Overcoming Silent A-Fib—Ablation by Dr. Patrawala
by Kevin Sullivan, 2011
I was 46 years old, played basketball three times per week, and lifted weights. I thought I was a healthy person and expected to live a long healthy life. I started having some strange sensations in my chest and noticed that on some days when I played basketball, I had a difficult time catching my breath. I assumed this was just what it felt like to get old. But I thought that it was odd that one day I would have trouble breathing, but the next I would feel fine.
Silent A-Fib Diagnosis
I went to see a cardiologist to determine if I needed to take medication for high cholesterol. They looked at my heart with ultrasound and asked if I could feel “that.” I asked them what they were talking about, and they told me that I was having atrial fibrillation. That was the first time I had ever heard of the phrase. I went back to the doctor two days later, and I was in sinus rhythm. I soon learned how to tell if I was in A-Fib or not based on how excited I felt and by checking my pulse. I started keeping a journal of how often I went into A-Fib, and it was for about two days out of every two weeks.
I noticed that my A-Fib started at night while I was sleeping. One night when I woke up, my heart was racing and I felt sweaty. I started reading about things which contribute to A-Fib and learned that high thyroid levels and sleep apnea contribute to the condition. My brother had sleep apnea, so that made me think I might as well. I asked my doctor about it, and he told me that it was unlikely because I was not overweight and I did not feel tired during the day. I went to a sleep lab anyway, and it turned out that I do have sleep apnea. My A-Fib was being triggered by apnea episodes during the night. I got an APAP machine to address the sleep apnea and hoped that was the end of my A-Fib. I went about three weeks without A-Fib, but then I had my first daytime onset of A-Fib that I was aware of. This brought me down as I was hoping that fixing the sleep apnea would fix my A-Fib.
Discovering Pulmonary Vein Ablation
I read about A-Fib online. It was often associated with a gradual decline in the health of people and with a deterioration of the heart. I suddenly felt like I was an old man who was getting ready to fade away. I thought about A-Fib all of the time, and it made me wonder what other health issues I had that I did not know about. I was losing hope for the active and healthy lifestyle that I expected to have. I felt sad for my son and my wife thinking about how I would be a burden to them. I then found A-Fib.com and started reading about the pulmonary vein ablation procedure. It sounded experimental and I was skeptical, but it gave me some hope. I found the website of some doctors in Palo Alto who claimed that they had a greater than 90% success rate after two ablations with people that had paroxysmal A-Fib. I decided this was too good to be true and dismissed it.
The Fear and Anxiety of A-Fib
I lived with A-Fib for about six months, and it drove my entire life. I was depressed when I was in A-Fib, because I had read about the remodeling of the heart that can take place when you are in A-Fib. I did not like the thought of that. When I wasn’t in A-Fib, I was always thinking about what I might do to trigger it. For me, the two worst symptoms of A-Fib are fear and anxiety.
Fainting in the Gym
My local cardiologist prescribed Flecainide to me and recommended that I take Flecainide the rest of my life. He also put me on Coumadin. I had a strange sensation in my head from the Flecainide – it felt like I had a mild flu all of the time. I was talking to a friend at the gym with whom I had played basketball for the past ten years, when I started to feel light-headed. I was telling him about how I had discovered that I have A-Fib and what it was, when I suddenly fainted. He and another friend grabbed my arms as I passed out for about ten seconds. Given the story I had just told him, he asked for someone to call the paramedics. I was sent off to the ER in an ambulance. I thought I was fine, but the whole experience scared me.
Deciding on Pulmonary Vein Ablation
I decided to look into pulmonary vein ablation. I interviewed a doctor at Cedar-Sinai who told me that I had about a 70% chance of success and that I would probably be in the EP lab for about six or seven hours. I asked everyone I knew if they knew anyone who had A-Fib and if they had an ablation. I found three people who had ablations, and all of them were successful. This was encouraging as my cardiologist told me that he had sent ten patients out for ablations, and all but one came back unsuccessful. It turned out that all of the three success stories that I found were treated by the same doctor in Palo Alto – Dr. Roger Winkle. This doctor headed the group that had the website that I found earlier with success rates quoted as greater than 90% after two ablations (for patients with paroxysmal A-Fib) (Cardiovascular Medicine and Cardiac Arrhythmias). I went to see Dr. Patrawala, an associate of Dr. Winkle, and I was impressed with the thoroughness of their ultrasound imaging process and their answers to questions that I had asked. A-Fib.com had armed me with quite a bit of information to ask them about. I signed up for the procedure after thinking it over for a week. I was scheduled to have it done in three months. I decided that I could always cancel if my A-Fib stopped or lessened.
Ablation under General Anesthesia—Fainting after the Procedure
I developed a cold just prior to my ablation, and I was worried about how this could affect the procedure. The doctor told me that so long as I did not have a fever, then I would be fine to proceed with it. I was in the EP lab for about two hours. I was under general anesthesia, so I don’t remember anything about it. When I woke up, my bladder felt like it was going to burst (they use an irrigated catheter for the ablation which fills your body with fluid). But I could not elevate my body. So they put a catheter in me. I had to remain laying flat for six hours. I was also told to avoid tensing my abdominal muscles so that I did not bleed through the hole that was put in my groin, but my cold forced me to cough a bit. That was one of the worst parts of the procedure, but I did not have any bleeding problems. I eventually got up to go to the bathroom and fainted, causing a bit of an alarm for the staff and the other patients in my room. But this was just due to the effects of the anesthesia. I went home the next day in sinus rhythm with a resting heart rate of around 72. This was interesting to me because prior to the ablation my resting heart rate was typically in the 40’s.
In Sinus Rhythm!
I remained in sinus rhythm for about ten days. One night I awoke and I was in A-Fib again and was sweaty. I think that I had a sleep apnea episode again which triggered the A-Fib, even though I was using an APAP machine. The doctor also told me that it was normal to have A-Fib episodes during the first three months following an ablation, and that this did not mean it was a failure. My A-Fib went away after about ten hours. I have not had A-Fib since then. It has been ten months now, and my doctor tells me that very few (if any) patients get A-Fib again if they go without A-Fib for one year following an ablation.
I don’t know when I started having A-Fib. I could have had it all of my life without knowing about it. I have always had an unusually low heart rate (below 30 at times) which my doctors attributed to a sign of a healthy heart which received a lot of exercise. Following the ablation, my resting heart rate is around 60 now. I feel better than I can remember for quite a while. I am back to playing basketball and lifting weights, and I feel stronger than I have for many years.