Roger Finnern

A-Fib Patient Story #94

Finally in Sinus Rhythm After 4 Years in Chronic Asymptomatic Atrial Fibrillation

By Roger Finnern, Tempe, AZ, February 2017

Steve, I had to let you know how thankful I am for all your recommendations and help over the past year. Feel free to use the following on your website or whatever, to give hope to others going through the process.

My Atrial Fibrillation: I was Told to “Just Live with It.”

I contacted you last in December 2015 as I was in chronic A-Fib without symptoms, age 67, and I had a cardiologist who wanted me to do nothing but take a low dose aspirin and live with it.

My cardiologist wanted me to do nothing [about my A-Fib] but take a low dose aspirin and live with it.

After two years of being in Chronic A-Fib, I went out on my own. With your recommendation, I contacted Dr. Vijay Swarup, Arizona Heart Rhythm Center. I ended up getting a RF ablation in early February 2016.

After Ablation, Back in A-Fib

After my ablation, I was in rhythm only 2 days before it reverted. They performed cardioversion twice before releasing me from the hospital, and each worked only for a minute before reverting back.

Dr. Swarup was a bit miffed as he had tested all ablated points and could not produce any response back to A-fib. He said something to the effect that my heart was highly irritated. They put me on the antiarrhythmic drug amiodarone to convert at home.

Amiodarone Works—Finally in Sinus After 4 Years!

The amiodarone worked, and one week later I saw my doctor and had my first normal EKG since 2013!

On August 2, six months post-ablation, I was taken off amiodarone. (I was kept on amiodarone longer than normal, due to the rough time we had getting into rhythm initially.)

Being on amiodarone over a long period, I was fortunate that I seemed to not have bad side effects. But I did notice after being off it for a while, that I breathed easier.

Need a Blood Thinner If In Normal Sinus Rhythm?

I was maintaining normal rhythm, so during my October 25, 2016 appointment, I asked Dr. Swarup about getting off the blood thinner Eliquis. .

So he ordered a Transesophageal Echocardiogram (TEE) to check the strength, shape, etc. of my left atrial appendage (LAA). From that we could also determine if Eliquis or the Watchman occlusion device would otherwise be feasible. [If blood isn’t being pumped out properly from the LAA, there is more risk of clots forming and stroke, even if one is in sinus rhythm.]

My LAA pumping velocity was good. Dr. Swarup has taken me off Eliquis, so things have turned out exceptionally well for me.

I had been taking 1 gram of krill oil with the Eliquis. Now that I am off Eliquis, I have decided to double it for now just in case―strictly a personal choice.

Sleep Apnea Study―Philips DreamWear Mask

During the last nine months [post-ablation] I wore a heart monitor [e.g. holter or event monitor] for a 10 day period.

I also did a sleep study at home―required by Dr. Swarup. They furnish the equipment, and it is fairly easy to do. I turned out to have mild sleep apnea.

I have been on a CPAP [Continuous positive airway pressure] machine for the past two months. My episode numbers reduced considerably, so they are happy with the results.

Probably like everyone else, I did not think I could handle the mask, but it has turned out just fine. I highly recommend the DreamWear mask by Philips as it is very comfortable, only one strap, and a pillow type cushion under the nose. I barely know I am wearing a mask.

I have also traveled through airports with the machine in a provided carry-on case and have had no problems whatsoever. It also does not count toward your carry on limit as it is a medical device.

Acupuncture Helps

Throughout my process, I went to a highly experienced acupuncturist about once every week and I will probably continue to do this forever.

Steve, she was well aware of the heart points you had in an article on the website way back and had a few others of her own. [See my article: Acupuncture Helps A-Fib: Specific Acupuncture Sites Identified.)

While those points were used by doctors to maintain rhythm after an ablation, I tried them before the ablation just to see if they might work anyway. This opened up the field of eastern medicine to me, which I now have a healthy respect for. I think there is definitely something to this, as it seems to have such a calming effect.

I Feel Fantastic!―But I know This is a Process

Who knows what the future brings, but I feel fantastic and wanted to let you know, Steve, how grateful I am to you for your guidance.

Dr. Swarup says this is a process…we got the rhythm back and now the job is to keep it.

Lessons Learned

Recognize that Tiredness May Be a Symptom of A-Fib: My A-Fib first showed up on a routine physical. Looking back, other than some tiredness, I hadn’t noticed any thing unusual up to that point. Since I stay in good shape, hiking, biking, golf, and some high intensity interval exercises, I had just attributed the tiredness to getting older and just kept on going.

I Waited Longer Than I Should Have: The EKG in April, 2014 which showed that I had A-Fib really shocked me. I did my research, found your website [A-Fib.com], and learned all about magnesium and acupuncture.

In hindsight, I waited longer than I should have. But I had to find out if these natural treatments would straighten out my A-Fib condition without going through an ablation procedure.

Doubted my Cardiologist’s Advice: Also, a cardiologist told me to do nothing since I had no symptoms, though in my mind I started doubting him almost from the beginning.

Get an Ablation Sooner Rather Than Later…But May Not be Easy: My lesson learned is to plan for an ablation sooner than later.

And don’t think that this will necessarily be an easy procedure. Everyone is different. My experience with the ablation and the required cardioversions in a three-day period in the hospital really knocked me for a loop. Despite my relatively good physical condition, I definitely had a case of the rubber legs.

I personally recommend to anyone getting an ablation, that you should plan on taking a week or even two off work to really recover before getting back to your normal routine.

Need for Second Ablation? If I ever have to do a second ablation, I will probably go ahead. But I will have to think long and hard about what kind of symptoms I have, as well as how much older I am.

The future is just speculation. As for now, having an ablation was definitely the right decision and turned out great.

Thanks again,
Roger Finnern, Tempe, AZ

Editor’s Comments:

Amiodarone Dangerous Drug: Amiodarone is the strongest and often the most effective antiarrhythmic drug, but it’s also the most toxic. (See my post Amiodarone Effective But Toxic)

Amiodarone is used in difficult cases like Roger’s after his ablation to get his heart in the habit of beating normally, but usually only for a short period of time.

It has to be carefully monitored for bad side effects. Some say amiodarone is so toxic that it shouldn’t be used at all, even in cases like Roger’s. It’s a difficult decision. It worked for Roger, but he did notice that amiodarone affected his lungs and breathing. “After being off of it…I breathed easier.”

“No Symptom” A-Fib May Not be Accurate: Some say that there really is no such thing as Asymptomatic A-Fib, that people just get used to how A-Fib affects them and put up with it. That seems to have been the case with Roger. He writes that now being in normal sinus rhythm feels “fantastic!” and very different than being in Chronic “asymptomatic” A-Fib.

Some would say that because Roger had few noticeable symptoms and was in Chronic A-Fib for some time, that it wasn’t justified to perform a catheter ablation on him. But A-Fib is a progressive disease. See my Editorial: Leaving the Patient in A-Fib—No! No! No! for a list of damage caused by A-Fib over time.

For Roger, being A-Fib free has radically improved his health and quality of life. Even if you are “asymptomatic,” you may still want to be A-Fib free. You have a right to do so.

Blood Thinners after an Ablation? Some would say that Roger should forever be on blood thinners (especially drug companies) for continued risk of stroke, even if he is A-Fib free.

But research indicates that a successful ablation reduces the risk of stroke to that of a normal person. (See my FAQs A-Fib Ablations: Blood Thinner Post-Ablation?) Blood thinners are not like taking vitamins. They have their own risks, like causing bleeding.

A Very Difficult Case: Someone in Chronic A-Fib for a long time is usually the hardest to ablate and make A-Fib free. In addition to the Pulmonary Veins (PVs), their hearts often have many non-PV triggers which have to be carefully mapped and ablated.

Not all EPs have this level of skill and experience. Roger was fortunate to go to Dr. Vijay Swarup who seems to have made Roger A-Fib-free after only one ablation.

O.R. Operating Room Report: Roger’s OR report showed how Dr. Swarup had to work very hard to find and ablate all of Roger’s non-PV triggers. After isolating Roger’s PVs, Roger was still in atypical atrial flutter, often one of the hardest arrhythmias to find and ablate. Dr. Swarup had to make a Mitral Isthmus ablation line and a Left Atrium roof line.

Then Dr. Swarup found right atrium flutter and made a caviotricuspid isthmus line to block it.

Afterwards, when Dr. Swarup administered isoproterenol to Roger to stimulate any remaining non-PV triggers, he found a tachycardia coming from an unusual spot―the posterior-septal aspect of the tricuspid annulus. (In all the O.R. reports I’ve read, I’ve never heard of an A-Fib signal coming from this spot.) When Dr. Swarup ablated this focal site, Roger terminated into sinus rhythm. That’s the best result an EP can hope for from an ablation. Further administering of isoproterenol couldn’t produce any other non-PV trigger sites in Roger.

If his A-Fib Returns: Roger knows that he may not be completely out of the woods yet. A second ablation will usually take care of any gaps or hidden triggers and will often be a much easier, faster ablation than the first.

And each day Roger is in normal sinus rhythm and A-Fib free makes his heart healthier, stronger and more apt to beat normally. Not to mention how much better Roger feels both physically and emotionally.

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