A-Fib Patient Story #14

International Traveler/Scuba Diver Dizzy and Fainting from A-Fib

Michael Waring

By Michael Waring
Palma de Mallorca, Spain, September, 2006

I am 59 years of age. I first became aware of my A-Fib problem by chance in 2001. I went to have a medical for life insurance. I was wired up to the exercise bicycle, but immobile, waiting for the cardiologist to arrive when I noticed that the monitor read a heart rate of 170. I indicated to the technician who was there that I thought the machine was faulty. He turned white when he saw the readout! I had felt nothing.

I had always done a lot of sports and had a normal resting pulse of around 45  bpm. As I got older I continued with regular exercise in the gym, walking and my passions, scuba diving and horse riding. I had done nearly a 1000 dives, traveling all over the world to dive intensively.

In retrospect, following an extremely bad dose of influenza in 1998 when I needed to call the doctor because of dizziness, I had noticed some shortness of breath from time to time and also some tiredness. However, I had just come through a very difficult time both in business and with family issues and put my feelings down to stress. In fact exercise helped me considerably.

Following the initial discovery of the A-Fib, I was put on a course of Statins for my cholesterol and a 50 mg per day dose of Flecainide. This seemed to do the trick, and my heart beat remained well controlled. When in fact it did get out of hand, a short run seemed to settle it back quickly.

At the end of 2004 we left the UK to live in Mallorca, an island in the Mediterranean. I had by then semi-retired and was feeling much more relaxed. Other than the issues of completing the renovation of the house we had bought I had very little stress and was feeling pretty happy with life. I preferred the climate to the UK, and Mallorca reminded me of my home town Cape Town in South Africa. I also had the sea close to hand.

At the beginning of 2005 I began to be very conscious of the A-Fib really for the first time. It occurred more frequently and the incidents were for longer periods. I also began to have frequent dizzy spells, something that I had not had since my influenza attack. My cardiologist in the UK had retired, so I sought the advice of a local cardiologist in Mallorca. After being hospitalized following a particularly bad attack, the cardiologist added to my drugs a Beta blocker; but as I later found out to my cost, without taking me off the Flecainide. The result over the next few months was disastrous. I kept having very serious dizzy spells and in one case blacked out completely while walking down the isle of the aircraft I was traveling on.

As a result of this I was referred to an electro physiologist who worked at San Pau hospital in Barcelona, Spain but who visited Mallorca every month. He had a serious lack of bedside manner and was extremely arrogant in his dealings with me. To his credit he immediately took me off the Beta blocker and determined after some months that the cause of my fainting and dizziness was my abnormally slow normal heart beat aggravated by the Beta Blocker. What was happening was that after fibrillation and before the commencement of sinus rhythm, the drugs were causing my heart to beat even slower or to pause in between the move from A-Fib to sinus rhythm.

He felt that alternative drug therapy would be counterproductive and in a dismissive tone told me to go to Bordeaux or Milan for treatment, and dismissed me. This seemed to me ludicrous at the time. Surely the USA or UK were the centers of excellence for heart related treatment?

When I later tried to make contact with him to discuss the matter further, he never answered or returned my calls. I was left hanging. The result was that I decided to do my own investigation into the matter. What I found out was that for my particular problem it seemed that Bordeaux and Milan were indeed using the latest methods, with particular success in Bordeaux. My research was significantly helped by the information available on this web site and the email exchange I had with Steve Ryan.

I sought advice from a family member who was a retired cardiologist in South Africa; I sought a second opinion through London College’s The Heart Hospital and saw the leading electro physiologist there. All spoke highly of the work and reputation of Bordeaux in particular, and said they were undoubtedly the leaders in the field today.

I made contact with both Milan and with Bordeaux.  Milan was extremely tardy in the way it responded (if they responded at all), whereas Bordeaux was very diligent and helpful in all ways. I spoke on the phone and had numerous emails with Dr Pierre Jaïs, who was helpful in every possible way. After again deliberating with family and doctors I decided to opt for Bordeaux, and what a great decision that was!

I had to wait six months to get a place (it is a state hospital and treatment of private foreign patients is limited).

The documentation I received from the Bordeaux hospital setting out all the actions I had to take before the operation, e.g. course of Warfarin, tests etc. was extremely clear and precise. They provided a full packet of information on what I could expect at the hospital, what accommodations were available etc. In fact they could not have been more helpful.

We flew to Bordeaux the day before the operation. I checked my wife into a hotel (an old winery) set in the middle of the vineyards about 20 min from the hospital and then proceeded to check in. I used to speak French, but since learning Spanish seemed unable to get a French word out of my mouth. The registration staff was very helpful, the nurses even more so. Their explanations of what needed to be done to prepare me for the next day were clear (some spoke broken English but one reasonable Spanish which helped communications). Dr Jaïs who spoke English came to introduce himself and told me that the operation would take place the next day and that I was number two on a list of three for that day. Naturally I was apprehensive and maybe because of that was in pretty permanent A-Fib.

The next day I waited in my room only to be told that patient number one’s operation was taking longer than anticipated… in the end it took 8 hours! This definitely made me even more apprehensive, and as a result I was in permanent A-Fib.
I need not have bothered. When I finally went down to this strange operating theatre with one nurse, 4 TV monitors hanging over the table and three doctors (one with the catheter and two behind a glass screen on computers), it was a piece of cake. Although Dr. Jaïs subsequently told my wife that I had had quite considerable pain during the procedure particularly when they were repairing the flutter, I remember nothing other than a slight discomfort and pressure near the end of the procedure (when, as it turned out, they were dealing with the flutter). And for the first time ever I was not sick or hung over from the aesthetic, nor did I have any discomfort at all after the operation other than a slight tight feeling in the chest which they had told me to expect and which disappeared after a week.

The procedure took six hours. They advised me that the mapping of the heart which they do before correcting the “short circuits” was made easier by the fact that I was in A-Fib. They had been successful with the A-Fib, but it had been more difficult dealing with the flutter; although they were hopeful that it was corrected as well.

The next day I could not believe how little after-effect the operation had had on me. My heart beat was stable at about 80 bpm. The following day I had my exercise test which went well; and on the third day I returned home, much relieved that all had been so easy.

I followed rigorously the schedule they had given me, gradually lengthening my daily walks; and after four weeks I increased my activities back to horse riding and aerobic and strengthening exercise. After three weeks my resting heart beat was a steady 70-72 bpm. After 6 weeks I was back scuba diving.

I cannot stress sufficiently how impressed I was with the professionalism and helpfulness of the team in Bordeaux, or how successful the treatment has been for me. I would recommend it whole heartedly to anyone in my predicament.

Finally my thanks to this website and to Steve Ryan whose information was crucial in getting me to make the correct decision.

Michael Waring
Palma de Mallorca, Spain
September, 2006
michael-waring (at) msn.com

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