The Unwelcome Guest

Ever have a house guest show up unannounced? And then once they were there they wouldn't tell you exactly how long they were going to stay? I found out atrial fibrillation is kind of like that.

I wasn't sure what to expect after being discharged from the hospital after my first AF episode. I was given several new medications that were supposed to help one way or another. These included Flecainide (anti-arrhythmic), Cardizem (heart rate), Lisinopril (blood pressure), and Coumadin (blood thinner). The diabetes I was diagnosed with resolved itself after switching to a low-carb diet and weight loss. My stroke risk was considered much lower without the diabetes so after several months I was able to discontinue the Coumadin and switch to a daily adult aspirin.

Both Melinda and I were on edge during those first several weeks. The doctors acted like the AF might not ever come back but everything I had read told me it would. About a month and a half after my first episode, I woke up with AF. We both freaked. The uncomfortable memories of the hospital stay were still fresh in my mind and I wanted desperately to avoid a repeat. We sat looking at each other - me checking my pulse every minute or so and Melinda asking me each time if "it" was gone. I would say no and we both would sigh and our eyes would fall to the floor. This went one for about 90 minutes. Finally I felt a regular pulse. This time when Melinda asked me if "it" was gone I said "I think it might be". I had to check my pulse for several more minutes before I let myself believe the that AF had converted to normal. I think waiting out that first repeat episode was more stressful than the 4-day hospital stay.

Consistent with what I had read this pattern of repeat or breakthrough AF episodes continued. First about 40 days apart, then 30, then 20, then 10, then down to weekly episodes. At first I reported every one of my episodes to my cardiologist. He and I eventually accepted my progression as fairly normal for AF and I stopped reporting or even keeping track. Normally if I woke up with AF I would get up, take an higher dose of Flecainide, and rest or go back to bed to wait it out.

A couple of times I woke up with AF and decided I wasn't going to let it get the best of me and went on with my plans for the day. This was a mistake. Even with the meds my heart rate would shoot up and my heart would pound so hard I felt like my head would jerk with each beat. These episodes proved the hardest to convert. I had one in August 2007 that I was able to convert with another extra dose of Flecainide and Cardizem. The last one was in October. I woke up on a Saturday morning in AF. I tried the normal high dose of Flecainide and waited. Two hours later I was still in AF but needed to go into work. By the time I got home my heart rate was in the 120s. I took another dose of meds and went to bed. The unwelcome guest was still there Sunday morning.

I figured the next step would be my second electric cardioversion. I called my cardiologist who advised against a cardioversion but increased my meds instead. He also referred me to another doctor who specializes in the electrical system of the heart, an electrophysiologist (EP). I saw the EP 2 days later and he was in favor of a cardioversion but by this time it had been more than 48 hours so now it was more complicated. I went back on the Coumadin and had to wait for it to build up to the proper level. The EP also increased my meds over and above what my cardiologist had already done. Altogether I was in AF for 3-1/2 weeks this last episode. I was finally able to have the cardioversion and this time it was not nearly as scary since I knew what to expect. The worst part of it was getting the IV started. Just like before, one jolt and my heart was back to normal.

During this period I developed some unpleasant symptoms. Most of my evenings were spent sitting in a chair with a horrible headache and feeling light headed. None of my doctors could offer an explaination so I just lived with it. At first I figured it was the AF but the symptoms continued after the cardioversion. Melinda and I went out to eat one Friday night after work and it got so bad I asked her to take me to the ER (did I mention already that I don't like going to the ER). They did the required workup including a head CT scan to check for bleeding (one of the risks associated with Coumadin). Nothing showed up in the head scan (get over it, that joke has been done already) or in the other test so the diagnosis was probable medication side effects. I have since found some small relief by decreasing my morning dose of Flecainide. My doc considers this unconventional but he is not the one suffering. I had to try something and I'm not as worried about my morning dose since all my AF episodes have been at night.

Quiz time! Don't worry, it is multiple choice - just like my favorite tests in school:

1. Accept the AF and live a limited and probably shorter life.
2. Increase the meds to a more effective level and live with the side effects.
3. Find out what option C is.

Not sure about you but I am leaning towards option C.

Dave