A-Fib Patient Story #43
A-Fib Causes Devastating Effects—From Shanghai to Bordeaux. Unusual Right Atrial Appendage Ablation
by Max Jussila, 2010
I am a 54-year-old Finnish lawyer working in Shanghai, PRC since 1996. My work is rather stressful and very hectic from time to time, but I love it. I mostly deal with corporate and commercial law but also project financing.
First A-Fib Attacks
I experienced my first event of Atrial Fibrillation in 2003 on a beautiful summer morning in Finland. I was on a holiday from China, and during the previous night some friends and I had had BBQ with quite excessive drinking. The doctors at the ER immediately called it a “weekend heart” or “holiday heart;” and since it converted by itself in just a few minutes after an EKG had been taken and the diagnosis made, they just sent me home. I was not given any medication at that time nor was I prescribed anything to take on a permanent basis.
The second incident appeared more than half a year later, also in Finland, on winter holiday; but this time I hadn’t had any alcohol to drink. I went to the ER, the A-Fib converted by itself after maybe a half-hour again while I was waiting (EKG was already taken), and I made an appointment with a cardiologist. He did the routine tests, lipid panel, heart echo, and stress test on a bike and told me my heart was in excellent condition. But that, based on the EKG, I unfortunately had paroxysmal atrial fibrillation. He also told me that many people have it and it is NOT dangerous. (A-Fib is dangerous and can cause stroke and other heart problems.) I started metoprolol beta blockers and tried to forget the whole thing. My A-fib stayed away for almost a year. I don’t believe that metoprolol had anything to do with the benign outcome. We just don’t know how often the incidents occur, and it’s really different from people to people.
Devastating Effects of A-Fib
After that peaceful year it was all down-hill for me. I started having A-Fibs (and PACs and PVCs) more and more often and had to be cardioverted electronically a few times. The Christmas of 2007 and early 2008 until the end of the year was absolutely the worst time that I have ever experienced. I was in A-Fib on and off, and nothing seemed to help. I had Rhythmol as a pill-in-the-pocket. It usually helped to convert the A-Fib; but after each incident and having taken Rhythmol, I was totally exhausted. And I had started getting A-Fibs every morning around 7 o’clock, regularly. The good thing was that they very often converted while taking a shower or on my way to the foreign clinic in Shanghai.
I was, however, constantly working. And I have to say that I have never been mentally so incapable and in plain words stupid as I was during that time. My memory was gone, my speech was gone (I speak five languages), and even the simplest work-related problems seemed impossible for me to handle, let alone solve. I had become totally obnoxious towards my wife and colleagues, and I was absolutely desperate. I was only 52 years old; I should have been on the peak of my professional skills and capabilities at that age, but mentally I was reduced to a 6-year-old child with constant tantrums. I understood that I had to do something about my situation.
Deciding to Go to Bordeaux
I started surfing the Internet and found Steve Ryan’s website. What a day! I studied everything very carefully and meticulously, discussed with my wife and with my Chinese cardiologist (a very nice chap). Since he supported my decision to have a catheter ablation (mind you, I’d have had it done even if he’d been against the whole thing!), I wrote to Bordeaux in August 2008. I was given a time 9 months later. Since I had A-Fibs now on a daily basis and was seriously frightened that the atrial fibrillation would become persistent, I wrote to Bordeaux again asking for an earlier appointment. The response was positive, and I was scheduled for a catheter ablation on 19 January 2009.
I first flew to Finland to see my 90-year-old Mother who is in persistent A-Fib, and had a TEE (trans-esophageal echocardiogram) done in Helsinki. It took about 15 minutes and was not at all unpleasant: the doctor sprayed “something” (novocaine?) into my throat and inserted the catheter, checked, found nothing, and it was over (I’ve read other people’s stories on [A-Fib.com] and found out that some have been sedated for TEE. Why?). I then flew to Paris, took the bullet train to Bordeaux, and stayed two nights at the Holiday Inn near the heart clinic of Hopital Haut Lévêque – Bordeaux Pessac. I went to downtown Bordeaux to see the city which was an experience per se.
On Monday the 19th I went to the hospital around 1 PM. The welcome was very nice and professional, most of the nurses understood English and my rusty French, my private room was very nice, food was good, and everything made me feel confident. About 1.30 PM a nurse rushed in and gave me a bottle of Betadine solution (bacteria-killing shower soap), and told me to take a pre-operational shower. She was going to come and shave my groin after fifteen minutes, and I was supposed to be taken to the OR to have the ablation done. The ablation was actually scheduled for the next day, Tuesday, but why not? I did as I was told, and very quickly I was down in the OR where a very nice and soft-spoken (and gorgeous) Dr Mélèze Hocini introduced herself, asked how I felt, and told me that she’ll perform the ablation. I was given local anaesthesia on my right groin, and Dr Hocini started. During the ablation I received something for pain. The pain was not unbearable but might have been unpleasant without the medication. So, I was conscious all the time. And Dr Hocini told me every now and then what she was doing which was very interesting. Pr Pierre Jaïs popped in after a while to lead a catheter through the septal wall in my heart. Dr Hocini finished after 6.5 hours having isolated all the pulmonary veins and ablated the cavotricuspid isthmus with complete linear block. It was 8 PM, and she was totally finished, I could see that. A more than 12-hour working day for her, which I understand is not anything exceptional. I just have to admire these wonderful people!
The post-ablation stay of 5 days and the check-up next Monday went fine, nothing in the stress test or otherwise. I cannot say that I had any chest pain really, just a little bit uncomfortable feeling. But the bed in OR had been quite uncomfortable, and I had been lying on it for 6.5 hours and could certainly feel that. I was given Nexium 40 mg to prevent esophageal fistula, and Coumadin to prevent blood clots. During my stay at the hospital I watched history documentaries on my computer from CDs I had brought with me.
A-Flutter Post Ablation
I flew home to Shanghai, but problems started a couple of weeks after the ablation. I had two subsequent A-Fibs, which converted by themselves. But then a Flutter begun. It was electrocardioverted five times but persisted. I had to fly to Beijing to negotiations and was in Flutter with a heart rate of 108. The Flutter lasted for a couple of weeks despite taking flecainide, and then suddenly converted into normal sinus rhythm at a wedding we attended on 9 March. I couldn’t believe the feeling!
I had already been in contact with Dr Hocini who agreed to a second ablation. The second one took place on 30 March. The experience was exactly like the first one: I was very well and professionally treated, and I really felt confident that I was in very good hands. Now two doctors were working on me, Dr. Hocini and Pr. Michel Haïssaguerre. It took them another 6.5 hours to ablate.
This is how the doctors described the procedure: “The PVs remained isolated. Burst atrial pacing induced several AT (atrial tachycardia) mainly with a focal mechanism and one rotating around the mitral annulus. A mitral isthmus line was performed which resulted in transformation of the tachycardia to AF. That AF terminated after targeting all fractionated and complex sites in the right and left atria. Finally termination of AF was obtained during ablation at the right atrial appendage. Following this, atrial pacing demonstrated a complete linear block at the LA roof, mitral isthmus and cavotricuspid isthmus.”
I was told my case was really difficult (I’m not bragging, I really wish I had had a very simple-to-cure problem!). The right atrial appendage is seldom ablated according to my understanding. Post-ablation time at the hospital (3 days) went without any incidents, and I returned to Shanghai. Maybe it was due to the skills of the doctors. But after those two ablations I had no chest pain, no bruises in my groin, nothing to make me feel uncomfortable. I also think that it’s a good thing not to be sedated during the procedure, because that way you are aware of what is happening around you and can even interact with the doctors. The only “uncomfortable” thing was the amount of fluids that were pumped into me, so I had to ask for a bottle to urinate in three times during the procedure.
I kept a diary of my “feelings” and I have to say that this time I actually really felt that I was cured. In the early weeks of April I could feel some extra systoles, but nothing really bad. I experienced one strange night by the end of April when I had really bad nightmares, but I have no idea whether they were heart-related or not, and I guess not. I had the first post-ablation 24-hour Holter monitor study done on 14 May with just 3 supraventricular ectopics, nothing else.
Now I am 20 months post my second ablation, feeling absolutely fine. I’ve had periods of extra beats, although a 24-hour Holter done 3 July this year showed only 4 supraventricular and 2 ventricular ectopics.
After all that I have experienced I’m quite sure I know what my heart is doing, whether it’s in A-Fib, Flutter or something else! Since the second ablation I’ve felt nothing really bad except those occasional extra beats. I am 54 years old now, and my heart rate is a steady 70 and my BP is 120/75 (this morning). I was given my life back, literally, by the extremely skillful doctors in Bordeaux.
I have started Chinese Kung Fu, san da–style which is practiced by the Chinese Army Special Forces (extremely good for muscles and joints), I exercise on my bike watching CNN news broadcasts half an hour twice per day, do some weight-lifting and swimming, and will most likely take up diving again. I cannot believe what a wreck I was before these two catheter ablations!
Grateful and Willing to Help Others
I am very grateful to Steve for these wonderfully informative pages on A-Fib. Whatever happens later on, I will be eternally grateful to the wonderful doctors in Bordeaux (especially Dr Hocini who is a straight shooter as well). They are developing their methods every day; and I am sure they will reach more and more people, that the results will become even better everywhere in the world. And to all those who suffer from this terrible condition called Atrial Fibrillation: do not listen to your doctor if he/she suggests medication as a long-term solution! Medication is a very short-term and temporary phase to keep you somewhat functional for a short period of time BEFORE catheter ablation. The doctors who see medication as a solution commit serious negligence and are ignorant of the terrible nature and consequences of atrial fibrillation.
I am an A-Fib Support Volunteer in China and am happy to help others get through the ordeal of A-Fib.
20 December 2010
Editor’s comment: The French Bordeaux group follows a protocol for difficult cases which can be read at 5-Step Ablation Treatment for Chronic A-Fib. In Max’s case they had to go through all five steps plus ablate in unusual areas such as the Right Atrial Appendage. Max’s case required a great deal of A-Fib detective work to track down and ablate all the A-Fib and A-Flutter spots in his heart.