A Long and Bumpy Road—Unfortunate First Ablation, Then Second Ablation by Dr. Reddy
by Rick Fitspatrick, 2011
My name is Rick Fitzpatrick and as of today, I have a happy story to a long and bumpy road with arrhythmias. As background information, I’m currently 50 years old, am a director of a software development company, have a family and some exciting outside hobbies – hang gliding, wake boarding, and snowboarding. I am an expert hang glider (30 years) and strong intermediate wake boarder and snow boarder. I used to play ice hockey also. So, that gives you some indication of my nature, which I expect many of the readers can relate to.
SVT When Young
As an adolescent, I occasionally had bouts of SVT (Supraventricular Tachycardia). I would lie down, breath slowly; and they would go away, at first. Eventually they got worse. So I went to a cardiologist. The meds he gave me worked. Then I stopped taking those meds, but happily the SVT had gone away.
It came back when I was in my 30’s, so I went back to a cardiologist. We found a beta blocker that helped manage the it for a while, but the SVT slowly progressed to be more intrusive to my activities. It came on during exercise, and that wasn’t acceptable. The doctor suggested a new procedure, an EP study and ablation to cure this. The regional hospital had one of the pioneers of that procedure, and I signed up. They did the EP study but discovered that the electrical problem was on the other side of the heart (the left atrium). They were not yet “poking”” through to the other side, so they didn’t do any ablation. While they were trying to trigger the SVT, they triggered A-Fib and had to knock me out completely and cardiovert me. At this time my EP said that no one was ablating A-Fib.
A-Fib Becomes Permanent
Back to the cardiologist. I began having A-Fib episodes that weren’t terribly symptomatic. I could continue my activities at the time, but I was aware of the A-Fib. We tried different mixes of medicine and eventually settled on Toprol, Rhythmol and aspirin. I did not need to take warfarin yet, since I had no other risks (under 70, good cholesterol, good blood pressure, etc). But as frequently happens, the A-Fib became more frequent. We tried other medicines Sotalol, Flecainide, etc. Rhythmol was still the most effective, but eventually the A-Fib became permanent. My doctor told me that there was now an ablation procedure that was effective for A-Fib.
I made an appointment with the EP who had originally performed surgery on me, and he referred me to their new A-Fib expert who had been recruited in from the Cleveland Clinic. He expressed confidence and reviewed the risks as required; and I scheduled an ablation, without a whole lot of thought. My life centers around managing risk and surviving, so I’m definitely not a scaredy cat…
First Ablation—Tamponade, Stroke, and Still in A-Fib
The ablation procedure took place in early Feb 2006. It was expected to take 6 hours. They took me off of Coumadin and put me on Heparin (Lovenox injection ahead of time). About 2/3 of the way through the procedure, they recognized a lowering of my blood pressure, a potential sign of tamponade. Tamponade is when blood leaks through a hole in the heart and becomes lodged between the heart and the pericardium sack that holds it. Your heart basically gets strangled. They called a surgeon and applied protamine (the antidote to heparin). Maybe they did a TEE also, because they performed the surgery with a probe in there so they could stay clear of the esophagus—another of the big risks of the ablation. A surgeon put a drain in my heart through my ribs like a needle insertion, and drained the blood into a bag (pericardiocentesis). That session was now done…
I was in CCU for 3 days. On day 2, I noticed that I couldn’t see anyone on my right side. People were talking to me whom I didn’t know were there. Because of the drain in my heart, I couldn’t turn my head. A quick manual test showed that my peripheral vision was no longer functioning on my right side. A cat scan was ordered which showed that I had suffered a few strokes during the time when the surgery was being performed. They mostly impacted my peripheral vision and possibly some small motor skills also, but I have never noticed them. The peripheral vision loss is permanent.
Coping with Stroke and Worsening A-Fib
When I got out, I was determined to get back to do as much as I could possibly do. Since I had suffered a stroke, I needed to go on warfarin; so ice hockey was now off the table. In general my activity level dropped also. I gained some weight and had nagging elbow pain. We finally found out that was from gout. That was one of the best discoveries in this whole story (who cheers for gout, anyhow?). Gout can be triggered by many surgeries, I believe. I stopped drinking completely, improved my diet, and started a daily exercise routine. A year later I was back to as good or better than I had ever felt, except that I was still in and out of A-Fib. I also switched cardiologists. My former cardiologist thought that I should just respect my age and take it easy, and the A-Fib wouldn’t be a problem. I found one with a personality more like mine.
Of course my occasional A-Fib became more frequent and more problematic. I was looking forward to Multaq, hoping that it would be effective. It wasn’t, and my A-Fib became permanent again.
The new cardiologist told me that I should get another ablation. I kind of dismissed him at first. But since I’ve been lurking on the yahoo A-Fib support site for many years, I decided to take his advice and find the best doctor I could in the area. I was still doing all of my sports. But I noticed that my half hour on the elliptical was burning less calories that I used to, because I couldn’t push hard at all with the irregular heartbeat. Also, I was out of breath walking up stairs.
Meeting with Dr. Reddy
I found Dr. Vivek Reddy at Mount Sinai Medical Center in NY and made an appointment. It took some time to get in, but I was very impressed with him. He had read through all of my documents and was aware of my history. He asked some questions about it, and answered mine. My first question was had he ever had tamponade happen while he was operating. His answer was yes, that anyone who had done many of these has had that happen before. I also asked that if having had tamponade previously made me more or less likely to have it again. He said less, and he had good reasons for that. This was also confirmed by my cardiologist. Dr. Reddy told me that he expected I would need two ablation procedures. Hopefully, the first one could get me into sinus rhythm, but there would probably still be some flutter. Then a second operation would be performed shortly after that. I wasn’t happy at the thought of two ablation procedures, but really respected the fact that he was warning me of that up front. I see so many people on the A-Fib group go in for a second one, and not knowing it might be necessary adds a lot of unnecessary stress.
After thinking about it for a while and talking with my wife (she wasn’t too keen), I decided to schedule the ablation procedure, Nov 2, 2010. We’re not city folks. So the idea of the hospital there, and waiting rooms, and parking wasn’t exciting; but in retrospect it may have been the best decision we’ve ever made.
The ablation procedure was scheduled for 2:00 pm. We got there at about 1:00. I didn’t eat anything all morning. After some brief paperwork, I was brought in to get prepped. I changed clothes, meet the nurse, and get an IV started; and they drew blood to check my INR. Dr. Reddy performs the surgery with therapeutic levels of warfarin and heparin. Then they rolled me into the EP lab. Very similar to the previous one. Lots of electronics (big screen TV monitors), and a flat bed. This one actually had some inflatable cushions on it that the original one didn’t have. They shaved me all over and put on a gazillion stickers and wires. They also attached some of those big pads like they use for the cardioversion. They put me to sleep through the IV. Thankfully, the urinary catheter was saved for after I was asleep.
I woke up in the recovery room with my wife by my side and a sinus rhythm monitor beating away. I knew that might change, but so far so good! Dr. Reddy told my wife (me too, but I don’t remember) that he was very pleased with the results. He saw the scarring from the previous surgery on one of the arteries and touched that up, and then did the other three. He also touched up a couple of other areas that were needed. He said that he doesn’t expect that I’ll need a second operation, but clearly we won’t know for 3 months. That’s when my appointment is with him.
For now, I can do nothing for two days and have to avoid bending the groin. Then I can begin walking, but nothing more than that until two weeks are up. I can begin to get back onto a regular exercise routine as my body allows.
Two Months after Dr. Reddy’s Ablation
Since the ablation, I have got into A-Flutter a couple of times. The first time was a week or so after the ablation. I was put back on Rhythmol and cardioverted. After 9 days of sinus, the A-Flutter recurred. Dr. Reddy then put me on amiodarone (loading load, then 200 mg/day) for a couple of weeks before another cardioversion. As of today, I have now been in sinus rhythm for more than 3 weeks. A new world record…
A Second “Touch-up” Ablation
Dr. Reddy has recommended that I undergo the second ablation that had been expected. I am currently scheduled for Feb 3, 2010—3 months after the first surgery. This is expected to be a shorter procedure.
I never really thought that such progress could be made. My fingers are still crossed, but I’m so thankful for support through all of this—not only from family and friends, but the yahoo group has been a deep source of information for years.
Thanks and best of luck to all of you going through your A-Fib battles!