A-Fib Patient Story #81
Two Months After A-Fib Diagnosis, 62-Year Old Cyclist Has CyroBalloon Ablation; Difficult Three-Month Blanking Period
By Joe Mirretti, Gurnee, IL, May 2015
I just turned 62 and have been an active cyclist all my life. I also run and lift weights. My resting heart rate is 47.
December 2014: First A-Fib Attack
On December 11, I got on the stationary bike, and my pulse was 100 without doing anything. When I started pedaling, it went up to 140. I thought something was wrong with my heart rate monitor. When I drove home, my heart rate was all over the place.
My wife, Wendi, took me to the Emergency Room (ER). One nurse came in and thought I had gone back into sinus rhythm since my pulse was in the 70s, but that was double my normal heart rate. When I stood up, the ER staff became more alarmed—my pulse jumped up to 170-180. They confirmed that I had Atrial Fibrillation (A-Fib).
Electrocardioversions Don’t Last, Drugs Have Bad Side Effects
The A-Fib felt terrible. I was out of breath, had palpitations, I couldn’t exercise, my heart was thumping in my chest.
The A-Fib felt terrible. I was out of breath, had palpitations, I couldn’t exercise, my heart was thumping in my chest….Even with drugs, the A-Fib would wake me up in the middle of the night.
They Electrocardioverted me December 12, 2014. That worked for about a week. But December 17 while lying in bed I sneezed and went right back into A-Fib. I had another Electrocardioversion December 19 which this time only lasted 4-5 days.
For a while I was on Diltiazem 160 mg/d and later flecainide 150 mg/2Xday. They also put me on the blood thinner Eliquis. But I had terrible side effects from these drugs, such as vertigo. When I’d take flecainide, hours after dinner my pulse would even out before going to sleep. But 3-4 hours later the A-Fib would wake me up in the middle of the night.
In early January I had a chiropractic adjustment to my back which seemed to put me back into sinus rhythm for 12 days.
With Active Life Style, Learns About Catheter Ablation
Because of my active life style, my cardiologist at Northwestern in Lake Forest (North of Chicago), Dr. Ian D. Cohen, thought I would probably need a catheter ablation.
He helped me schedule an appointment on January 9 with Dr. Albert C. Lin of the Northwestern Un. Feinberg School of Medicine/Bluhm Cardiovascular Institute which has a branch in Lake Forest. I was very impressed by Dr. Lin. He was very interested in hearing everything we had to say and was confident. I asked him if the chiropractic adjustment was responsible for getting me back into Sinus. He couldn’t say for sure, but he predicted I’d go back into A-Fib. Needless to say, he was right.
Extremely Symptomatic, Decides “I Can’t Live in A-Fib”
My wife, Wendi, and I both agreed that I should have a CryoBalloon ablation as soon as possible. I was so symptomatic I couldn’t live in A-Fib, the drugs caused me terrible side effects, and the cardioversions didn’t work.
I had read that the faster you correct or get A-Fib cured, the better.
I had read that the faster you correct or get A-Fib cured, the better you are. And we liked Dr. Lin. He was very encouraging, but wasn’t telling us we need to do this. He said, “Don’t make a decision now. Go home and discuss it.”
We decided to go with the ablation. Dr. Lin was able to schedule us for a CryoBalloon ablation February 12, 2015.
A-Fib Research Online: Encouraged By Stories on A-Fib.com
I Googled everything on A-Fib as much as I could. The stories and information you gave on A-Fib.com really helped me move forward.
I just think it’s so wonderful they are developing these ablations so quickly and improving them. I read your story how back in 1998 you were in the hospital for nearly two weeks when you had your ablation. (See Steve Ryan’s A-Fib story.) I was only in the hospital overnight.
I’ve always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.
I don’t understand how some people don’t feel anything when in A-Fib. I always wore a heart rate monitor when I worked out. I’ve been keeping records of my workouts daily going back 25 years. I noticed a couple of years ago I may have had some brief episodes of A-Fib, but they corrected themselves. However, I didn’t know anything about A-Fib at that time.
I’ve always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.
February 2015: My CryoBalloon Ablation Day Arrives
I remember counting the days until the scheduled ablation. That’s how bad the A-Fib symptoms were, and they were getting worse. I had an MRI on February 10, 2015 at Northwestern in Chicago.
The morning of February 12, ablation day, we got up at 4:00 am since I was the first patient of the day. My wife, Wendi, did a great job getting me there, as she does not like to drive in the city, and rush hour in Chicago is crazy. (I had not driven in three weeks because of the vertigo.)
The ablation took about four hours. I woke up in perfect sinus rhythm! Dr. Lin said he CryoAblated all four pulmonary veins, and that everything went as well as possible. He sent me home the next morning on no meds except Eliquis.
Difficult Recovery—Dealing With Weird Sensations and Worry
The recovery was difficult. The next day, out of the hospital I felt pretty rough, like I had been hit by a truck. I had no A-Fib the first 8 days, just occasional rapid heartbeats.
I was encouraged to exercise. The eighth day I got on the stationary bike for an hour. Later I had a short A-Fib attack. Dr. Lin put me back on a ½ dose of flecainide for a while.
Like everyone has said in their stories, A-Fib does such a job on your head. Every time you feel something, it scares you like you’re going back into A-Fib.
That’s been a mental battle. That’s why reading those stories helps, what other people went through those first three months. You’re going to get a number of strange things happening to you during the 3-month blanking period after an ablation. Mine have been very short.
Dr. Lin and his office were terrific during this time. I could call any time, and his assistant or Dr. Lin would call me right back.
I’m not having any A-Fib, my skipped beats and palpitations are getting shorter and shorter.
But it’s a mental battle. What I’ve read is your heart is trying to go back into A-Fib and the beat is now blocked. Your heart is adjusting and getting used to beating normally again.
On and Off Meds During 3–Month Blanking Period
The day I left the hospital Dr. Lin took me off of all meds except Eliquis. But after I got the short bout of A-Fib, he put me back on ½ dose of flecainide, 75 mg 2X/d for one month. Then he put me on a little bit of metoprolol 25 mg because Diltiazem caused me such bad side effects. He said he did that because there is a possibility that the flecainide in rare cases could cause rapid heartbeat.
About a month after my ablation, he took me off of flecainide. Since then I’ve only been on 25 mg of metoprolol and Eliquis. I have given up my morning expresso and only have one glass of wine with dinner.
Lessons Learned: Three Months Post-Ablation
I am very pleased I went ahead with the ablation. I’ve passed my 3 month blanking period (I was 30 days on a Holter monitor) with no A-Fib. I’m biking for an hour 3 days a week. I hope to encourage others with A-Fib to seek help. There are solutions out there.
If you have A-Fib, I would definitely explore ablation options as soon as possible for many reasons (i.e., avoid side-effects or reactions to meds, increase your chance of success with just one procedure, reduced anxiety and stress, etc.).
It’s helpful to read stories of other A-Fib patients. (Go to A-Fib.com/Personal A-Fib Stories of Hope.) It helps to hear what other people are going through.
After ablation, don’t push too soon. I advice you to get back to exercise slowly to give your heart a chance to heal.
In writing my story, I hope to encourage others with A-Fib to seek help. There are solutions out there. I was very healthy to begin with which probably helped the odds of the ablation being successful.
Ablation as First Choice Treatment: From the date Joe had his first A-Fib attack to his CryoBalloon ablation was barely two months!
I want to commend Dr. Ian D. Cohen, Joe’s cardiologist at Northwestern in Lake Forest. He understood that A-Fib patients don’t have to suffer through months or years while trying different drugs. Current guidelines allow you to get an ablation right away. Based on Joe’s active lifestyle he referred Joe for an ablation.
More doctors today understand how A-Fib drugs are often ineffective and have intolerable side effects, and how terrible it can be to live in symptomatic A-Fib.
You can have a catheter ablation right away if you want. A catheter ablation is a low risk procedure (it isn’t surgery—there’s no cutting involved). It’s one of the safest cardiac procedures you can have.
Coping with the Blanking Period: We’re grateful to Joe for calling our attention particularly to the mental aspects of dealing with the blanking period after an ablation. We certainly need to develop more help and instruction so that patients can cope better during this time.
The Genetics of A-Fib: Joe’s son developed A-Fib, too. Although the exact incidence of the familial form of atrial fibrillation is unknown, recent studies suggest that up to 30 percent of people with atrial fibrillation may have a relative with the condition.
If you have a family member who has A-Fib, your chances of developing A-Fib are much greater than the average person’s. You need to be more attentive and you ought to see an Electrophysiologist (EP) to get tested for silent A-Fib. (Some people say that all A-Fib is genetic. But we don’t have the research and studies to confirm this hypothesis.)
Join the Genetics Research Studies Underway: Several A-Fib research centers around the US are doing ground-breaking research on genetic A-Fib. If you have 3 or 4 family members with A-Fib, you can join these studies at no cost (except travel). You and your family would be involved in cutting-edge research that is changing the way we identify and treat A-Fib. For further info, contact Dr. Patrick Ellinor at Mass General:
Dr. Patrick T. Ellinor, MD, PhD Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit St., GRB 109, Boston, MA 02114. 617-726-5067 Fax: 617-726-2155 E-mail: pellinor(at)partners.org
1. “Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?”
A doctor’s choice of drug therapy depends on one’s overall heart health, i.e., if there’s a heart condition other than Atrial Fibrillation.
In general, current medications don’t always work on A-Fib. People tend to react differently to meds. What works for one person may be terrible for another. What medications are best for you is a judgment call only you and your doctor can make..
When trying a new med, there is a fine line between allowing time for your body to adjust to it versus recognizing that this drug is causing bad, unacceptable side effects.
When starting a new med, your doctor may hospitalize you in order to monitor how the drug affects you and to get the dosage right.
If you’ve just been diagnosed with paroxysmal (occasional) A-Fib, flecainide (brand name Tambocor) or propafenone (Rythmol) might work for you. Some people have had good luck with the relatively new drugs dofetilide (brand name Tikosyn) and Rhythmol SR (propafenone sustained release). The newest antiarrhythmic med is Multaq (dronedarone) which is a less toxic substitute for amiodarone. Also see Treatments/Drug Therapies.
Guidelines from the ACC/AHA/ESC based on one’s overall heart health and heart conditions other than Atrial Fibrillation:
• Minimal or no heart disease. Flecainide, propafenone, sotalol. The object is to “minimize organ toxicity,” to select drugs that will not harm the rest of the body. The above drugs can cause “proarrhythmia” (an increase in heart rhythm problems), “but in patients without heart disease, this risk is extremely small.”
• If these drugs don’t work, then dofetilide and amiodarone can be considered. And “in experienced hands one might choose (Pulmonary Vein) Ablation (Isolation) for a primary cure.”
• Congestive heart failure. Only dofetilide and amiodarone have been demonstrated to be safe in randomized trials.
• Congestive heart failure and significant lung disease. “I would likely consider dofetilide as my first choice.”
• Congestive heart failure who are “hypokalemic” (have low levels of potassium). Amiodarone.
• Coronary artery disease. Sotalol is recommended because of its beta blocking and antiarrhythmic effects. Amiodarone or dofetilide combined with a beta blocker can also be used. Propafenone and flecainide aren’t recommended.
• Hypertension. Propafenone or flecainide.
• Hypertension and substantial left ventricular “hypertrophy” (increase in size). Amiodarone, because it has the least proarrhythmic effect.
(These guidelines are based on a presentation by Dr. Eric Prystowsky, see Boston AF/2003/ Prystowsky.)
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