A-Fib Patient Story #86
My Stubborn A-Fib Returns: A Third Ablation with Post-PVA Complication
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.
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.
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.
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.
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.
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.