A-Fib Patient Story #4

His Successful A-Fib Ablation: Husband and Wife Each Tell Their Story

by Earl Tyler and by Flo Hopkins

Editor’s Comment: First, Earl Tyler tells how he was cured of Persistent A-Fib; then, his wife, Flo Hopkins, describes the impact of her spouse’s A-Fib.

Runner and CYCLER: My A-Fib story

by Earl Tyler, November 2003

In November of 2002 I had just turned 54 & was in great health as far as I knew.  I had been running & cycling for 8 or 9 years, including 10 marathons. I cycled sometimes as much as 200 miles in a weekend.  In general, I felt great.  But there had been a few occasions in the previous couple of years when I had not felt so good. There had been a few times when I went out for an easy run but just had no energy. I chalked it up to over-training, took a day off, & forgot about it.  There had also been a couple of occasions when I felt a bit light-headed at work.  I went to the local med center where they found nothing. My heart rate was in the 80’s which they said was normal, even though I told them my resting heart rate was usually in the low 50’s.

Then, on the day before Thanksgiving, I had another light-headed episode which was somewhat more severe.  I called my family doctor who told me to come to his office immediately.  An EKG revealed that I was in A-Fib. I was sent to the hospital where I spontaneously converted to sinus rhythm before my admission was completed. I was sent home & scheduled for a thallium stress test in 2 weeks.

I knew nothing about A-Fib at this point, but tended to believe that it was probably a transitory thing that would not have any lasting effect on my life.  I was just too healthy, I thought, to have any serious heart problems.

In 2 weeks I had the stress test & everything looked fine until after the test had been completed & the technicians were starting to remove the electrodes. At that point I went back into A-Fib & was sent back to the hospital. This time I was converted with Corvert. That was the beginning of a string of 12 hospitalizations over the next 4 months. I was converted with Corvert several more times & with an electronic defibrillator on two occasions. During this time I was prescribed a wide variety of antiarrhythmic drugs, none of which were effective. I was beginning to understand the truth about A-Fib: it can have a severe impact on one’s lifestyle.

I consulted with the local cardiac electrophysiologist who recommended flutter ablation (right atrium only) with continuous medication to moderate the fibrillation to flutter. This was not particularly appealing to me since I did not like the effects of the drugs I had been taking. I wanted to get back to my active lifestyle, & to me this meant getting off medications.

Meanwhile my wife & I had been searching the Internet to find as much about A-Fib as we could.  A-Fib.com provided us with the most comprehensive source of information, especially about physicians who perform ablation procedures.  As soon as I learned about catheter ablation, I believed that this was the treatment for me.  My local cardiologist & electrophysiologist recommended against it, saying that the procedure was too experimental & that I was not an appropriate candidate.

By March of 2003 I was in persistent A-Fib, & no further attempts were made to convert me to sinus rhythm.  I communicated with several of the physicians listed at A-Fib.com, & decided that Dr. Andrea Natale at the Cleveland Clinic was my first choice.  I visited the Cleveland Clinic in March & was scheduled for an ablation in October. I went home & tried to wait patiently, still in A-Fib. But my quality of life had deteriorated enough to make me impatient to get the ablation done sooner.  When I pleaded my case to the Cleveland Clinic, I was offered a July ablation date with Dr. Walid Saliba; I accepted.

It seemed like an eternity, but July finally arrived, and I went to Cleveland.  Dr. Saliba performed the procedure assisted by Dr. Khajkin, a fellow.  I was awake during much of the 6.5 hour procedure & aware that Dr. Natale, the department head, was called in for consultation more than once during the procedure.  I did not know whether to be glad that he was available, or worried that he was needed. The procedure was not painful at all, but I would describe it as uncomfortable. I was extremely hot & drenched in sweat because of the lead blanket used to protect me from the X-ray which was used to guide the catheters.  I could not feel the catheters at all except when the doctors called for RF energy to be applied. Then I could feel a slow warming in my chest which stopped before it actually felt hot.

After the procedure Dr. Saliba said that it had been a difficult procedure, but everything went fine.  They performed circumferential ablation around all 4 pulmonary veins as well as focal point ablation at several other points.

I was allowed to get out of bed after about 6 hours of recuperation.  I felt some tightness in my chest, & some minor discomfort at the sites of the catheter insertions.  But I was elated to be back in sinus rhythm for the first time in over 4 months.  I was released from the hospital the next day, & went home the following day.  I was still feeling some tightness in my chest & shortness of breath, but I understood that this was to be expected immediately after the procedure.  I had been told that I could expect to return to normal activities after 48 hours.  I knew that running was not considered to be a “normal activity” so I did not expect to resume that for a while yet.

After 72 hours, however, I was still feeling pronounced shortness of breath with mild exertion, like climbing a flight of stairs.  This frightened me, so I made an appointment to return to Cleveland to get checked out. They found no problems & suggested that I give it more time. Within 2 weeks I felt substantially improved, & in 3 weeks I was ready to return to light exercise.  In retrospect, I believe that my procedure may have been somewhat more extensive than the norm, requiring proportionately greater time for recovery.

I started biking again about 3.5 weeks after the procedure.  After biking one day I experienced a brief (1 hour) A-Fib episode, but this did not recur. I continued to take Rythmol for 60 days after the ablation. Just after the Rythmol was discontinued, I set out on a 10 mile run.  After about 2.5 miles my heart rate jumped suddenly from about 120 to 160 (I was wearing a heart rate monitor). This lasted 15 or 20 seconds & returned to normal after walking a few paces.  This sequence repeated itself 3 times within the space of about 5 minutes. After that I completed the 10 miles with no further problems. Since that time I have been in normal sinus rhythm with a full exercise schedule.

In October I returned to the Cleveland Clinic for one final visit, the primary purpose being a catscan to check for pulmonary vein stenosis. No problems were detected & I was unconditionally released. Dr. Saliba said that the success rate of A-Fib ablations has increased dramatically in the past 2 years. I suspect that this is true primarily at facilities like the Cleveland Clinic that perform a lot of the procedures. Dr. Saliba also reminded me that there are no studies yet on the long-term effects of A-Fib ablations, since the procedure is still quite new.  We don’t really know what to expect after 10 years or more.

But I know that I’m glad to have my life back.  I just completed a 100 mile bike ride this Saturday, & plan to run a half-marathon in January.  Regardless of what the future brings, I am confident that I made the right choice in going for the ablation.

I would highly recommend Dr. Saliba & the Cleveland Clinic to anyone considering this procedure.  And I would like to express sincere gratitude to Steve Ryan for the web site A-Fib.com.  My wife & I relied heavily on this site as we searched for the best treatment for me.  I know it represents a significant expenditure of time & effort, & it is greatly appreciated.

Update April 2006: Earl and Flo recently wrote me that Earl is now running marathons!

My Husband’s A-Fib: a Spouse’s Story

by Flo Hopkins, November 2003

My husband, Earl Tyler, had a successful ablation (normal sinus rhythm, no medications) for atrial fibrillation in July of 2003.   Afterward I emailed Steve Ryan, creator of this web site, to thank him for the invaluable information he supplies.  He asked that my husband, Earl Tyler, and I share our stories which we are happy to do.

Earl and I were active 55 year olds in the fall of 2002.  We generally biked over a hundred miles a week and would run between 20 – 30 miles a week.   We loved our active lifestyle until Earl was diagnosed with atrial fibrillation in November of 2002.  We immediately began researching on the internet and found this web site (A-Fib.com).  The information and resources here guided our interaction with our local doctors.  If we had relied on their advice and not done the research ourselves, my husband could have been relegated to a greatly diminished quality of life.

Earl was in the hospital 12 times between November 2002 and February 2003 with extensive testing, cardioversions and medicine changes which had to be supervised during hospital stays.

As this web site had warned, the electrophysiologist wanted to do a flutter ablation though Earl only presented with flutter when on medications.  (This doctor only performed flutter ablations – not atrial fibrillation ablations.)   Earl asked about the left atrium procedure.  The doctor highly discouraged it saying the procedure was too risky, and Earl was not a good candidate.  This information was not consistent with the considerable research we had done by this point, so we parted ways with this doctor and proceeded basically on our own to try to find the best treatment. Our local doctors did not seem to have accurate and current information on the details of the atrial fibrillation ablation methods and success rates.

Medications were ineffective for Earl, and finally the cardiologists refused to do another cardioversion at which time Earl was left in persistent atrial fibrillation.  Earl was symptomatic when he was in A-Fib.  His thinking was fuzzy.  He could feel the palpitations, and his stamina was gone.  He was sure he did not want to live in this state if treatment was possible.  By this time (and again thanks to this web site [A-Fib.com]) we had contacted Dr. Marcus Wharton in South Carolina, electrophysiologists at Massachusetts General, Dr. Neal Kay at UAB, and Dr. Andrea Natale at Cleveland Clinic.  Earl was evaluated by several of these doctors; and when the dust settled, we decided on Cleveland Clinic.  Our original appointment for ablation was in October 2003 with the department head, Dr. Andrea Natale; but since Earl could not be kept in normal sinus rhythm, we opted for an earlier July appointment with Dr. Saliba at Cleveland Clinic.

On a personal note, all of this decision making was very difficult for us.  We are non-medical people and had to undertake this most life changing decision about what treatment to choose and where to go basically without the help of our local physicians.  We educated ourselves about each of the doctors and facilities as best we could and made trips to several of them for evaluations.  Repeatedly we read that the procedure was “operator dependant,” so we wanted to get the best “operator” we could find.

My life changed dramatically.  I had been used to Earl being physically strong and mentally very adept.   We have a small business which he and I run.  During the time he was in A-Fib, I felt I had to take over as much responsibility as I could – at work, in the medical solution search, physically, and emotionally.  It was very, very hard as crisis periods tend to be.

So to make a long story short.  He had the six and a half hour atrial fibrillation ablation done at Cleveland Clinic in July of 2003.  This is November 2003, and he’s in normal sinus rhythm.  He’s biking over 100 miles a week and running over 20 miles a week.  He has his life back.  We have our lives back, and we are very, very grateful.

We have great confidence in Dr. Saliba and in Cleveland Clinic.  They have been specializing in this procedure for a number of years, and their success rates (normal rhythm, no medications) are getting quite good.  That said, I must note that while we were so careful getting the right doctor because of the “operator dependent” issue, Earl ended up with a “fellow” doing his procedure under the supervision of Dr. Saliba.  Though we should have anticipated this since Cleveland is a teaching hospital, we were surprised and somewhat frightened by it.  Of course all’s well that ends well, and we are convinced now that Cleveland has very strict control over these ablations.  Still, it is something one would do well to discuss with the doctor in advance to avoid surprises.

This excellent website (A-Fib.com) was invaluable to us when, of necessity, we had to take on the responsibility of finding the best treatment available. We are very fortunate that this treatment was available and successful, and we are especially fortunate that we were able to find it.

Thanks, Steve, for this website which provided us with so much help, and for your gracious responses to e-mails.  Your work has made a great difference in our lives.

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