25 Years in A-Fib: Cured After 2nd Ablation in Bordeaux with Touchup Ablation
by Gisela Zukor, 2007
I am a 69 year old female with a 25 year history of Atrial Fibrillations. During my 25 years of A-Fib I tried at least 10 different heart medications at different times. None of them were any help for my condition.
I had my first ablation in 2005 in Los Angeles, where I live, performed by Dr. David Cannom. Unfortunately after 24 hours the Atrial Fibrillations returned, and I was terribly disappointed. After the first ablation the attacks were slightly shorter and the distance between episodes was perhaps a little longer. (The A-Fib would occur at least once a week and last about 20 hours.) Before the first ablation, I was used to 3-4 days of heart palpitations which would occur at least once a week.
When the incidents and duration of palpitations began to increase in 2006, I began to think about going to Bordeaux and have Prof. Haïssaguerre or Dr. Jaïs perform a further ablation on me. When I wrote to the office of Dr. Haïssaguerre, I was informed there was a waiting list of 9 months. I put myself on that waiting list and got a date for July 2, 2007.
In December of 2006 the palpitations became much more severe and longer and finally turned into persistent A-Fib that would not stop. I wrote back to Bordeaux pleading for a sooner date, since my condition had turned worse. My cardiologist, Dr. Mark A. Zatzkis, was very supportive and wrote a letter himself to the office of Dr. Haïssaguerre and Dr. Jaïs. The secretary told me that they might move up the date of the ablation to the end of May, 2007. In the meantime I also explored the possibility of going to the Cleveland Clinic, where Dr. Andrea Natale is quite well known as a skilled ablation-surgeon. But even there the waiting list was 6-12 months.
Fortunately I received an e-mail from the secretary of Prof. Haïssaguerre and Dr. Jaïs that they had a cancellation date for the 5th of March. I was delighted and immediately accepted that date. I wire-transferred the money (which was not easy since the bank would only make transfers in dollars) and scheduled the necessary trans-esophageal echocardiogram in St. John’s Hospital in Santa Monica. It was an uncomfortable but relatively short procedure performed without any sedation (which I had been promised and expected).
My husband and I left for France on the 2nd of March and arrived in Bordeaux on the 3rd in the afternoon. I had received a list of hotels in the area. We decided to stay in the Holiday Inn which is about one kilometer from the Hôpital Cardiologique du Haut-Lévêque, in an industrial park just outside of Pessac, a suburb of Bordeaux. The hotel is new, clean and comfortable. The staff is very courteous, but not always helpful. It is better to reserve rooms 2 weeks before the arrival. The rates change drastically, as we found out, when you stay there without prior reservations; and business groups frequent the place often filling the relatively small hotel. On Monday the 5th of March I was supposed to check into the hospital between 2-4 p.m. We made a trial run walking to the hospital to be able to locate the right department in the afternoon. I can only say that i was fortunate to speak French, since very few people (except for Dr. Jaïs and a few interns) spoke any English.
I did not see Dr. Jaïs (Prof. Haïssaguerre was in Prague at a conference) the day before the ablation, and I made sure I was still awake after being given a sedative by IV to verify that he was there before I was semi-unconscious. The ablation started around 8:15 a.m., and fortunately I was the first patient. Six hours later I was finally in the recovery room in sinus rhythm.
Following is a technical description of the ablation performed.
1. All four Pulmonary Vein openings were ablated to electrically disconnect them from the left atrium. Atrial Fibrillation persisted.
2. An ablation line was made at the roof of the left atrium connecting both superior Pulmonary Vein openings.
3. All sites in the left atrium and Coronary Sinus displaying rapid/heterogeneous activity were ablated.
4. An ablation line was made at the Left Isthmus between the left inferior Pulmonary Vein and Mitral Annulus. At this point Atrial Fibrillation terminated and was transformed to an atrial tachycardia which was mapped to a small re-entrant circuit in the Septum which was successfully ablated.
5. All linear lesions were checked for complete block.
The recovery room turned out to be the only unpleasant experience, since the young nurses there were unresponsive and unsympathetic. During the long ablation procedure I had been injected with 4.5 liters of water to cool down the tip of the hot catheter. When I kept asking for a bedpan to relieve myself, I was often ignored and told that I did not need it again. I kept asking to be released to my room, since I was perfectly awake: but they kept me there for over two hours. Only when I flagged down a passing doctor and asked him (in French) to release me, was I able to return to my room where my husband and daughter were anxiously waiting.
I did not see Dr. Jaïs after the operation that day and not for the next 5 days, since he also went to Prague for a conference. The nursing care on the third floor of the hospital was very good, and all the nurses were friendly and helpful.
I read in another report of a patient, who also went to the same hospital, that he loved the food there. Well, they must have changed chefs, because i have never had worse food than in that hospital. My husband, who did not stay in the same room with me, even though there were two beds, refused to eat there but was always offered food. The hospital cafeteria is not open to the public, but there is a limited newsstand/snackbar. There is a gourmet lunch restaurant across from one of the sides of the hospital’s vast acreage, Le Fleuret.
After the ablation I felt good and had no pain. I was given anticoagulants in injections and also started to take Coumadin again. Since I had been given Vitamin K during the ablation procedure, it was difficult to build up the Coumadin level. On Friday, after being operated on Tuesday, I was released from the hospital, since that section of the Cardiology Department shuts down on the weekend. The severe cases can stay on the other side of the hall, where they have constant care.
We went to stay in a hotel in the center of Bordeaux, which is a beautiful city, and I felt good and relieved. My heart beat normally in sinus rhythm. We took a lot of little walks and ate at some wonderful restaurants.
On the 10th day after the ablation, the A-Fib palpitations returned while I was resting in bed. It was a shock and utter disappointment. Of course it was Friday evening, and the doctor was out of reach. We sent him an e-mail but did not hear from him at the hotel. We cancelled our return flight, which was scheduled for 2 days later. The next day, Saturday, I went in desperation to the department that is open during the weekend. The nurses took an EKG and told me to wait to talk to an intern. He gave me a beta-blocker and told me to come back Monday morning when Dr. Jaïs was expected back.
On Monday I was at the hospital early and had my blood taken and another EKG, but had to wait to see Dr. Jaïs for four hours. He wanted me to go home for a while and then come back to have an additional ablation. I told him I felt worse than when I arrived in Bordeaux and that I was not going to return home in that condition. He finally agreed to perform another ablation on Friday, March 23, 2007.
I checked back into the hospital on Friday morning at 7 a.m. and was the first patient. He took a little more than 2 hours to eliminate another source of A-Fib that had emerged. (Two focal atrial tachycardias were ablated at the left septum and at the base of the Left Atrial Appendage which restored sinus rhythm. There was no reconduction at the Pulmonary Vein openings, and all linear lesions were still completely blocked.) Fortunately they didn’t move me to the unpleasant recovery room this time. Dr. Jaïs was pleased, and I stayed for one night in the other section of the Cardiology department. After an additional stay of 3 days at the Holiday Inn, we flew back from Bordeaux to Paris, and the next day back to Los Angeles.
Unfortunately the airline refused to provide seats from our cancelled return flight despite our pleas that the cancellation was due to an unplanned hospitalization and our willingness to nevertheless pay a cancellation fee. So, we had to buy another roundtrip ticket.
I was given a lot of injections of Lovenox (an anticoagulant) which I had to administer to myself twice a day. This was very unpleasant and left my stomach area black and blue.
Now I have been home for almost a week, and it is 12 days after the 2nd ablation. I feel well and free of Atrial Fibrillation.
E-mail: zukors (at) verizon.net
Update: May 27 (2007)
Gisela wrote that she is still in sinus rhythm. She had one brief hour-long heart racing episode May 3. She took Bisopropol 5 mg (a beta blocker) and hasn’t had any problems since then.)