.
If there was one piece of advice I wish I’d had more than any other, it was to not be alarmed at all the little heart-related symptoms that popped up, in one or other form, every day for the first 6 weeks, and less frequently up to 12 weeks. After the second ablation, the rock-solid rhythm of my heartbeat was always reassuringly, but I still had constant annoying reminders that I had a heart condition. For example, there’d be a few minutes of slight nausea, or a loud heartbeat for a while (especially during or after exercise), or a slight speedup (to a rate say 25% above resting), or a bout of frequent yawns, or just a general slight malaise. Or there’d be the single ‘bump’ or palpable beat that I didn’t know was a sign of a PVC or ‘restart’, and which is benign in small doses… In time, I learned to convince myself that these are all regular recovery symptoms. I just wish I’d known to expect them.
As someone used to monitoring their pulse for regular (sinus) versus irregular (A-Fib), I was shocked and hugely disappointed to discover an irregular beat on day 6 after the first procedure. But no! After a sleepless night, the EKG showed no A-Fib, but instead a pattern of “sinus with pause”. My doctors attributed this to stress. And the next day it had gone away. But I’ll say I was stressed out!
Coping with the mental stress of A-Fib
Frequent short rests helped. So did a relaxation exercise that I learned. Staying hydrated was important. And so was remaining unstressed! But of course the mental games that A-Fib plays, the constant lurking fear that A-Fib may spontaneously return, are insidious. I absolutely needed to develop coping mechanisms. I firmly encourage you to do the same!
One, as mentioned, was a 17-minute relaxation exercise that I followed religiously, daily or whenever feeling anxious, for some months. It can be downloaded from the following web site as an mp3: http://drdeangiven.com/?page_id=76. In addition I developed an “anxiety thoughts log,” making myself write down word-for-word what the anxious thought was, as well as noting the physical event that seemed to trigger it. By confronting my most extreme fears very explicitly (Is this a TIA or A-Fib? I’m afraid of a stroke, I might die or be disabled. I can’t contemplate a third ablation!), it became easier to re-state and contextualize them in a more reasonable frame of mind, thereby reducing my anxiety. If fears of A-Fib prey on your mind, I encourage you to seek out the help of a professional psychologist, as I did. After a few sessions of consultation, and with the continued use of tools like these, I was fully able to cope.
We can’t thank Anthony enough for telling us what worked for him to relieve the fear, tension and anxiety of A-Fib. His “anxiety thought log” is brilliant and something anyone can and should do. And listen to Dr. Given’s audio relaxation exercise. It’s very calming.
Dr. Kerwin was one of the first to use Cryo (freezing) catheters to treat A-Fib. Today doctors use CryoBalloon catheters which are easier to use and faster. Cryo catheter ablations took a long time to do compared to the CryoBalloon catheter.
Anthony’s lung problems may have been due to Phrenic Nerve injury which is much less of a problem today with improved Cryo ablation strategies. The Phrenic Nerve may have been affected by the cold, but then eventually returned to normal. But collapsed lung is a very rare complication in catheter ablation.
We’re grateful to Anthony for his frank discussion of his minor recovery problems, for alerting other A-Fib patients to cope with them. (To this author Anthony had significantly more problems than most people experience.)
Pradaxa was the first of the new anticoagulants to be approved by the FDA. But among other problems, it has no reversal agent. If anything, it may work too well. Many people have died in the ER, because doctors can’t stop their bleeding. See Stop Prescribing or Taking Pradaxa: Suspect in 542 Patient Deaths. Anthony points out another potential problem with Pradaxa that people taking Pradaxa should watch out for.
And Anthony’s analysis of the fear and anxiety A-Fib produces, even after a successful ablation, is most appreciated. In this author’s opinion, Electrophysiologists today don’t focus their attention on and don’t effectively help patients deal with the fear, anxiety, depression, etc. that A-Fib often creates.