A Failed Ablation, then AVNRT Diagnosed and 2nd Ablation—Now Finally A-Fib Free

By Bob Thompson, Spokane, WA, August 3, 2020

Prior to 2015, I was an active 67-year old male who had taken up running in my late 30’s. I had been diagnosed with Essential Tremor [involuntary shaking or trembling] early in my life but otherwise was considered to be very healthy. I had never experienced any heart issues. Little did I know how much my life was about to change.

Late in the evening of July 11, 2015, I began to feel like my heart was racing and immediately went to a local Spokane hospital ER. After a short period of time, I was informed that my heart was experiencing atrial fibrillation.

Since I was already taking the beta blocker metoprolol for my Essential Tremor, the ER staff intravenously gave me some additional metoprolol. Approximately 12 hours later, I was back in normal sinus rhythm.

Surprised by A-Fib―Researching on the Internet

But what was atrial fibrillation? I had never heard of this diagnosis before the summer of 2015. As is my custom when I am unfamiliar with something, I went to the internet and began to research A-Fib.

I discovered Steve Ryan’s website, A-Fib.com and almost immediately ordered a copy of his book, Beat Your A-Fib.  Both Steve’s website and book have been invaluable resources in my quest to deal with my A-Fib.

A-Fib Attacks Continue Lasting 10-12 Hours―Tries Drug Therapy

Over the next few years, I went into A-Fib over 50 times with each bout lasting on the average 10 to 12 hours. Increasing my dosage of metoprolol while in A-Fib, resulted in being able to get back into normal sinus rhythm, and I never needed to have a cardioversion.

My first electrophysiologist (EP) recommended that I take flecainide whenever I went into A-Fib (the so-called Pill-in-the-Pocket treatment), but I found that particular drug did nothing but cause extreme stomach discomfort.

The EP also recommended I try some additional drugs such as sotalol and amiodarone, but I resisted because of the likely side effects that would result. I did, however, agree to take the blood thinner Eliquis.

After Three Years, Time for a Catheter Ablation―Disappointing Failure

After dealing with A-Fib for over three years and with the occurrences becoming more frequent, I opted to have a heart catheter ablation on September 15, 2018.

Result: the ablation was a complete failure. The EP was only able to ablate three of the four pulmonary veins.

A-Fib Occurrences Increase, Exploring Mini-Maze Procedure

Subsequent to the ablation, my occurrences of A-Fib rapidly increased. I began to explore another option, a mini-maze procedure. I met with a cardiac surgeon in Spokane who suggested I try one more catheter ablation before I opted for the mini-maze procedure.

The surgeon informed me that the best EP in Spokane was Dr. Mark Harwood whom he would be seeing later in the day. I informed the surgeon I was aware of Dr. Harwood’s reputation, but I was never able to see him because the EP who had performed the first ablation was part of the same practice of EPs.

Dr. Harwood’s Office Calls Me the Next Day!

One day after meeting with the cardiac surgeon, I received a call from Dr. Harwood’s office informing me that Dr. Harwood could see me the next day. Upon meeting with Dr. Harwood, he informed me that he was confident of his ability to ablate all four of my pulmonary veins.

I was scheduled to have my second ablation with Dr. Harwood on March 15, 2019, but it was contingent on the results of a stress test. A few days later, the stress test was performed and was a success.

However at the completion of the stress test, I went into A-Fib. Dr. Harwood detected an irregularity (Tachycardia) that lead him to also perform an AVNRT Ablation.

Another Ablation in March 2019

As scheduled, I had an atrial fibrillation ablation on March 15, 2019. Unlike my first ablation, Dr. Harwood was able to successfully ablate all four pulmonary veins.

In addition, at the same time, Dr. Harwood also performed an AVNRT (Atrioventricular Node Reentrant Tachycardia) ablation which he felt was needed after detecting an irregularity in the EKG during the earlier stress test. [For more about AVNRT, see my Editor’s Comments below.]

Success! A-Fib Free Since March 2019

Subsequent to my 2019 ablation procedures, I have had no recurrences of A-Fib. I no longer need to take the blood thinner Eliquis.

In other words, after almost four years, I am A-Fib free, and I and my wife now have our lives back.

Lessons Learned: My Advice

Here is my advice to others who are battling A-Fib:

1. Never give up in trying to find a cure for this insidious disease. Do not accept the words “Learn to Live with It”.

2. Do not settle for seeing the first available EP which is a mistake I made. Talk to other physicians and medical professionals and ask them for recommendations.

3. It is normal to have anxiety when dealing with A-Fib. My digestive system was a complete mess until I was finally convinced to take some anxiety medication.

4. Try to avoid being tired. Looking back at the chart I kept for my A-Fib incidences shows a definite pattern of going into A-Fib after excessive exercise or work.

5. If you have doubts as to whether or not you are experiencing A-Fib, go to a local fire station that has a paramedic on site. You will be able to have an EKG at no cost.

In Gratitude

In conclusion, I will be forever grateful to Dr. Mark Harwood of Providence Spokane Cardiology-North, for going beyond the parameters of a normal ablation of the pulmonary veins and performing the AVNRT ablation which likely resulted in my cure.

In addition, I am so thankful for the input I have received from Steve Ryan from his website and book as well as one-on-one correspondence.

You can contact me at easychatt@aol.com.

Bob Thompson
Spokane, WA

Editor’s Comments

All EPs Are Not Equal: It’s a shame that Bob’s first EP wasn’t able to isolate all of his PVs. Unfortunately, all EPs are not equal. One of the hardest tasks A-Fib patients face is finding the right EP.

Don’t be afraid to get a second (or third) opinion. Don’t just go with an EP who happens to work near you. Be prepared to travel. Go to the best, most experienced EP you can find, afford, and to where you can reasonably travel.

Search Out the Best EP You Can Find: One of the best ways to find a good EP is what Bob did: talk to doctors, nurses, or support staff who work in the field. They can often tell you who is the best and whom to avoid. But getting this kind of inside info isn’t easy and isn’t possible in many cases.

How Do You Find the Right EP for You? To learn how electrophysiologists differ and how to find the right EP for you, see two of my articles:

• A Tale of Two Ablations and Why All EPs Are Not Equal
• Considering a Catheter Ablation? Know Complication Rates When Choosing Your Doctor.

Bob’s Persistence: What’s inspiring about Bob’s story is his persistence in getting to the best EP in Spokane. God bless the wonderful surgeon who recommended that Bob see Dr. Harwood, even though that surgeon might lose a patient for his own Mini-Maze surgery.

Technical Description of Bob’s Ablation

Kudos to Dr. Harwood for discovering that Bob had AVNRT and an extra circuit (from the Sinus node and within the AV Node).The ablation for ANVRT is a somewhat unusual procedure.

AVNRT stands for Atrioventricular Node Reentrant Tachycardia.

Normally, the AV Node electrically connects the atria and ventricles and is normally a single electrical road. But in AVNRT, there is a re-entry [extra] circuit within or adjacent to the AV Node.

Catheter Ablation of Pulmonary Veins

Bob’s Left Superior Pulmonary Vein [RSVP] needed to be ablated at the roof, and the Left Inferior Pulmonary Vein [LIPV] needed to be ablated at the ridge.

After isolating Bob’s PVs, Dr. Harwood administered adenosine to confirm entrance and exit block. He then waited 30 minutes to re-confirm that all PVs remained blocked/isolated.

Ablation for AVNRT

Next Dr. Harwood used atrial pacing on isoproterenol to induce Supraventricular Tachycardia [SVT].

Then he ablated this extra pathway or circuit which eliminated Bob’s re-entrant tachycardia without damaging Bob’s normal AV Node circuit/pathway.

In effect, he found and engaged Bob’s “Slow Pathway” circuit which was adjacent to his normal AV Node circuit.

Related Posts