“Cut to the heart” might sound like a dramatic title but all will become clear. I recently underwent a “catheter ablation” operation in an attempt to bring a heart rhythm issue under control and the reason for this article to detail my experiences with this operation, in case it can be of benefit for anyone else with a similar problem.
Irregular heart rhythm
About nine years ago, while on a train trip holiday, I had a very strange episode where I woke up during the night with my heart pounding and I thought I might have been having a heart attack. This passed after about an hour and I started feeling better. It was a one-off event and I put it behind me. Now, I realise two things about this event – (1) it was following an evening of heavy drinking of alcohol, and (2) it was one of my first episodes of atrial fibrillation (or AFib). My first AFib episode might have happened a couple of years before this when I was visiting China and, again, after an evening of heavy drinking of alcohol. I can’t remember this episode very well, but I remember feeling very bad for an hour or two.
A couple of years ago, I started to get AFib frequently. Something like every two to three days on average, for a period of between 15-60 minutes and often in the middle of the night. It would wake me up and I’d be worried about what was going on. I went to A&E a couple of times but by the time I arrived, the AFib had ended and the ECG was normal. Nothing to be seen.
Checking the heart
I saw a heart specialist as soon as I could and he said that the best way to analyse what’s going on is to wear a heart monitor for seven days. He suspected that it could AFib or one other thing (can’t remember what that was though), but the only way to find out would be to record it on the heart monitor.
Even before getting the heart monitor I had an ultrasound test and, because of a history of heart disease in my close family (my father), an MRI of the heart. Then I wore the heart monitor. What a pain to wear and sleep with three big wires stuck on my abdomen and connected to a small electronic device.
After all this, I went back to see the specialist. Would you believe that in the 7-day period that I wore the monitor I didn’t have any AFib events? Well I didn’t. I was wearing that uncomfortable thing for no reason! Argh.
The specialist said that my ultrasound and MRI both came back well. They showed that my heart was structurally sound and that my arteries had only mild build-up of plaque. At least that’s some good news. Regarding the monitor, we’d have to try again in a few months.
As a precaution, he recommended I take the following medications every day – a statin (because of the mild plaque build-up and my family history), a beta-blocker (to reduce the heart activity and minimise the chance of AFib), and a blood-thinner to minimise the chance of rogue blood clots if I do have AFib.
In the following months, I found that the severity of AFib was increasing. A couple of times I had AFib for many hours in a row. It’s not very pleasant and I really wasn’t liking it (that’s an understatement). It was starting to interfere with my gardening work. The specialist was concerned about these long AFib sessions and told me to increase the beta-blocker dose. It helped a bit, but not too much.
Eventually, I was wearing a 7-day heart monitor again and luckily (or unluckily, depend on your view), many, many sessions were recorded this time. Now the specialist could confirm that I definitely had AFib. Based on my age and health profile, he suggested that I’m a very good candidate for an “ablation” and recommended me to another specialist who’s an expert in this procedure. At the time, I knew nothing about ablations, just that they went through a vein and did something to stop the AFib.
I also began to notice that the probability of having an AFib session was linked to the amount of alcohol that drank. For a couple of months, I stopped drinking alcohol all together. Much reduced AFib sessions, but I still got them.
The ablation specialist confirmed I was a good candidate for an ablation. He said that if I didn’t have the ablation, most likely the AFib sessions would become more and more common and then, one day, I would have AFib all the time, and then there’s nothing that could be done. He said that an ablation has a 70% chance of helping with the condition, a 29% chance of resulting in no difference and a 1% chance of making it worse. It was a pretty easy decision for me to opt for the ablation.
An ablation is a day surgery, but it’s a heavy day. Upon arrival, they have to carefully check you out. Lots of blood tests and blood pressure readings. Because they access the heart via a vein in the groin area, there’s the process of having hair shaved away (both sides – I guess they can’t tell which side the surgeon will prefer). Then the long wait to go to theatre.
It’s done under a general anaesthetic (I believe mainly because they really don’t want you to move at all) and It seems like I was in theatre for somewhere around three hours. During the procedure, they put an ultrasound sensor down your throat because they can get really close to your heart that way, and hence get good, high-resolution, real-time images of the heart. From the groin, they feed a catheter up to and inside the heart.
They enter the right atrium via a vein and then they punch a small hole through the wall of the heart (yikes!) to get into the left atrium, where the pulmonary vein enters the heart. Next, I’m not sure how, but they analyse the electrical impulses inside the heart and map out the location of the rogue electrical impulses that are the root cause of the AFib. The aim is to contain the rogue electrical impulses by creating scar tissue that the impulses won’t cross. That’s right, they are going to deliberately create some scar tissue inside the heart (yikes again!). One way to do this is by making small cuts (a cut to the heart!) and another is to use a small balloon cooled with liquid nitrogen I guess to burn inside the heart and thus create scars. While they’re in there, they do some checks to make sure they’ve contained all the impulses that need to be contained.
After the operation, I felt like crap. To be expected after a general anaesthetic. However, the biggest concern after such a procedure is the puncture wound in the groin. I had to lay flat for four hours while being regularly monitored before I could leave. The nurses were very wary of the puncture wound in the groin especially as I (and I assume most patients having an ablation) was on blood thinner medication.
I was quite tender while my wife drove me home. The major sources of discomfort was the wound in the groin and a dry, sore throat. At home, I took it easy and rested. One of the bits of advice given to me was to not do anything that would make my heart speed up too much for a week or so. Apparently, everyone’s speed of recovery from an ablation is different, from a couple of days to a few weeks.
On about the second day, I had the bravery to try changing the dressing on the groin wound. I shouldn’t have worried too much as the wound looked good and was healing well. In fact, the way the original dressing was put on the hospital meant that it was constantly pulling on the skin – this was one of the reasons the wound felt so uncomfortable. With a new dressing, it was more comfortable.
I started working from home while recuperating and one day, I realised why they said not to do anything that would make your heart beat faster. I was upstairs, in the house on my own and a delivery person was at the front door. It looked like he was going to leave so I ran downstairs without thinking about it. Afterwards, I could feel pain in my groin and then I started to feel like I was hit by a bus. My head was spinning and I felt like I was about to fall over. Then I realised that my heart had been through a lot (with “a cut to the heart” and a hole punched through its wall, etc.) and it was still recovering and wasn’t able to work under high load yet.
Monitoring my health metrics
Some weeks before have the ablation procedure, I bought myself a small Fitbit device because it constantly measured the pulse, could take a crude ECG and even detect AFib events. Whenever I felt AFib coming on, I could see it and record it on the device.
After the ablation procedure, I saw some dramatic changes on the recorded health metrics. I noticed immediately that my resting heart rate jumped up. Before the ablation, my resting heart rate was in the 50’s, and I now believe a significant reason for this was because of the beta-blockers I was on. Immediately after the ablation, when the surgeon came to check on me, he said that I should now begin to reduce the dosage of the beta-blockers with a view to getting off them altogether. So, I immediately reduced from 5mg a day to 2.5mg, then a couple of weeks later to 1.25mg, and then to zero. During this time, I noticed my resting heart rate continue to increase. My guess is that the beat-blockers reduce the resting heart rate. Today, my resting heart rate is somewhere around 68-73 bpm (it’s now six months after the ablation and I can’t tell if my heart has completely recovered now or not).
At a follow-up consultation with the ablation specialist, he told me a significant jump in resting heart rate after an ablation is positively linked to a successful procedure. So something to be happy about, I guess. It shows that the ablation has a definite effect on the heart’s function.
The other significant change I noted was in “heart rate variability”. Apparently, a higher heart rate variability is a sign of good heart health in general, but mine dropped about 30% after the ablation and it’s stayed there. Also, it’s much more consistent now hovering mostly between 7 and 10 milliseconds these days. So, clearly, something has happened to my heart and I’m not sure if it’s going to stay as it is now forever, or whether it will change.
The good news
Well the good news is that in the six months since I had the ablation, I have had zero AFib events. Zero! That’s great. With my fingers firmly touching some wood, it appears that the operation has been a great success (I have a few friends who weren’t so lucky, so I feel truly blessed). The ablation specialist told me that every year after the procedure there’s a 5% higher chance of AFib returning. I suppose the rogue electrical impulses eventually find a way around the scarring.
One negative is that now I don’t notice any AFib side-effects from drinking alcohol, so I’m probably drinking too much (something else to work on). But I really have to thank the brilliant specialists, surgeons and nurses who used tremendous expertise to help me with this problem. It really has turned out to be well worth having a “cut to the heart”.