From Gary Minar
Atrial
Fibrillation – do you know about it? August 14, 2010
The
purpose of this missive is to inform 1958 classmates concerning
symptoms and treatment for Atrial Fibrillation (A-fib). A-fib
is a subset of Heart Arrhythmias (irregular heart beat).
There
are several types of Arrhythmias; always slow, always fast and
irregular. Some are treated with pacemakers (the ‘always slow’
type). Other arrhythmias are treated with meds or the more advanced
surgical procedures as discussed below for A-fib. One should
search the web and focus on renowned hospital sites for best
descriptive medical info. A-fib is when you heart goes crazy at
a very high rate, maybe 3-4 times normal, so you’re your blood flow
thru the lungs and to all parts of the body, is very inefficient –
you get tired real fast. A-fib heart irregularity is where the
electrical signals between the upper/atria and the lower chambers are
confused, causing a very rapid inefficient heart beat. This story is
not intended to replace qualified medical advice! There are such
things as Congestive Heart Failure and this may cause some of these
symptoms also, but is far more serious. This tale only deals with a
tiny portion of possible heart maladies – A-fib.
At
our age, we 1958 Navy classmates are prime candidates for this A-fib
malady. This tale may be lengthy and boring, but I found that
several of my friends who have Atrial Fibrillation had little
knowledge of what they were dealing with. Nor were they able to detect
A-fib when it occurred! Thus, I think good info is essential so
that you can understand the diagnosis and treatment. Risk of stroke is
high with A-fib, especially when Cardio Version is needed!
Quick
Summary
My
A-fib began as a brief random event when I was 52, and was then
quiet until age 66, which began a series of A-fib events, each
being resolved by Cardio Version (electric shock). The cardiologist
also put me on several heart meds during this period, with off &
on use of Coumadin blood thinner. This year at age 74, the
cardiologist said that the medications did not seem to be able to keep
the A-fib in check and recommended Atrial Ablation, a minimally
invasive surgical technical. That A-fib fix seems to be
successful!
My
A-fib - detailed
My
experience with A-fib began when I was still working, at around
age 52 (1988). I was in the aerospace biz and doing extensive
travelling and systems engineering type efforts on fast track
programs. I was also keen on staying in shape and working out whenever
I could – lots of stress. One day, I noticed a strange feeling in my
chest and took my pulse, noticing that it was about 120 or so and
varying widely, where my normal heart rate was around 50. With fear,
but little knowledge I contacted the local Emergi-Care center and they
advised me to go directly to a hospital emergency room! I received
immediate attention and they stabilized me with blood thinners, etc.
Over that night, my heart rate returned to normal. So this first A-fib
episode lasted less than 24 hours. The cardio doctor said he could
prescribe some medication for long term use, but he was unsure if the
diagnose warranted cardio meds, considering my age. I concurred and
went on with no meds, and continued my tough work schedule and
exercise schedule with no effect. The cardiologist could not give me
any clue as to why this A-fib occurred.
About
14 years later at age 66 it happened again. This time I was still
working hard AND being very busy entertaining all my grandchildren
during their vacation, with all the things that we do for them when
they visit (in summary, lots of STRESS). My heart rate began to race,
this time it was around 180. I finally went to the ER, but could not
confirm exactly when the high heart rate began, thus they put me on
several meds immediately, including the fast acting blood thinner (Lovenox)
to reduce risk of stroke. The risk with A-fib is that, without
a blood thinner, if A-fib has been in place for over 72 hours,
blood clots can develop in the atrium and perhaps be released and
cause a stroke! Thus, they took these extreme medication measures, and
Coumadin was one of the meds, which takes a few days to build up and
give its effects in the blood. I had a fine cardiologist and he took
great interest in my case. He spoke about ultimately using
Cardio-Version later on if the medications did not return my heart
rate to normal in reasonable time. After about 60 days with no help
from the medications, he decided that the Cardio-Version was
necessary. This procedure is where they put you ‘out’ briefly and
shock you with electric paddles to ‘restart’ your heart, hoping
that the heart will reboot at the normal rate. Note that Cardio
Version is only attempted if you’re A-fib has been in place
for less than 72 hours! Otherwise they wait until they are sure your
blood is stable and ‘thin’ via Coumadin before such procedure, so
that there is minimal risk of blood clots being set free and causing a
stroke.
This
procedure worked and I was OK for a few more years. During this time I
was taking Amiodarone (to regulate the heart rate) and Coumadin to
thin the blood. I began to use a Heart Rate Monitor watch to ensure
that I was aware of my heart rate daily and to see how it performed
during vigorous workouts. Some people are apparently NOT able to
recognize an unusual heart rate, and this really worries the
cardiologists. The next A-fib event required another cardio
version. Repeat this same story for the next few years, with a couple
of events being able to go away by taking larger daily doses of
Amiodarone and resting (including one event at the 50th USNA Reunion).
Because of the lengthy periods between A-fib occurrences, AND
that I was able to detect it when it occurred, the cardiologist
decided to let me stop using Coumadin for several years. I was also
working out vigorously during these years with mountain bike and road
bike. This routine was OK until late 2009, when I had about 4
close-spaced recurring A-fib bouts, each needing a
Cardio-Version.
So
in early 2010, my cardiologist changed me to Multaq due to the
dangerous side effects of Amiodarone, along with regular daily
Coumadin. I also changed cardiologists because my favorite doctor
moved up to head of hospital staff. The Multaq seemed to work for
about six months, but the A-fib came back. The new cardio
doctor was rather direct and told me that he thought the medicine
approach to correct A-fib had ‘run its course’. He
suggested that I speak to a well respected expert here in Santa
Barbara, where they have just acquired the equipment and the team to
perform Atrial Ablations. His conclusion was that I needed this
Ablation procedure since the meds were not working any more, and the
risk of repeated Cardio Versions to temporarily correct A-fib carries
too much risk of stroke, etc. During the few weeks I waited for the
Ablation, they also added Metoprolol for further slowing my heart
rate. This med really slows you down and gives you ‘unusual’
dreams, among other things!
Some
Web info on Atrial Ablation:
1.
At the Mayo Heart Clinic site, I found a fairly informative story
about A-fib and the Ablation fix.
2.
I also looked at the Johns Hopkins Medical site, BUT it seemed to show
the older Ablation procedure where they use several holes in your
chest to place the instruments. This seems much more invasive than the
newer procedure.
3.
The Santa Barbara Cottage Hospital site describes the less invasive,
state-of-the art, Ablation procedure and some very good info on the
wide range of heart maladies:
http://www.cottagehealthsystem.org/chunkiid/35525/HealthLibrary.aspx
This
Santa Barbara Cottage Hospital site also has a nice video explanation
about the heart and how it works and an explanation of some
abnormalities. (Find and click on: Related
Media: Understanding Atrial Fibrillation)
My
A-fib Ablation Experience
I
had the procedure (A-fib ablation) done on Wed., August 5,
2010. It was no piece of cake, but glad it is over. As it turned out,
they did both the ‘flutter’ fix on the R side atrium and the A-fib
on the L atrium.
Doc
said that he is convinced that the heart rate seems to be normal after
the ablation, but could fluctuate in next several months while the
body gets used to the ‘changes’ they introduced via the tiny
‘electro tool’.
The
Ablation procedure is performed in a special operating room called
Cardio Electrophysiology Center. They make incisions in your
‘groin‘, which means very close to your penis. They put 2 tubes in
the veins on each side. One
side set goes to R atrium, other to the L. These tubes contain the RF
telemetry transmitters, the heat styli and some other toys.
They
do the necessary ablation work inside the atria; R side is for
flutter, and left side is for A-fib. This is a very high tech
process, guided by GPS coordinates on a magnetic plate on your back,
illuminated by the RF on their ‘soldering iron’. Precise location
is crucial. I think they use fluoroscopy to help map and guide the
tools also, with some viewing and sensing tools via your throat. The
process is vividly displayed on huge video screens to aid the surgeon
and team members with large 3-D views – some impressive hardware.
Flutter
fix alone by ablation is far less invasive, but the A-fib part
of the ablation fix is lengthy since they must build ‘ridges’
around the 4 ports that come into the atrium. The
team of men was really great, and teamwork is what is important when
they are monkeying with your heart.
The
preps began at 1000 and the OR started about 1230. Theoretically I was
‘sedated’ (sedated means that they do NOT give you general
anesthesia), but I was truly ‘zonked’. I next remember seeing a
clock at around 2230 at night while the nurses did some tasks. So I
was out for that time. For all I know I could have given them my Swiss
bank account numbers or sang opera during that outage. My wife saw me
at around 1900 when I came to the hospital room, but I don’t have
any memory of that. They finally pulled the tubes from the entry
points at around 0230 or so. Nurses were great and very understanding
of what was going on. I went home around lunch time the next day.
Chest
felt like an elephant had stepped on me for 2 days. First night home
was not ‘restful’ at all. And was sort of challenging since the
chest pain was #1 concern and the swelling in throat due to both the
tubes they put in there and irritation from all the heart work made it
very hard to sleep. By the next night I was able to get fairly normal
sleep. The next day I went outside for a little walk to keep my
flexibility up.
In
theory, if this Ablation holds, I’ll be able to quit the Coumadin in
a few months, but time will tell. All in all, I’m glad it’s done
and am hopeful that the results are as advertised. Ablation is a very
specialized procedure and needs the skilled surgeon and team and some
very costly equipment, which they recently have acquired in Santa
Barbara.
Bottom
Line
Any
malady of your heart is sure to get your attention immediately. A-fib
is one of those, but is not as dangerous as some that can occur
suddenly, such as cardio infarction (heart attack). Other heart
maladies are well described in the literature via a web search. If you
find that your heart gives you trouble, you should immediately find a
skilled cardiologist to handle your case. The sites given above have
great info on heart abnormalities. A-fib, as of this writing
appears ‘fixable’ with the minimally invasive Ablation procedure. A-fib
is NOT fixable with a pacemaker, as might be used to correct
abnormally slow heart beat.
I
also strongly urge you to get a Heart Rate Monitor (HRM) watch if you
have any sort of heart abnormality so that you can be aware of your
heart rate. You can find an HRM from around $20 up to several hundred,
depending on how many bells and whistles you demand. I prefer
simplicity and low cost. Check E-bay too. I bought mine from Big-5
Sports.
I
trust this info helps you understand a bit more about this fairly
common heart malady, that affects millions. A-fib is age
related, and at our age we are prime candidates for such! And again,
do not take any of this as absolute medical truth. Consult the
hospital web sites and/or your cardiologist for best data.
You
may contact me if you have further curiosities.
Gary
Minar gary.minar@1958.usna.com (805) 688-7957