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A-Fib Patient Story #3

Mirjana Clark’s A-Fib ExperiencePhoto of Mirjana Clark

by Mirjana Clark, 2003

Mirjana Clark is a 70-year-old retired medical researcher from Emory University in Atlanta where she worked for twenty years. (Her son works in tech research.) She emigrated to the US from Croatia in 1965 and likes to travel. She plays the piano and, before going into Persistent A-Fib, loved to line dance. Except for her A-Fib she was active, healthy, and into organic foods. Her story is particularly important for those who have Persistent and/or Chronic A-Fib.

I had paroxysmal vagal lone atrial fibrillation (LAF) for 10 years. It improved during the last two years, from 3-5 (even 7) episodes per month to only 1-2. The A-Fib episodes usually lasted 1-8 hours, though sometimes an A-Fib attack would persist for a few days. In earlier years all attempts to ease the frequency and duration using drugs, diets, supplements, etc. failed. Oral magnesium worked for a while, but then it caused diarrhea and I had to stop taking it.

A couple of years ago I learned about magnesium in liquid form which is absorbed sublingually, and it was apparently very effective. For all that time I lived with A-Fib without too much trouble.

Then, in November 2002 two things happened. First, I switched to another magnesium formulation from the same company, to be absorbed through the skin while in the bathtub, either through the whole body or only through the feet. I am not sure if this latter product worked. Second, I had a very bad experience with dental work which caused a lot of anxiety.

An A-Fib episode followed which lasted 2 1/2 days before I went to an emergency room for conversion. This was my third time in ten years. They did not want to convert my heart, because they thought I might already have developed a blood clot. I left the hospital with the fear that, if my heart converted on its own, I might get a stroke. So, instead of converting spontaneously as usual, my A-Fib became persistent.

My life changed completely. Before I was very active. Now I became sedentary and spent nights feeling the beats of my struggling heart. The only way I could get some sleep was by sitting up in bed. Ablation was my only hope. I called the Cleveland Clinic, which had a 7-month waiting list. I also called Bordeaux (France), where the waiting list was 3 months long.

From my reading of bulletin boards on the web and speaking with cardiologists, I was not always encouraged to go ahead with an ablation. Most people recommended waiting another two years. This was unacceptable to me. Even if it had a 50% chance of success, I was willing to get the procedure done. I thought that if the ablation failed, I could always get a MAZE operation.

In this state of mind I flew to Paris, took the bullet train to Bordeaux, spent two days in a motel near the hospital. There I read the book “The Healer Within” by Roger Jahnke. This book was a real help during those lonely days full of uncertainty in the motel room.

On March 24th I bravely walked down the road from the hotel to the hospital with my suitcase rolling behind. Shortly after being admitted, Dr. Haïssaguerre kindly came to meet me in my room. We exchanged a few words, but what I remember most is having to hide my deep admiration for him.

Later that day the ablation procedure was performed by Dr. Jaïs. The procedure was not simple. It lasted four hours instead of the expected two and a half. One good thing was that he did not have to puncture the wall between the atria.

Editor’s comment: Doctors usually have to pass the catheter from the right atrium to the left through a membrane called the foramen ovale formed early in life as the heart develops. In early fetal development the left and right atria aren’t completely separate. As the transseptal wall forms between the two atria, this foramen ovale opening usually closes up. But in Mirjana Clark’s case, the foramen ovale membrane never closed up completely.

A second good thing was that the sources of A-Fib were close to the surface, so they were easy to ablate. The problem was there were many of them. I had to receive eleven electrical shocks, and I really felt the last ones.

Editor’s comment: According to Dr. Jaïs the electrical shocks were necessary to reestablish sinus rhythm in order to evaluate the ablations that were made and to complete them if necessary. Ms. Clark also had a source or focus of A-Fib that didn’t come from the Pulmonary Vein openings where most A-Fib originates. Cardioversion was necessary to find this non venous focal point. “This was really a difficult case.”

When I first felt that my heart had returned to normal rhythm, I was exhilarated. I did not know how to express my gratitude to Dr. Jaïs.

But two days later I developed AV Tachycardia (right atrium) (Junctional Tachycardia, AVNRT) and had to have a second ablation. This was a tricky procedure because of the risk of damaging the AV node which would have required the implantation of a pacemaker. Dr. Haïssaguerre performed the procedure, which was quick and successful. He also verified that the sources of fibrillation had previously been successfully ablated.

Then I left for Paris to celebrate my recovery. One week later, walking down the Seine river I had another attack of tachycardia and had to return to Pessac-Bordeaux. This time the problem was in the left atrium. Dr. Jaïs successfully performed this third ablation and also checked everywhere for possible sources of A-Fib, and found none. Apparently, both sources of tachycardia had been present for many years. I had not been aware of them, because tachycardia usually rapidly turns into A-Fib.

Editor’s comment: According to Dr. Jaïs, Ms. Clark had a small reentrant circuit in the anterior left atrium, a relatively rare condition. He has seen only six cases of this.

During my seven days in the hospital, Dr. Jaïs visited me daily. During his visits he gave me his full attention, listening, explaining procedures, drawing sketches. He did not show the least urgency to leave, although the nurse told me in the procedure room that they were very busy performing three to four ablations a day. The last time I saw Dr. Jaïs that day, he was going to perform an ablation on a pregnant woman. I had full confidence in him and in Dr. Haïssaguerre. It was a pleasure and a privilege to meet them both.

Editor’s comment: The doctors at Bordeaux advise patients with Persistent and/or Chronic A-Fib to schedule a three to four week period in France if coming for treatment from overseas. Patients with Chronic A-Fib are more difficult to cure and usually require more than one ablation procedure.

It has been two months since I had the ablation, and I still do not know if I will stay permanently free of A-Fib. I am still not taking any medications. Regardless of the outcome, I know I made the right decision.

Now I still experience occasional PACs (Premature Atrial Contractions, extra heart beats) which are sometimes uncomfortable, especially at night. I hope this will improve, as the heart fully heals. However, I much prefer having these than A-Fib.

In conclusion I am pleased that I made the decision to have this procedure. If I had to, I would certainly do it again.

Mirjana

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