A-Fib Patient Story #51

Alcohol Addiction Causes A-Fib. Cardioversion, then A-Fib Ablation by Dr. Mazur at the Un. of Iowa

Kris’s story

Kris, 2011

My name is Kris and this is my A-Fib story.

In November of 2008 I was admitted to the hospital with double pneumonia.  I also had an excessively fast heart beat that averaged 140 beats per minute.  My GP tried different meds to slow the beat, but my heart would not go below 90 beats per minute.  I was in a rural country hospital that housed an outreach clinic for the University of Iowa Cardiovascular Unit.  I was fortunate that the outreach clinic’s heart specialist took over my case.  He ordered an EKG which showed that I had atrial fibrillation.  I remember thinking this is not possible for me to have a heart condition!  I am barely over 50 – this can’t be happening to me!  But it was.  I was transported by ambulance to the University of Iowa Cardiovascular Unit within six hours of being diagnosed with A-Fib.    

 The next five days I spent in the U of I Hospital going through various tests which included a cardiac catheterization to see if I had a blood clot or blockage of the heart.  The doctors performed an endoscopic (EGD) where they insert a flexible tube outfitted with a light and camera down the throat to have a look for abnormalities.  The University is a teaching college, so I had a staff of specialists, fellows and doctors coming in to visit me.  Each had a different opinion, but none of them would tell me what would happen next.  I learned that by being persistent I could generally find one doctor that would answer my questions giving the explanations that I needed. 

Electrical Cardioversion

I was scheduled for a cardio convert on November 23^rd.  The convert successfully put my heart back into sinus rhythm.  The procedure was performed in the afternoon and I was immediately released to go home.  I didn’t understand why I could go home so quickly after I had just spent 5 days in the cardiac unit.  I was told there was nothing more that could be done.  We had to wait to see if the heart would heal and stay in sinus rhythm. 

 I was also given an array of medicine:  lisinopral (blood pressure med that works through the kidneys), metoprolol (blood pressure med that works on the heart muscle), furosemide (fluid med or ‘water pill’ that is used to reduce fluid retention), Coumadin (warfarin a blood thinner), digoxin (used to regulate the heart) and omerprazole (Prilosec – to keep me from getting nausea so that I could take the other meds).  I wasn’t told much about side affects of the meds.  I found out more about side effects of the meds from the pharmacists than I did from the medical team at the hospital.  I do experience fairly interesting side affects from meds so I need to know all I can about meds that I am taking. 

Back In A-Fib

By the 19^th of December my heart was back in A-Fib.  I felt I had a death sentence even though I was told by doctors and nurses that ‘If you have to have a heart condition, A-Fib is the one to have.  It is more of an inconvenience than life threatening’.  This is not exactly what a person going through depression, weight loss, fatigue and irregular heart wants to hear.  The best I got was to go on another med:  amiodarone – which slows the heart by relaxing the heart muscle.  The plan was to determine what was causing my A-Fib and schedule another cardio-convert after my INR blood level tested between 2 and 3 for 3 weeks straight to ensure that a blood clot hadn’t formed. 

Admitting to Alcohol Addiction

One of the most difficult things that I had to admit to was to tell my doctor that I drank alcohol excessively.  I have an addictive behavior disorder – which is another story – and most people would consider me an alcoholic.  Binge drinking is one of the top 5 causes of A-Fib.  My A-Fib was brought on by a combination of alcohol, stress, bacterial pneumonia and over the counter cold medications.  I could have prevented my A-Fib by not drinking alcohol in excess; most A-Fib can’t be prevented.    

Back In Emergency Room

I proceeded to have the scariest 6 weeks of my life waiting for the INR level to stabilize to have my 2^nd cardio-convert.  My heart became totally erratic.  Light headedness usually happened within ½ hour of taking the meds.  I would wake up in the middle of the night with a bizarre sensation and butterflies in my stomach.  Sometimes all I could do was to walk to work the heart muscle so that I would feel better. 

I ended up in the emergency room one evening because my heart beat totally flipped out and my blood pressure crashed.  Nothing out of the ordinary was found after the EKG was read.  I was given an anti-anxiety med with script to fill and sent home.  I tried to reach the heart specialist through his nurse.  I described my symptoms but was told that I had to have blood pressure readings to give to the doctor before anything could be done.  I should have pushed harder.  It seems that the combination of digoxin and amiodarone was too much for me. 

Successful Electrical Cardioversion!

Finally the INR stabilized for 3 weeks, so another cardio convert was performed. My doctor told my sister that he expected my heart to be back in A-Fib within 6 months.  But I wasn’t told this until a year and ½ later.  I had a small miracle when my heart stayed in sinus rhythm for 1 ½ years.  I became my doctor’s ‘successful project’.  

Amiodarone Damages Eyesight, But Not Permanently

Shortly after the 2^nd cardio convert I began to have difficulty focusing, so I made an appointment to have my eyes checked.  I thought it was time to get stronger contact lenses.  My optometrist was concerned when he discovered I was taking amiodarone.  He said that one of the side effects of amiodarone was a chemical buildup on the retina that could eventually damage eyesight.  But my medical doctor assured me that I would not be on the amiodarone long enough to cause lasting adverse side affects.  I stopped taking the amiodarone in June of 2009.  Within 3 ½ months my eyesight improved.  I guess that weak eyesight versus an arrhythmia is the lesser of 2 evils.   

In Chronic A-Fib

In June of 2010 I went for my checkup only to be told that I was in A-Fib again.  I had guessed that the arrhythmia had just happened.  I was outside on a hot humid day doing very physical labor that caused an increase of adrenaline and stress.  My heart went back into A-Fib.  The decision was to wait 3 to 4 months to see of my heart would revert to sinus rhythm on its own.  It didn’t.  I had chronic A-Fib.  I would have good days and bad days.  I was constantly fatigued.  I had palpitations almost every day.  I just didn’t feel good.  It showed in my personality.  I did not consider this a quality life.

Deciding On an Ablation

In September of 2010 my doctor told me I would need to make a decision on how to treat the A-Fib.  Three different treatments have shown success.  The first was to control the rhythm with meds.  I was tired of fighting the med side affects.  I also didn’t feel that meds were successfully controlling my A-Fib.  The second was to have another cardio-convert.  But studies are showing that cardio-converts are only successful for a short period.  The third treatment is an ablation.  It was scary thinking about a doctor going up a vein at the groin to ‘burn’ part of your heart to change the electrical signals to obtain sinus rhythm. 

I wanted to fix or cure the A-Fib, so an appointment was made for a preliminary consultation with Dr. Alexander Mazur, an ablation specialist at the University of Iowa Cardiovascular Clinic.  Sure I considered going for a second opinion.  But I couldn’t see increasing the time I was in A-Fib to find another medical facility for a consultation.  So I researched the U of I specialist that would perform the ablation.  I found that he had been performing ablation procedures first in Europe and then the United States for over 10 years.  He was brought to the U of I as a teacher and to help expand the Cardiovascular Clinic’s ability to treat arrhythmias.  I was comfortable – besides I was very impatient and wanted the heart ‘fixed’ immediately.

The Ablation Procedure

Cardiac ablation is used to treat certain types of arrhythmias.  An ablation can be done during open heart surgery.  The more widely accepted method for cardiac ablation uses catheters, long flexible tubes inserted through the groin vein on each leg to travel to the heart to scar or destroy abnormal tissue that produces A-Fib signals.  The procedure is done under conscious or general anesthesia and usually lasts 5 hours.         

My ablation was scheduled for November 2^nd, 2010 at the University of Iowa Hospital and Clinics.  Several things could have kept it from happening.  One would have been having a blood clot.  A diagnostic X-ray is done to look for clots.  I was to have the diagnostic X-ray on the 1^st right along with blood tests, anesthesia consultation and pre-admission.  I would have preferred spending the day with my sister shopping instead of us both in the hospital preparing for a medical procedure.

An IV is inserted for a diagnostic X-ray.  Iodine is injected through the IV into the vein and followed through the body looking for clots.  A heart specialist, in addition to the X-ray tech, is present during the procedure for heart patients just in case there are problems.  Of course I was having my usual anxiety attack.  So the doctor placed a nitroglycerin tablet under my tongue ‘just in case’.  What an awful taste and horrible headache, but that was nothing compared to the iodine injection.  I felt a hot flash go through my body after the iodine was injected into the IV.  I felt like I was burning from the inside out, and it lasted longer than I would have liked.  I got very hot in the groin area and was convinced that I had wet my pants.  I was expected to hold still the whole time this was happening, though I really wanted a cold shower.  I found out how long I could hold my breath when I was told to take a deep breath and hold it until told to breath normally.  I was lying on a table that was moved back and forth through a large noisy rotating circle.  The circle was probably 3 foot wide, so only a portion of my body was in it at a time.  What a relief to discover that my jeans were dry when the diagnostic X-ray was finished.  And I didn’t have a blood clot, so the ablation could go on as scheduled! 

I had to be at the Cardiovascular Clinic at 7 AM the next morning, November 2^nd.  My sister went with me as my closest relative.  She also got custody of my Solara while I was in the hospital.  I think she may have had the better deal – except for the 15 hours she spent waiting at the hospital. 

I was having another anxiety attack after being admitted, thinking about what my doctor told me of a 2% to 3% chance of ‘something’ happening.  He didn’t quite define something but I knew it was either a chance of stroke, death or other.  But those are better odds than living in A-Fib.  The doctor was cautious and told me that there was a 50% chance that the ablation would be effective.  He also thought that I may have to have a second ablation.  Fortunately my anesthesiologist gave me a ‘happy’ med through the IV that the nurse had put in.

 Then I met and grilled the Fellow that would be assisting in the procedure.  He was a qualified cardiologist, having passed all of the state boards for licensing as well as practiced in the cardiology field.  He was studying with my specialist to learn how to perform ablation procedures.  He had participated in 20 ablations.  His job was to assist the primary physician, my specialist who has over 10 years of ablation experience. 

In Sinus Rhythm!

I remember receiving another dose of meds in my IV along with someone saying it was time to go.  That was at 8 AM.  The next thing I remember was waking up in recovery.  My doctor was standing at the foot of my bed telling me I was in sinus rhythm.  But I already knew that the A-Fib was gone by the way my heart felt, the way it beat.  I got attuned to the heart rhythm from living with the ‘inconvenience’ for so long.  This was at 4:20 PM.  What was considered a 5 hour procedure actually took over 8 hours with prep time and closure.

I got bits and pieces of the success of the ablation from my doctor, the fellow and the anesthesiologist.  My heart went into sinus rhythm of its own accord after the last tissue burns.  My blood pressure also crashed when my heart went into sinus rhythm.  Sometimes a cardio convert has to be done to get the heart to beat in sinus rhythm after an ablation, but that didn’t include me (Yea).  My doctor is cautiously optimistic of the success of the procedure.  He still maintains that I may need a 2^nd ablation down the road for a ‘touch up’.  He said that a ‘flutter’ could develop that would need to be taken care of.

Recovery

I had a male nurse in recovery whose only task was to take care of me.  I had to lay flat on my back so the 2 ‘sites’ wouldn’t bleed.  The site is where the catheter is inserted into the vein.  I had 2 IVs in my arm and an A line (intra-arterial catheter) in my right wrist.  The A line is used to monitor blood pressure, take blood samples for testing, and check oxygen saturation.  I also had a urinary catheter.  I had a vision of my body hooked up to plastic lines, just like in the alien horror movies, during the procedure.    

I couldn’t comprehend why I had to remind myself to breath.  I had a constant cough.  This was from having the breathing tube down my throat.  I was given an anti-nausea drug in my IV to help with nausea.  I wanted to get up and walk out of the recovery room.  There were other patients in the room and one of them would not stop moaning.  But my blood pressure had crashed, so I was kept in recovery longer than anticipated.   

My family was told that I would be in my room at 5:30 but I didn’t make it until 7:30.  I was confined to lying flat on my back.  I wasn’t supposed to move for several hours due to the sites’ healing process.  I wasn’t a happy camper being immobile.  The nurse did raise the bed a little and then let me elevate my legs around midnight.  Good news, I could eat anything that I wanted, as long as it was on the heart healthy menu. 

My blood pressure wasn’t going up, so I was given fluids to raise it.  I wasn’t allowed out of bed for some time because my pressure was still low.  They were afraid I would pass out.  By mid morning of the 3^rd I finally convinced my nurse to take out the catheter and let me go for a walk.  Of course the doctor had to approve it first.  The blood pressure dramatically improved after I became the walking water balloon from all the fluid that I was given.  It took 5 days for my legs and ankles to return to normal size.  What was scheduled to be an overnight process turned into a 3 day marathon because my blood pressure had crashed.

New Energy and Attitude—Living a “Normal” Life

I had a dull pain in my heart for the 1^st 24 hours after the ablation.  I could have taken a pain killer but I didn’t.  The pain gradually went away.  I did have palpitations the first couple of weeks because I had been in chronic A-Fib.  I felt like my heart was attempting to return to A-Fib but couldn’t find the electrical pulse to accomplish it.  My sister noticed an immediate positive change in my attitude.  I rediscovered the energy that I was accustomed to before A-Fib.  The worst outcome from the hospital stay was the sinus infection that I got and my hip/back going out of alignment from lying on a pillow in one position too long.  I had developed one heck of a headache that lasted 4 days.   

I have been taken off all blood pressure meds.  I was kept on Coumadin and Prilosec with the addition of Sotalol to slow the heart rhythm.  I had to give myself Lovenox shots in the stomach for a week.  Lovenox is a blood thinner.  I was able to quit taking the Coumadin two months after the ablation and start taking a full aspirin.  Hopefully I will be taken off the Sotalol in March.  I am on a very low dosage of Sotalol because it makes me light headed and sleepy.  It can make me nauseated.  Roughly two weeks after the procedure I woke up with severe stomach cramps which can be an adverse side affect of Sotalol.  I do occasionally have stomach cramps which I get to go away by taking a hot shower and staying warm.

I am glad that I had the cardiac ablation.  I feel great and have energy to live a ‘normal’ life.  It has lessoned the symptoms of my Reynaud’s Syndrome, poor circulation in fingers and toes that can cause pallor, numbness, pain and cold extremities.  My quality of live has improved.  A friend called me ‘bouncy’ again, which I had lost during A-Fib.  I also know that I need a life style change:  no alcohol, watch what I eat, exercise, get plenty of sleep, focus on God and have hobbies to reduce stress among other changes.  Life, family and friends are worth the effort!

Kris
E-Mail: rottie1009lab(at)hotmail.com

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