A-Fib Patient Story #86

My Stubborn A-Fib Returns: A Third Ablation with Post-PVA Complication

Marilyn Shook - A-Fib story at A-Fib.com

Marilyn S.

By Marilyn Shook, July 2016

Note: We first posted Marilyn Shook’s personal A-Fib story, Pill-In-the-Pocket” for Five Years, then Catheter Ablation for a Cure (#25) in 2008. She then sent us updates in 2014, 2015 and earlier in 2016. Her latest installment is about a third ablation in late April 2016.

It’s been a few weeks since my third PVA [Pulmonary Vein Ablation] and I am doing well.

Just to jolt your memory―I had my first PVA in 2007 and did well for 7 years. My A-Fib returned in 2014. To document any arrhythmia, I had a tiny Medtronic Reveal LINQ cardiac monitor implanted. The captured data confirmed my A-Fib, and I had a second PVA in October of 2014. [su_pullquote align=”right”]Marilyn Shook is also one of our many A-Fib Support Volunteers and lives near Detroit, MI.[/su_pullquote]

I was A-Fib free until February 2016 when A-Fib/Flutter returned. I opted for my third PVA, which was performed in April 2016 by Dr. David Haines at Beaumont Hospital [Michigan].

Post-Ablation Complication: Cardiac Tamponade

Under general anesthesia, my PVA was extensive work but completed in about 4 hours. I was in sinus rhythm before and after the procedure. After my ablation, I was awake, alert and responsive and then suddenly became unresponsive, with thready pulse, blood pressure plummeted. [su_pullquote align=”right”]A Cardiac Tamponade is when blood fills the sac around the heart. During a PVA, it’s usually caused by a small hole created by a penetrating ablation burn.[/su_pullquote]

I was having a post PVA complication―a cardiac tamponade―an emergency situation!

A drain was inserted into my pericardium, [the sac around the heart] and one liter of blood removed. I was transfused with 2 units of blood, then transferred to the ICU with the drain in place. Total blood drainage was about 2 liters.

All I remember is seeing Dr. Haines’ face and hearing all sorts of commands. I remember no pain.

Sent Home but Develops Sinus Tachycardia

After 3 days, the tamponade was under control, and I was discharged from the ICU and sent home. A couple of days later, I felt a very rapid, regular heartbeat. It started on a Sunday, and I waited until early Monday morning to contact my cardiologist. [su_pullquote]”After a couple of days at home, I felt a very rapid, regular heartbeat. My ECG showed I was in sinus tachycardia, a rapid, but regular heartbeat.”[/su_pullquote]

My ECG showed I was in sinus tachycardia [a rapid, but regular heartbeat], and I was sent to the hospital electrophysiology lab. After a TEE (Transesophageal Echocardiogram) and cardioversion as an outpatient, I converted into NSR [Normal Sinus Rhythm].

Back at home, I did better every day, but initially I was so fatigued. Ten years ago, recovery from my first PVA was rapid and easy. Recovery from my second PVA took a little more out of me, but the recovery was easy.  This time, I was much more fatigued, no pain, just fatigue.  Of course, I am 10 years older than when I had my first PVA, and this time there was a major complication.

My Latest Cardo Appointment: No Arrhythmias!

I saw Dr. Haines in late June and he checked the data from my LINQ monitor―I had no arrhythmias. I am not on any cardiac medications. But I remain on Xarelto for another 6 weeks.

He told me extensive work was performed during my PVA. Interesting was the fact that the pulmonary veins were mapped and all was quiet in that area [from previous ablations]. Much work was performed in the left atrium. There was extensive mapping, remapping, re-ablation, observation and provocative testing.

Lessons Learned

Lessons Learned graphic with hands 400 pix sq at 300 res

The O.R. report from my third PVA documents that my A-Fib was not caused by my pulmonary veins but by non-pulmonary vein triggers.  These triggers were identified and isolated.

Research at this time suggests that there are no significant differences in complication rates between first, second, third or fourth ablations.

We must remember that all ablation procedures have a chance of complications. Cardiac tamponade complications occur in less than 1% of catheters ablations. Never did I think it would happen to me. [su_pullquote align=”right”]To learn how choose the right doctor for you and your treatment goals, see Finding the Right Doctor for You.[/su_pullquote]

I survived and I am doing well because I was at a great hospital with a team of physicians and nursing staff ready to identify and correlate my care during a cardiac emergency.  I had a very knowledgeable electrophysiologist, an expert in the field of Pulmonary Vein Ablations, and top-notch anesthesiology at my side.

All these variables matter, so choose your doctor carefully.

Would I have another catheter ablation?  Yes, if I am a candidate, I would.  But, I have confidence that my A-Fib will not return.

Marilyn Shook
E-mail: nmshook(at)sbcglobat.net

Editor’s Comments

Why Did the Tamponade Happen? Of the nearly 100 Personal Experiences we have published on A-Fib.com, Marilyn’s is the first description of a tamponade. Dr. Haines had to perform extensive mapping, ablation and re-ablation in the left atrium. Somehow one of these catheter ablation burns made a small hole in the heart causing blood to drain from the heart into the pericardium sac.
It’s probable she was at increased risk of a tamponade because of the high difficulty level of her ablation which required more extensive burns than an ordinary ablation. Even the most skilled, experienced EPs can have a tamponade occur.
No Lasting Damage from Tamponade: All experienced EPs and their staffs anticipate and prepare for complications. Dr. Haines and his staff were well prepared and handled this tamponade by draining the leaked blood from the pericardium sac while the small hole in the heart healed by itself. Marilyn went home in three days and was fine. There was no lasting damage to her heart.
This is not to discount the dangers of a tamponade. Without attentive care, Marilyn could have suffered severe heart damage and even have died.[su_pullquote align=”right”]Free download: How and Why to Read Your OR Report – a special 12-page report for Atrial Fibrillation patients by Steve S. Ryan PhD.[/su_pullquote]
For You Technical Types: Marilyn’s O.R. Report: Marilyn sent me her O.R. report so I was able to read what Dr. Haines found and what he did.
He found that Marilyn’s Pulmonary Veins (PV) were still completely silent with no A-Fib. He made a linear ablation line in the left ridge (between the two Left Pulmonary Veins) which terminated her A-Flutter into normal sinus rhythm (that’s the best outcome).
But instead of stopping there, Dr. Haines used electrical signals (pacing) and was again able to induce A-Flutter. He discovered mitral annular flutter and made a linear mitral annular ablation line which again terminated the A-Flutter into sinus.
When he paced again, he found high frequency A-Fib signals coming from the Left Atrial Appendage (LAA). He ablated in this region and extended a linear ablation line towards the base of the LAA which terminated her A-Fib. At this point he ended her ablation.
The locations of Marilyn’s A-Fib/Flutter signals are somewhat unusual. It’s troubling that we don’t know why she developed them. What’s encouraging is that a good, experienced EP was still able to make her A-Fib free.
The Bottom Line: The risk of a tamponade shouldn’t scare you away from having a catheter ablation. Look at how efficiently Dr. Haines and his staff handled Marilyn’s tamponade!
Even in this worst case scenario, Marilyn is fine and A-Fib free.
Find the Best EP you Can Afford: Marilyn did her homework when she selected Dr. David Haines as her EP. She was confident in his treatment advice. She continued to rely on him and his staff over the years as her A-Fib poked up its head again in 2014 and 2016.
This is why we always advise you to see a heart rhythm specialist and to carefully choose your electrophysiologist (EP). To learn how, see Finding the Right Doctor for You.

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