A-Fib Patient Story #31
Living with a Pacemaker/ICD
By Ira David Levin
30 Years of Heart Problems
I have been a heart patient for just short of 30 years. I began this career in 1980 with a heart attack so mild it wasn’t properly diagnosed until 4 days after the event, and I never did go to the hospital. That heart attack was preceded by more than 15 years of sedentary life augmented by indulgences in every form of coronary risk possible: poor diet, lack of exercise, alcohol consumption, smoking and, worst of all in my humble opinion, family history: my mother’s side of the family was rife with heart disease.
As a former competitive swimmer in college, my answer was to return to the pool with a vengeance, not so much motivated by a belief in healthy living, but more to demonstrate to myself that I was hale and hearty and not an invalid. I began with a program not much different from my college training routine and maintained it for 25 years slowing down as I aged. I went to an improved diet, although I continued drinking wine, since I have been living in Italy since 1970, and the wine here is excellent and varied. Fortunately I had given up Smoking 5-1/2 years before the first heart attack.
And so life went on swimmingly until 2001, when during a period of mild depression, I had another mild heart attack and drove myself to the hospital.
I recovered and returned to my swimming and walking routine and was in excellent shape for a 68-year old. The next summer I did my usual swimming routine in an outdoor pool where the water was much cooler than usual. That resulted in my third very mild heart attack. But after the usual convalescence I returned to my swimming routine with as much determination as ever.
My A-Fib Starts
The following year I developed atrial fibrillation of the paroxysmal type and was put on sotalol by my cardiologist. This was a new experience. I had understood heart disease as a plumbing problem, but this electrical rhythm disorder was something quite different.
My cardiologist in Rome, who is first-rate, careful and honest, counseled against an ablation in Rome, because at that time (6 years ago) he held the success rate not good enough. I researched A-Fib on the web; and with the advice of a cardiologist friend of a close friend of mine, I had an ablation done in the town of Asti where a particular electrophysiologist had established a first-rate team. I didn’t go to a much better known and more controversial EP in Milan.
Successful Pulmonary Vein Ablation
The procedure went well, and I was one of the lucky 50% whose ablation worked on the first go. And so I didn’t have to return for a touch-up ablation, as the other 50% have to do. The hospital monitored me every 6 months for 2 full years after the ablation to see if the A-Fib had returned, and I happily reported each time that all was well.
Heart Setback (Not A-Fib)
I returned to the pool and unwisely continued pushing the envelope until things began to turn nasty. One day in 2006 I really overdid it in the pool and set off dyspnea (labored breathing) and a tachycardia where the heart rate was so fast it seemed like a steady-state signal. It passed after a couple of minutes and I returned to the workout, but much more slowly.
Three days later the next time I went swimming, I didn’t feel right; so I contacted my cardiologist. I now had PVCs on an irregular basis and was put on beta blockers which helped control them. Unfortunately, I couldn’t take a regular dose of beta blockers, because by nature I was slightly bradycardic with a normal pulse rate of 58-59 bpm. With beta blockers and other heart medicines such as ace inhibitors and calcium channel blockers, my rate went down into the mid 40’s and sometimes into the 30’s at night. My cardiologist mentioned the possibility of a pacemaker, but felt it wasn’t necessary at the time.
Pneumonia and Heart Tachycardia
Then a chain of events and their cardiac impact pretty much took over my life for most of 2008. After a modest flu, I suffered a stubborn Bradycardia of 38 bpm that after 5-6 hours left me feeling quite weak. I went to the emergency room. After bringing my rhythm back to normal, they admitted me not to the cardiology ward which had no room, but to another department where there was an available bed. Two days later I had pains in my back, which turned out to be a pneumonia caught in the hospital.
This naturally put a strain on the metabolism in general and the heart in particular and set off a tachycardia of something like 220 bpm. I felt very strange and did not understand what was happening. It felt like an extreme state of nervousness, so strong that it seemed palpably physical. I was convinced it was a nervous reaction to the news the doctor had just given me of the positive result of a chest X-ray I had done earlier that day. I didn’t react to the tachycardia for close to 5 minutes and then started down the hall to ask the doctor for a tranquilizer.
Fortunately, the doctor and 2 nurses were in the corridor and saw me weaving as I walked and immediately understood the gravity of the situation, which I still didn’t. They slammed a wheelchair under me and brought me back to my room, set me on a monitor and administered a massive dose of amiodarone intravenously, which brought the pulse rate from 220 to 80 in short order. I had been panting uncontrollably trying to get the oxygen that wasn’t arriving from the blood my heart wasn’t pumping, and I heard a nurse inform the doctor that she couldn’t find any sign of my minimum blood pressure. But despite these obvious signs, I still didn’t understand the seriousness of my situation.
They then put me out and did a conversion on me. When they left me, I was fatigued, but quite relaxed, and I thanked them for their efforts. The next day the doctor returned to see how I was doing and made the statement that the only reason I survived the previous night was because I had a very strong heart, which I ascribe entirely to the 25 years of serious swimming. I also began to realize the seriousness of what I had been through the night before.
ICD and Pacemaker
I was transferred to the cardiology department, and a few days later I was on the table in the electrophysiology lab where they sought to recreate the crisis I had experienced, so they could map the point of origin for future reference in case a ventricular ablation became necessary. With his catheters the electrophysiologist went into the left ventricle where the PVCs originated, expecting to find the starting point of the tachycardia there. After 45 minutes without success they switched to the right ventricle, & within 5 minutes they found the sensitive point at the juncture of the ventricle and pulmonary artery. They installed an ICD and set the maximum at 120 bpm and the minimum at 50.
Pacemaker Leads Infected
5 months later during a trip to the States, the pacemaker turned out to be infected at the end of the leads in the heart. That meant the ICD had to come out, followed by 6 weeks of intravenous treatment with vancomycin in a rehab hospital, after which I got a new ICD implanted before returning to Italy. I would love to have a ventricular ablation in addition to the ICD, but I have a feeling that a ventricular ablation is trickier than an atrial one and that fewer people know how to do it as well as an atrial one.
Living with an ICD/Pacemaker
I am able to live a more normal life with this problem than I was with my A-Fib, although I am now 5 years older and about to turn 75. So now I swim more for muscle tone than for aerobic value. I hope to stay out of hospitals for a while except for outpatient tests and to visit friends, who may be unfortunate enough to have to be admitted.
In the 14 months since I had the pacemaker implanted, I haven’t had a single shock. But I have had several pacer signals which interrupted tachycardia runs after 13 or 14 beats, and one or two where the heart interrupted the run by itself after 7 or 8 beats. I didn’t feel these signals and only learned about them later during a routine check of the pacemaker, when they download all the data.
During my stay at the rehab hospital, I didn’t have a pacemaker and had a run of 7 beats of tachycardia which showed up on the hospital telemetry. The alarm sounded, and the nurse rushed frantically into the room expecting the worst only to find me calmly sitting in the armchair next to my bed reading. My heart had interrupted the run by itself and was totally asymptomatic.
My pacemaker limits are set at 50 and 120, since my normal heart rate without medicines is 58-59. With medicines I sometimes go down to 45, which the pacemaker easily keeps at 50, and I feel nothing. But there are occasions when the Bradycardia wants to go lower, such as 30 bpm (one beat felt & one skipped) or 38 bpm. On those occasions I can feel a tug of war between the Bradycardia and the pacemaker. I will have the Bradycardia for 30 seconds to a minute or two. Then the pacemaker will give me regular beats for a minute or so before the cycle begins again. Had I not had the pacemaker, the Bradycardia would have stayed steady for hours and hours leaving me incapacitated.
My personal case history also includes 4 episodes of Pericarditis, one after each of the last 2 heart attacks, one after the ablation and one in 2006 apparently unrelated to any event. As I understand it, Pericarditis is not life-threatening if treated promptly, but it causes the most unspeakable pain with each heart beat and another equally nasty pain with each breath. The worst one I had lasted about 15 hours and was utter agony, unresponsive even to several doses of morphine. Lesser versions lasted longer (up to 2-3 days), but were only slightly less painful and unpleasant.
My cardiac career also includes cardiac asthma as the result of an immune reaction where a mild flu was mistaken by the immune system as an allergy. After 2 weeks of asthma where the usual medicine had no effect, I ended up in the hospital with a near edema due to the eventual weakening of the ventricular function, which was quickly taken care of by the staff once I was in the hospital.
Importance of Exercise
Even though my enthusiasm for swimming has got me into trouble, it is great for the heart, for muscles and for my psyche. I will do it as long as I can. I plan on swimming into my 80’s, God and good health willing.
I am enjoying a really good period right now pretty much free of PVCs. I now have the wisdom not to overdo it with a good thing, swimming. Swimming is an excellent form of exercise, because it exercises a vast array of muscles throughout the body, and because it rids the body of some of the annoying pains that come with old age. But for those people for whom swimming doesn’t come naturally, there are other forms of exercise that give similar benefits. Cycling, walking up long hills, and fast or even moderately paced walking on a level surface all have beneficial effects on the heart. Moreover, exercise is an excellent bulwark against depression.
Ira David Levin
Ira writes that his A-Fib returned five years after his successful ablation, but without A-Fib symptoms. He did experience a string of TIAs which are controlled by taking Coumadin. He is recently troubled by severe PVCs.
Ira David Levin shares his experience living with an ICD/Pacemaker. He had A-Fib but was cured by a Pulmonary Vein Ablation procedure. The ICD/Pacemaker is for other Ventricular heart problems.
Ira was born in Boston and returned there after college, where he met his future wife who was visiting from Italy. They moved to Italy in 1970, because she had to return for family reasons. He taught at the American Overseas School of Rome—Geography on the middle school level and Ancient History and Archeology at the high school level—for 25 years before retiring in the mid-1990s. His two children also attended American Overseas.
After retiring, he started a small travel company with an ex-history teacher from another American school in Rome. He loves Italy and wants to introduce Americans to the depth of beauty and extraordinary variety Italy has to offer.