Thursday, July 17, 2008
The Envelope Please...
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
Tuesday, May 6, 2008
Blood Is Thicker Than Water?
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
Thursday, March 13, 2008
Kick The Habit
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
Monday, January 21, 2008
One Month Update
Friday, January 4, 2008
Two Weeks And All Is Well
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
Monday, December 31, 2007
Questions Anyone?
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
Saturday, December 29, 2007
Home Sweet Home
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
Friday, December 28, 2007
Is There A Pilot On Board?
Thursday, December 27, 2007
Hey - That One Looks Like Mickey Mouse
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
Wednesday, December 26, 2007
On The Fifth Day Of Christmas...
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