PAC's, PVC's & a Cardioversion

Last week was a cluster healthwise. Of course my sciatic nerve pain is through the roof right now and I was running allot of PAC's and PVC's. I went out of rhythm Tuesday morning for a bit but converted back. Then I went to the hospital Tuesday evening to see if they could do some tests to figure out if my sciatica was being caused by a disc or some other ailment. They did some exray's and a CTA scan to rule out any clots in my leg. Everything came back normal so I still don't know 100% what's going on. Pretty sure its a bulged disc though so I'll have to wait it out.

I had sent Dr Natales office some recordings on Wednesday morning as I had gone back out of rhythm and they called and asked if I could arrange to get cardioverted within next week. I called my local EP and they scheduled me for last Friday morning. I worked Thursday night so  headed for the hospital straight from work Friday morning.

Cardioversion

If you have been keeping up you already know that my I have
already had one cardioversion done this year back in April. You will also know that the worst part of any EP experience for me has been the TEE. I was however curious as to how this one would go. My Cardiologist retired last month so I knew that he would not be doing the procedure. Which,, even though I hold the man in high regard his TEE skills pretty much suck.

So I arrived at the hospital early and got all the pre cardioversion stuff done which basically consist of a chest x-ray and getting an IV so they can inject the propofol for sedation. They hooked me up to a monitor then decided to wait on my EP to some in and verify that I really needed a cardioversion. He came in not too long after to talk to me about what was currently going on and to also catch up on the festivities in Texas. I handed him a copy of the ablation report and he quickly took it out and looked it over. He was very pleased to find all his work was solid, as I was always confident that it was. We then talked about the cardioversion and some small talk. He said that I was in a controlled flutter and that they would be doing a TEE then cardioverting me.



It was a while before they came to get me so I was just laying there trying to catch a nap but I kept hearing this music, Kool and The Gang to be specific. I originally thought that one of the other patients in the holding areas family members was playing music but I would eventually find out it wasn't them and where the music was actually coming from.

Eventually a couple of transport girls came to get me to take me to the EP lab. I stepped from my bed to the transport table then they wheeled me out into the hall. As we approached the hall the music got louder and the girls started to dance. There was a doctor sitting right outside the room and Celebrate must have been the music his computer played when he opened his computer. What a light hearted fun moment that was. Always a great experience at UPMC.

I eventually ended up at the EP lab where I met Karl. A very animated prep guy. He made me laugh several times. Then the nurse anesthetist came on and we started talking. Now if you have never had a cardioversion before there are allot of folks involved. You have of course the EP, a cardiologist, nurse anesthetist and of course and anesthesiologist. So rangeling them all together can be a task as stated by the cardiologist that soon entered the room.

She was very friendly and animated. She introduced herself and we talked for a while. I had told her about my many experiences with TEE's, good and bad and we laughed. Finally everyone showed up, I signed a couple more forms, then off to lala land/ I never even knew that she dd the TEE. The cardioversion went well. it only took one jolt to convert me back into rhythm and I have been there ever since. Hopefully that will be it for forever. So far as weather or not I am concerned about the success of my ablation, I'm not. I am just over 3 weeks in at this point so the heart is still healing. The fact that I went into flutter does not concern me either as it was probably all the PAC's and PVC's that put me there. I also realise that I may need a touchup procedure as Dr. Natale addressed some issues that hadn't been addressed before.

Hit And Miss

I have a great appreciation for these old machines. Its rare to actually see one of these in action but every once in a while, while out on a ride, I will here one being used for plowing or bailing.

Anyway this is just how my heart was on Sunday. Hit and miss. Mostly miss.

The weekend started out the same as its been since my ablation, nice calm NSR. I did some shopping with the family in the afternoon followed by church . Then home for a quiet evening. Sunday morning I awoke to find myself out of rhythm. This was the day I planned to start weaning myself off of the Ticosyn because the nerve pain has been creeping back. So I decided to wait until I had the opportunity to speak with my Afib nurse at TCA. Meanwhile I took some recordings throughout the day with the HEARTRAK (Kardia on its way).

The other odd thing that happened was Monday morning very early. I had woken up around 3am still out of rhythm. I got out of bed to get a drink and came back to bed, At some point shortly after I converted back to what felt like sinus rhythm. However, my heart rate was very low, 37 bpm. It stayed this way for a while then jumped back to around 70bpm. Then after a while back to 37. Now I was using a pulse oximeter to record these rates so the accuracy and interpretation of what was actually going on is up for debate. Though the rate was steady with no fluctuation at both rates. I did run back out to the kitchen to grab the recorder to try and capture the event but what I was feeling and what was recorded were two different things. This continued for the entire morning; until my heart decided to just go completely haywire for the remainder of the afternoon into the evening. I converted back to NSR early evening and have remained there ever since.

This is the first time I have ever experienced such a low hear rate. My normal resting heart rate now is 62 bpm. And has been as low as 52 bpm when I was more active. One thing I think that may have contributed to this was that I had taken 75mg of Metoprolol the previous evening to try to keep my heart rate down as the 50mg I had taken in the morning was not enough. This is only speculation though. I had been taking 75 mg of Metoprolol with the Ticosyn prior to my ablation for the same reasons when the Ticosyn was not sustaining NSR without any issues.

T minus 24 hours and counting

Well  less than 24 hours and I should be out of surgery..

Had my CTA and consultation with Dr Natale today. This is the first CTA I have ever had. First off the staff I the MRI lab were excellent. The test itself was easy. The only odd part is when they inject the contrast. They warn you first but it is a different sensation. I found it to be relaxing but others may be disturbed by the sensation. You can literally feel it flowing throughout your body.

The visit with Dr. Natale wasn’t very long but informative. My case nurse had discussed allot of things and answered questions for me before he arrived. So he was able to go pretty much to the nuts and bolts of tomorrow’s activities. I had asked if there was anything he had seen from my previous ablation notes that gave him any insight or made him suspect of any particular part of the heart that might be suspect.

He said that it probably is no longer PVI related as I have already had 2 ablation but he wasn’t ruling that out either. He did talk some about the possibility that it could be related to the left atrial appendage.  If this is the case it may require for me to come back for a second procedure. The reason for this is two fold. One being it’s location and second being structural. I’ll explain as best I can.

The left atrial appendage lies closely to the corroded artery. So when they ablate that area they can only allow the catheter to remain in any one area for a shorter period of time. The reason fo this is to eliminate the risk of doing any damage to it. The structural issue here is that the walls of the opening to the appendage are thick and thin depending upon the area. Also the structure of the consistency of the appendage is different as well.

The other caveat with the left atrial appendage is that if they do ablate it I will have to remain on anticoagulants for life. This is due to the fact that the LAA is a major cause for stroke by itself. Ablation only increases this risk. The other option to anticoagulants would be the Watchman Device. The Watchman is like a filter that they would implant that would catch any clots that may form thus eliminating 5he need for anticoagulants.

So for right now all I can do is wait and see what tomorrow brings.