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Atrial fibrillation

Today's Ablation Day: Surgery

Tue, Jan  31, 2012  - By Mike Muha

Ablation for Atrial fibrillationOK, so it’s ablation time. Well, not really. It turns out there are multiple preliminary steps that must be dealt with before the ablation procedure.

Wednesday, January 18

The next step was to get a MRI. Honestly, I’m not sure what the MRI iss for exactly, but I believe it helps pinpoint the locations in my heart that are causing extra electrical signals. I arrive at the appointed time knowing I’d be spending an hour and a half in the machine. It’s an active procedure: “Take a deep breath. Let it out. Now don’t breath”. I had to do this at least 60 times during the MRI.

MRI. No big deal: Lie down, hear same loud noises, stop breathing periodically.

They lightly strapped me down so I wouldn’t move my chest and put a heavy perforated material over my chest. Headphones were put over my head. And button was given me to press if I had any issues. They slid me into the giant MRI donut hole. I opened my eyes…and I freaked.

“Get me out of here!”

They rolled my out and I had them immediately undo the straps across my chest. I did not know if I could go back in. Weird and unexpected and totally irrational. The top of my head had even been outside the other side of the donut hole. But the mind does strange things. Claustrophobic? I guess so, strange for someone who pulls the covers over his head at night.

But I had to do the MRI in order to get the ablation. So I pulled myself together over the next few minutes and had them slide my back in. I furiously pretended I was on the beach on one of my Puerto Rico vacations, eyes closed, big open expanse of the sky above me, sun shining warmly on my face.

It worked.

A MRI is incredibly LOUD. It’s like a fog horn or semi -truck horn going off next to your ear. There’s also a background throbbing. The first half of the test involved sets of tremendous sounds lasting 6-8 seconds, or 14 seconds, or 25 seconds. I know, because I counted. I pretended the noises were ship horns (remember, I’m at the beach in my mind).

The next set of tests consisted of prolonged blasts of deafening noise, so loud and so long that the illusion of the beach disappears. Worse I start feeling my chest heating up. What the?!?!? I start freaking again.

“Get me out of here!” Part II

Between tests, I tell the tech I’m having issues and ask if I can come out for a few minutes. She says yes, but I’ll have to do the whole prolonged noise series over again once I go back in. She reminds me that my head is pretty much all the way through the machine and if I look back I would see the room. She turns of up the air that’s cooling my head to hurricane levels. I tilt my head back, open my eyes, and can see the room. I force my mind to calm, calm more, relax. “I’m OK now, let’s continue”.

It was a struggle, but I semi-maintained my composure through the rest of this set.

At the end of the set, the tech asked if I still wanted to come out for a bit. I told to continue with the tests, that I was OK. She said there were 20 more sound blasts and we’d be done.

I counted each and every one of them, and I was ready to get out by the end.

A short way into the tests, they put a contrasting dye in my blood, and for the next several hours I had a hard time focusing, probably because of the dye. I did not go back to work as I had planned. I went home and had a scotch…

Tuesday, January 24

I get a blood test before work. I think this is for the anesthesiologist.

Saturday, January 28

I went skiing! This was the interval session I mentioned yesterday. I thought I’d share my heart rate graph from the session, showing what it's like to be A-Fib while training:

Heart rate of Mike Muha doing cross country ski intervals while experiencing Atrial Fibrillation

Things to note:

  • Zone 5 (the red bar) is 95-100% of my max heart rate of around 166 bpm. During the intervals I'm WAY ABOVE my max heart rate - in fact, I hit 205 bpm or 123% of max. I have no idea why the heart rate has the plateaus at the top.
  • During my very easy warm-up, I'm in Zone 3 and 4, marathon and short distance race heart rates.
  • Just standing around doing nothing, I'm at 77% of max.
  • At the beginning of an interval, my heart rate doesn't gradually build up, it skyrockets up from the start.
  • The very last bit on the graph is my walking with my skis back to the lodge. My heart is at race pace. I'm breathing totally normally.

Let's see how tired you are after skiing 123% of max! I was toast the next day.

Monday, January 30, 2012

T-1: I get another blood test before heading into work.

Tuesday, January 31, 2012 – the Big Day

Today’s the big day! I’m to be at the Cardiac Center at the University of Michigan Hospital at 6:30am. Ablation starts at 7:30am; 11:30am I should be about done.

So what’s an ablation?

A catheter is run from my groin up into my heart. The catheter then delivers “ablative energy” in the form of radio frequency to essentially burn the tissue that cause the extra electrical signals to be discharging in my heart that cause the erratic and high heart rate. The lesions that are created block the trigger points that lead to AF. The number a lesions created during the four hour procedure can run over 200.

If you really want to know more, see The Treatment of Atrial Fibrillation put out by the University of Michigan Cardiovascular Center. It’s very readable, and covers more procedures than just an ablation. (In fact, you can read about the Cardioversions I had).

Post-surgery

From what I’ve heard, once the anesthetic wears off, I should be a little sore where the incision was made but otherwise feel fine. I expect to spend a boring night in the hospital watching TV, reading, or computing while they monitor me for complications. The next day I’m out. I plan on working the day after that.

I have several questions for the doctor:

  1. What is the likely cause of my AF?
  2. Do I have persistent or paroxysmal AF?
  3. What should I avoid going forward?
  4. Should I avoid caffeine AND coffee? (i.e., even decaf coffee?)
  5. I’m to have my teeth cleaned the end of February. That OK?
  6. Can I drive on Thursday?
  7. When can I go for mile-long walks with my dog?
  8. When can I XC ski again? When can I XC ski HARD again?
  9. Reports are that my resting heart rate will still be high after the ablations. Why, and does it return to normal over time?
  10. How many ablations were there?
  11. What’s the chance that I’m “cured”? What’s the chance that whatever caused it in the first place will cause it again?
  12. Does my wife have to wait on me hand and foot for a week?

Based on “The Treatment of Atrial Fibrillation”, I’m a little worried that I’ll be in for a second ablation. The success rate as of 2010 for people with persistent AF was only 50%.

Hopefully I'm cured: I need to get back in shape and give Eli Brown a run for his money….

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