The Envelope Please...

Next comes "And the winner is...". That is usually followed by some kind of speech where the winner thanks the spouse, the parents, the academy, and who knows who else.

I've been feeling the same kind of anticipation waiting for the results of the Coronary CT Angiogram (CCTA) that I had June 20th. The purpose of the CT scan was to check my pulmonary veins for any signs of stenosis (narrowing due to scars from the ablation burns). Dr. Natale requested the scan as follow-up and to rule out any future complications (pneumonia, etc). My cardiologist questioned the need for the CT scan since I was not having any symptoms indicating PV stenosis. I decided to go ahead with it since I could get a calcium score at the same time to find out my risk for future coronary artery disease (CAD).

The nurse finally called today with the results. She started out by asking if I had had an ablation. I said yes and that the CT scan was for follow-up. She said the cardiologist that read the scan said she could not even tell that I had an ablation and that whoever did it must have done a great job. The nurse then read the text of the pulmonary vein findings and everything sounded great. I should be getting a printed copy in a few days so I can fax it to Dr. Natale's office.

This was great news. My heart continues to do well. The skipped beats have calmed down considerably in the last couple months. My resting heart rate continues to be in the 80's so I am still hoping it will slow down some in the next 6 months. All in all we are extremely happy we decided to pursue an ablation with Dr. Natale.

So now the obligatory speech: I'd like to first thank Jesus Christ for saving my soul. Next I'd like to thank my wife Melinda for taking care of me through all this. An extra special thank you to Dr. Natale, Salwa, and all the staff at Marin General Hospital that were involved with my care. Last, but certainly not least, is a thank you to all our family and friends that have prayed for us and supported us.

Now I'll leave with my trophy made up of bottles of old, unnecessary heart meds with a wave and a final "Thank you everyone".

Until next time,

Dave

Blood Is Thicker Than Water?

Whoever came up with that expression must have never been on Coumadin. When I've gone in for my ProTime tests, I can usually tell if my blood is thin enough to be in the therapeutic range (INR between 2.0 and 3.0) before the machine gives a reading. If my blood comes out like cherry kool-aid after the finger stick, I'm good (sorry for the analogy).

But those days are finally behind me now. The Coumadin is now on the shelf next to the rest of my old heart meds. I guess I'll keep the meds around just in case but at this point they seem more like trophies celebrating a successful ablation. The Coumadin has been replaced for now with a single adult aspirin daily. I still need a small dose (5mg) of Lisinopril for high blood pressure that should have been treated a long time ago. I can deal much better with just one prescription med and the pharmacist won't get to see my lovely wife (or our money) near as often now.

I could have gotten to this point a few weeks earlier but it took a little bit to get scheduled for the required follow-up testing. I wore a 48-hour holter monitor a couple of weeks ago and the results showed normal sinus rhythm with about 80 PVC's per day. The Premature Ventricular Contractions feel like skipped beats but are not a concern. My cardiologist wonders if or why the PVC's are more frequent after my ablation since all of the burns were made in the atria. It could just be that I notice them more. Whatever the case, it seems like they are letting up even in the two weeks since the holter test. My resting heart rate is still in the 80's but not causing any problems or symptoms.

I had an echocardiogram a little over a week ago and the results were also encouraging. My left and right atria are still both mildly enlarged but have gotten smaller since my last echo in November 2007. Some of the enlargement is due to the AF, and some of it could be due to my untreated high blood pressure. I am thankful to see some improvement now that both possible causes are under control.

Normally these test are done closer to the 3-month point post procedure which would have allowed me to get off the Coumadin earlier. Dr. Natale would also like me to have a CT scan to check for any stenosis (narrowing due to scarring) of the pulmonary veins but I am still waiting for insurance approval for that test. My insurance only likes to approve a CT scan for this purpose if I am having symptoms (which I am not).

So that's the latest. I am definitely enjoying the spring weather and a normal heartbeat. I hope and pray the same for everyone reading this. Best wishes.

Dave

Kick The Habit

I remember the TV commercials from my childhood put out by the American Cancer Society. Their slogan was "Kick The Habit". Now, some 30 years later, I wish more than I can put into words that my mother would have listened to those ads. She was a smoker all the years I can remember but lung cancer got the best of her at a relatively young 75 years old. It took less than 2 months from the time the cancer was detected to take its final toll on my previously strong and healthy mom. If you smoke, I cannot urge you enough to quit. If you can't do it for yourself, do it for the ones you love and the ones who love you.

Of course the "Kick The Habit" slogan refers to cigarettes but I am borrowing the slogan now relating to my heart medications. Under doctors orders, I quit the Flecainide 2 weeks ago and the Cardizem was shelved a few days ago. Since stopping the Flecainide I have noticed a few more skipped beats but still no AF. My resting heart rate is still higher than before my ablation but I expect it will take months to settle down. For the most part my heartbeat has been invisible for the last 12 weeks. I am very thankful for the answered prayers of family and friends.

I continue the daily monitoring with the HeartCard device. The monitoring was scheduled for 3 months so I only have one more week left. After that I am looking forward to being told to discontinue the Coumadin. In the meantime I will continue to enjoy every day of sinus rhythm.

Blessings to you all,

Dave

One Month Update

It has been one month today since my ablation procedure and everything continues to go very well. I have not had any AF episodes that I am aware of. A few times I have had the all too familiar anxiousness in my chest that used to precede an AF attack but so far they have come and gone without incident. I haven't decided yet if this feeling is all in my mind or if it is caused by whatever stray electrical signals in my heart that used to trigger AF but are no longer able to because of the ablation lesions. Fellow afibbers know all too well the effect on your mind and outlook that living with AF for any length of time can have. This is regardless of how many medical folks tell us that AF is benign or not life-threatening.

I thought I might try to recap my recovery since most visitors to this blog at this point are people scheduled for or considering a similar procedure. The biggest questions I would have had beforehand for someone else who had been through an ablation would have been: 1) What did the procedure feel like?, 2) What was recovery like, and 3) How long did it take to get back to normal? I've posted before about the procedure itself and the hospital stay so now I will try to add some detail to what followed. As always, feel free to ask questions by posting comments and I will do my best to answer in a follow-up comment.

The discharge instructions said I could shower when I "got home" so that was one of the first things I did when we got back to the hotel. I wanted to remove the last of the bandages and try to feel a little more normal again. I can't remember how many days later I was still finding leftover adhesive from bandages, electrodes, and whatever else they stuck on me. During this first shower I could feel a lump about the size of a marble just under the skin at the right groin incision. This was the side that ended up with the worst bruising so I'm guessing it was a blood clot. I asked the EP nurse about it by phone a few days later. She said it was nothing to worry about unless it got larger or started hurting. It did neither and after a week or so I could tell it was starting to shrink. One month later it is a fraction of the original size and my guess is it will be completely gone in a few days.

As far as bruising goes, I ended up first with the normal bruises at my IV site and the inside of both elbows from all the lab draws. Four or five days after the procedure I noticed the beginning of a larger bruise just below my right groin that seemed to appear overnight. Over the next several days it continued to grow and at 10 days it was about 6" (150mm) x 2" (50mm). It took at least another 10 days to go away completely. I did end up with a small 1" (25mm) bruise under the left groin but it did not last very long. Initially there were no problems with the neck site at all but maybe 15-20 days later I was surprised to see a 2" (50mm) bruise on my upper right chest about 3" (75mm) below the site. This was the only one that was at all tender and still remains.

My heart has been fine so really the only limiting factor for me was the limited mobility because of the groin incisions. I was able to walk the day after the procedure but my venture from the hospital to the car to the hotel was made with very small steps using more my knee joints than my hip joints. The next day (2 days post-ablation) I was amazed with how good I felt overall so we went for a drive to the Golden Gate National Recreation Area. My wife and daughter walked the half mile trail down (and back up) to the Point Bonita Lighthouse. I felt I could have made the walk as well but common sense let me walk only a few hundred yards but it felt great to be outside. When we flew home a week after my ablation, I was walking normally through the airports with very little discomfort. I had no problems at all by the time I returned to work one week later.

Looking forward to one more month from today is when I should be able to discontinue the Cardizem and Flecainide. Another month after that I hope to be off the Coumadin. Follow-up testing should come at the 3-month mark as well and should be a good indication of how successful the ablation was. I have very high hopes based on how well everything has gone so far. I'll keep you "posted" ;-)

Dave

Two Weeks And All Is Well

After a memorable vacation, my wife and I like to reminisce during the following weeks by saying something like "remember where we were two weeks ago?". Maybe we are not the only ones who do this. Tonight, as I think back to two weeks ago, it was the evening of my ablation procedure. Not really the same memories as a relaxing vacation. I do remember laying in the hospital bed, relieved that the procedure was over, and waiting for the healing to begin. Two weeks later I can say that the healing has been much quicker and easier than I expected.

So far I have not had any AF episodes or any other sustained arrhythmias. I have maybe a handful of single "skipped beats" per day. This is to be expected during the ablation recovery and hasn't concerned me. I had many more skipped beats before the ablation and it was when they would string together one after the other that I had to be worried about an impending AF episode.

I finally returned to work today. I was expected back two days ago but the New Year came complete with a head cold. Air travel this time of year has its drawbacks including lots of other folks with sniffles. I had to rely on rest and fluids to get over the cold as I always worry any extra meds or vitamins will throw my INR (Coumadin level) off. Maybe you have picked up on the fact that I will not shed any tears when the Coumadin therapy is discontinued.

That's all for now. Welcome to 2008.

Dave

Questions Anyone?

Now that we are home, the initial purpose of this blog has somewhat been fulfilled. We wanted a way to keep family and friends updated during my ablation and recovery. We will continue to post progress at various milestones along with anything new of interest.

It is also our hope and prayer that this blog would be helpful to others dealing with AF or contemplating an ablation. I will try to provide some more detail in this post regarding my ablation and answers we got from Dr. Natale. We would also welcome any questions anyone might have. Leave any questions as comments to this post and we will do our best to answer them as a follow-up comment.

Here is some additional info in no particular order:

EP Study: I had read some ablation procedures are preceded with an EP study where lasso catheters are inserted into the left and/or right atria to map out the electrical signals inside the heart, including any abnormal signals. The doctor can use this mapping info to decide what areas need to be ablated. Dr. Natale said he would not need to do an EP study in my case. My guess is that was because my ablation was relatively straightforward.

CT Scans: The brochure we had gotten from Dr. Natale's office mentioned a CT scan would be performed before the procedure and again at 3 months post-procedure. There had been a discussion on the forum I watch about the risks of all the radiation from the multiple CT scans along with the fluoroscopy used during the procedure itself.

• Pre-procedure CT Scan: Dr. Natale did not ask for a CT scan before the procedure. I didn't think to ask why specifically but my guess is it was not necessary since I was not having an EP study.
• Post-procedure CT Scan: I did ask Dr. Natale if he thought a follow-up CT scan was necessary when there are no symptoms indicating pulmonary vein stenosis (narrowing of the pulmonary veins due to scar tissue or swelling). He felt it was very important to rule out stenosis as a complication for any future issues like pneumonia. He said otherwise you could be walking around with stenosis while not knowing it but it could be causing problems that would not immediately be connected to possible stenosis.

Vagal vs. Adrenergic AF: Dr. Natale said he felt the causes for AF were similar regardless and that vagal or adrenergic types described more the timing of AF onsets and not necessarily the cause. I definitely had vagal AF and my episodes were always at night usually following a late or heavy meal. Dr. Natale felt that the digestive process would cause an adrenergic response as extra blood flow is required to the gut. I'm not sure if we discussed it but I'm sure my sleep apnea events would also trigger an adrenergic response.

Pacing vs. Drugs to Induce AF: One local EP I saw said if I wasn't in AF for an ablation, he would electrically pace my heart to put it into AF. Dr. Natale said he could pace even a normal heart into some sort of arrhythmia and he preferred to use adrenaline like drugs to get the heart to reveal possible AF trigger sites.

The Ablation Procedure: Dr. Natale performed a variation of a PVI called a PVAI (Pulmonary Vein Antrum Isolation). My understanding is the "Antrum" part means the burn lines are moved further out into the atrium from where the pulmonary veins join the left atrium. Early PVI ablations placed the burn lines inside the pulmonary veins. Stenosis was a common undesirable result plus not all stray electrical signals were blocked. Dr. Natale's method reduces the risk for stenosis and isolates more of the potential AF triggers in and around the pulmonary veins. After the PVAI, Dr. Natale used adrenaline like drugs to reveal any other potential triggers. He found one other site in the coronary sinus that he ablated as well. I believe this would be considered a focal ablation.

Sleep Apnea and CPAP: I brought up my sleep apnea during the consultation with Dr. Natale as a concern I had while being sedated. He was more concerned that my SA might cause me to take deep breaths that could make keeping the ablation catheter in position with proper pressure more difficult. The easiest solution was for me to bring my CPAP machine and mask with me for the procedure. The morning of the procedure they called someone from respirtory to fit an oxygen feed inline between the CPAP and mask.

Boxers or Briefs: I understood from the brochure from Dr. Natale's office that there would be a total of 3 incisions made to insert catheters - two in the groin and one in the right side of the neck. I had never had an ablation before so I was not sure where exactly the groin incisions would be. The best way I can describe it is by saying you would not want to wear briefs anytime soon after an ablation. The incisions end up pretty much right where the leg openings in a pair of briefs would be.

Overall Impression: It helped me to read what others had said that had been through an ablation. Almost every account I read said the procedure was no big deal. While I hope and pray I do not have to have any more ablations, I would not hesitate to have another if I thought it would provide relief from AF or something similar. I would again seek the most experienced EP I could find and Dr. Natale would certainly be top on my list.

That is all I can think of for now. Submit any questions you have for me or Melinda as comments and we will do our best to answer. Happy New Year everyone.

Dave

Home Sweet Home

We finally made it home but it was a day later than expected. We made it to Kalamazoo at 12:30 AM this morning. We spent the night at our daughter's apartment there. Our son came and picked us up this morning and we made the trip to Grand Rapids to pick up our luggage. The airlines won't reroute your luggage if you decide to change you destination. We still figured it would be worth it to get back to Michigan last night versus waiting until Saturday night or Sunday. No offense to anyone from Minneapolis but 9 hours hanging around the airport there is about 8 hours too many.

My ablation recovery continues to go well. I've been in normal sinus rhythm since the ablation. I noticed more "skipped beats" (PVC's or PAC's) yesterday and today but I was seriously sleep deprived so hopefully they will calm down. My right groin incision is the only one giving me any problems. My "California" bruise was joined by Oregon and Washington and the area remains a little tender but nothing to worry about.

I continue the daily monitoring with the HeartCard device. I will have to call in the recordings from work or somewhere else because the device is not compatible with cell phones and that is all we have anymore. I was put back on my heart meds (Flecainide and Cardizem) after the ablation but my understanding is I will be able to discontinue those once it is shown I have not been in AF for an extended period. This is one reason for the daily monitoring.

So now it is time to catch up on sleep, mail, bills... you know the routine.

Dave

Is There A Pilot On Board?

That's one thing you don't want to hear on your flight. And one thing you don't want to hear at your connecting airport is "Your flight has been cancelled and we have nothing else available until tomorrow or the next day". So at the moment we are stuck in the Minneapolis airport trying to find a way home. We might get a flight later tonight into Kalamazoo but there is a chance that flight will be cancelled as well. Who knows where will end up tonight but we're hoping and praying it will be Michigan and not Minnesota.

Hey - That One Looks Like Mickey Mouse

Did you ever look at clouds as a child (or maybe an adult) and decide one looks like a shape or figure? Well now I can do the same thing with bruises. I'm not sure if it was the walking yesterday or just part of the normal healing process but I now have a new bruise on my right leg. If I had to describe it, I would say it looks like the state of California (including mountains and rivers). I'm not sure if there is any kind of connection but it makes me wonder if I should have tried to have my ablation in Rhode Island or maybe the District of Columbia. The EP nurse did tell me some people bruise all the way down to their knee. Would that be considered a Continental bruise? In any case we'll see how many more states join the Union so to speak.

Today is our last full day in California. We plan to take the rental car for another spin and use up as much of the pre-paid gas as possible. I'm not sure if this is out of principle or because we want to see more snow-free landscape before returning to Michigan (where there is a winter storm watch in effect for the time we are supposed to be arriving tomorrow). Until next time...

Dave

On The Fifth Day Of Christmas...

I know Christmas is past but I'll continue the theme anyway. Today is my 5th day post-ablation and this is the day the doc said I could venture out more. Today we plan on sight-seeing in San Francisco. This may involve quite a bit of walking so we will play it by ear.

Recovery continues to go well. You can't even tell I had a neck incision but the groin incisions remain a little tender. I haven't had any problems with external bleeding but internal leaks and bruising are somewhat normal since the ablation procedure was performed while I was still on Coumadin (blood thinner). I am just noticing a bruise now around the IV site on my right hand so I'm guessing it may take days for some of the bruises to show up.

I hope to make a quick stop by the lab this morning for a ProTime test. Anyone who has been on Coumadin before knows that the constant monitoring is one of the inconveniences. Diet has a big impact on Coumadin dosing and my diet has not been as consistent here as it would be at home, especially with our Christmas dinner yesterday.

That's all for now. Have a good Wednesday everyone.

Dave