Atrial Fibrillation - Personal Experiences

The purpose of these stories is to provide hope and promote courage in the struggle to be A-Fib free. The individual stories are listed by characteristics or qualities you may be interested in.

Atrial Fibrillation - Personal Experiences

3/4/09
I was treated by Dr Chun Hwang at the Central Utah Clinic and Utah Intermountain Hospital in Provo, Utah. (Editor's Note: Dr. Hwang is one of the pioneers of A-Fib ablation in the Western US. He has done over 2000 ablations. He also works at Cedars Sinai Hospital in Los Angeles on an as needed basis.)
I am writing this to reassure others with atrial fibrillation (intermittent or chronic) that the ablation procedure (also called PVI or pulmonary vein isolation) is a safe, effective and painless technique which is better than treatment with drugs. As I understand it, treatment of A-Fib with rhythm controlling drugs is not ideal, because of the dangers and side effects of these drugs and generally their poor performance. While treatment with drugs to control only the rate of A-Fib accepts the deleterious effects of A-Fib and requires chronic anticoagulation with warfarin (Coumadin) to prevent atrial appendage clot formation and possible embolization to the brain (stroke).

I contacted Dr Hwang by letter in November 2008 and a week later his secretarial staff called me and gave me the appointment date/time for a CT scan of the chest and a consultation with Dr Hwang. Of course they also requested copies of my pertinent medical history. The waiting time to see Dr Hwang was 3 months. I received an information package a week before the appointment, and a glance at Google Maps was helpful for finding the hospital and clinic parking lots in Provo.

I went to Provo a day early and found the Cotton Tree Best Western motel quite comfortable, located a half mile from the medical facilities. My CT scan appt was at 2PM and consisted of changing into a scrub top, having an iv started and having blood drawn for kidney function tests so the contrast media would not cause any ill effects. About 2:30PM I was taken into the CT room and told how to position my arms for the 4 1/2 minute CT scan in an open machine. Several deep breaths and a warm feeling from the contrast media, then it was over.

     Dr Hwang was punctual and spent about 15 minutes with me after having reviewed my records and the CT scan. He said he would do the ablation, answered my questions and instructed me be admitted to the hospital the following day.
    That next day I skipped breakfast and was admitted and taken to a private room on the cardiac telemetry ward where skilled nurses started an iv, put a pulse oximeter on my finger and hooked up the deck of cards sized wireless telemetry transmitter.
    Shortly thereafter one of the male RNs from Dr Hwang's lab came for me with a wheel chair, and in the lab 4 or 5 other male RNs made me welcome with various skin patches, some shaving, IV tubing and positioning adjustments on the operating table. Sleep came without warning, and the ablation was done.
    I awoke in the private room on the cardiac telemetry ward in no pain or discomfort with a urinary catheter in place. Under sedation I recall several nurses making visits to my room, blood pressure checks, etc for the next 4 to 5 hours. Then when I was able to stand and converse, the catheter was removed and I was allowed to go to the BR. Dr Hwang came by, and a few hours later I had dinner. I slept well; and the following day Dr Hwang visited me again, gave me my instructions (no lifting or straining for several days) and prescriptions (including one for warfarin for 6 weeks) and discharged me. I was driven back to the motel where life continued as though nothing had happened.

I hope anyone considering the ablation procedure might be encouraged by my experience and that they can then resume normal life without the anxiety of never knowing when A-Fib will recur or a stroke become evident.

I will respond to anyone who emails me for more information. Thanks to the author of this website...a marvelous asset. Ed ewjili (at) hotmail.com (The "@" is written as "at" to prevent access by spam mailing lists.)

   Ablation for Persistent (Chronic) A-Fib at Chapel, Hill by Dr. Paul Mounsey, UNC

    (Wes lives in Cary, NC. He worked as a programmer for IBM and RTI International and retired in 2008. Gardening and home projects are his hobbies. He is married (39 years) with a son and daughter living in the area. He grew up on a farm in South Carolina and still owns 14 acres of that land.)

    Wes first developed A-Fib in October 2005. He was electrocardioverted in November 2005.   He still had a few episodes of A-Fib that reverted by use of Rhythmol and a good night's rest. (In Feb 2007 he decided to lose weight and joined Weight Watchers at Work. He lost 30 pounds to reach his goal, and became a lifetime member. He considers it the best money he ever spent.)
    In June 2008 he reverted back into A-Fib due to an adrenaline rush. The rush came from a dream in which he was in a vehicle accident. He woke up at 120 bpm. His cardiologist concluded he was in persistent (chronic) A-Fib, and that he should consider an ablation procedure where they zap parts of the heart to stop the A-Fib. His Cardiologist, Dr. Sunil Desai, recommended he contact a "new guy" at UNC HealthCare in Chapel Hill, NC. That was Dr. Paul Mounsey. It took 6 weeks to get an appointment with Dr. Mounsey and another 6 weeks to get the catheter ablation scheduled. He searched the web on A-Fib and found A-Fib.com to be the best overall site for information.

Why Wes Decided on Pulmonary Vein Ablation

I went a total 360 degrees in my decision making process. I was geared up for ablation and was armed with A -Fib.com's questions when I met with Dr. Mounsey. Dr. Mounsey answered most of the questions before I could ask them. I felt comfortable with the ablation, but the doctor's discussion of Tikosyn had me leaning toward the medication route.
    I slept on the decision over the weekend which was good. By chance I emailed Steve at A -Fib.com because the site still had Dr. Mounsey at the University of Virginia Medical, and I wanted Steve to know he was now at UNC.
    I told Steve I was leaning to medication, and Steve provided information that convinced me to go the ablation route. I agreed that I had not considered there was no long term data on Tikosyn, and that it could always be a second option if the ablation was not successful. My wife had not let her feelings be known until the decision switch. She told me she thought ablation was the best first choice. That's why I finally decided on having an ablation.

I had considered going to Dr. Wharton in Charleston, SC, because I met someone locally who had it done in Charleston. But my meeting with Dr. Mounsey convinced me that they both used similar if not identical techniques. Traveling to Charleston would have been a 250 mile trip and a lot of inconvenience for my family. I decided that UNC was my best option. Dr. Mounsey was quite candid and informed me that no procedure was fool proof, and all had risks. He said that what was done during the ablation depended on what they found once they reached the heart and began the mapping.

I recommend the following book as a great help in making medical decisions. THE PATIENT FROM HELL (How I worked with my doctors to get the best of modern medicine and how you can too) by Stephen H Schneider.   While it concerns the author's battle with Lymphoma, it offers a lot of insight into how any medical issue can be customized to a real patient and not a statistical average.

Wes's Story

    I began writing this account after I returned home from the hospital, but I did not finish it until today. Now it is 7 weeks today since I had my ablation.

I had a Catheter Ablation to eliminate my Persistent Atrial Fibrillation and restore me to Normal Sinus Rhythm at UNC Hospital in Chapel Hill, North Carolina on Tuesday Sept 9, 2008. Dr. J. Paul Mounsey and his team performed the procedure. He had worked at The University of Virginia before coming to UNC Hospital to build an electro-physiology program there.

The Ablation Procedure

I checked in at 7 AM. The last thing I remember is having all these monitoring leads put on me around 8:15 that morning. (I had about 30 extra leads added mainly to my back since I agreed to take part in an A-Fib study that Dr. Mounsey was doing.) They said I was being injected with a sedative to relax me, and man did it. The next thing I know I was having wild dreams and I could hear the recovery room people telling me to keep my legs straight. I kept trying to bend them, and they must have had one person on each leg holding my knees down.

It took me maybe 5 minutes to be able to settle back to reality. I asked the time, and it was 5:30 PM! I had slept the whole day away. I was taken way out with anesthesia and had a breathing tube while unconscious. I probably should have required more information about the anesthesia and breathing tube, but I had been under the assumption I would have something like Versed where I was semiconscious. While they keep some A-Fib patients awake because they have to map areas and induce A-Fib, I was in A-Fib all the time with a mix of normal and fast heart beats.   I do remember asking if my anesthesia was all IV, and the Nurse-Anesthesiologist said it would be a mix of IV and gases.
    On my Oct 15 follow-up visit, Dr. Mounsey explained that it was desirable to have as shallow breathing as possible during the ablation, and that they did this by using general anesthesia and a breathing tube. I also had a Foley catheter inserted to collect urine. I did have a sore throat for a week or so but nothing excessive.   One night I got some Halls cough drops to soothe the throat, and I still have half the pack I was given.
    On my follow-up, I asked Dr. Mounsey if I could have had a sedative instead. He said yes, but that there were drawbacks such as if I dropped off to sleep I might snore. The vibrations from snoring could affect the ablations or at least postpone some work until I stopped snoring. I finally decided that though I did not want general anesthesia which may have some increased risk, so did ablation isolations where my movement or reactions could affect the isolations.
    All I can say is to be sure before hand what kind of anesthesia you will be having so you will not be caught by surprise as I was a day before the procedure. At the follow-up visit he also informed me that at the end of the procedure they can also increase the depth of the breathing to exercise my lungs to help clear them and improve function before I was awakened.

In The Recovery Room

I remember talking with the recovery room staff, but not a whole lot of detail. They let my wife have access at some point in time, and shortly thereafter I was taken to my hospital room. I arrived and got the regular meal. I don't remember what it was, but I wolfed it all down with no problem while still being almost flat on my back.
    That Tuesday night I was wired, I suppose because I had slept all day. About 9 that night I told my wife to go home as I could get to the bathroom on my own and felt fine. The groin was sore, but once I had reached the required time on my back to insure the catheter punctures were healing and getting the Foley catheter removed, I could move around very well although I was still attached to one IV drip. I asked for an icepack for my left groin. Their "icepack" was very creative. They took two new zip lock bio-hazard bags and double bagged the ice and wrapped it in a towel, which was probably better than the cost of a regular icepack like I bought when I got home.

I had a heparin drip which was removed the next morning. Then I started getting Lovenox injections until my Coumadin level built up. The Lovenox injections are done in belly fat and will leave some bruising. You only get 2 shots a day for 3 days. They made me give myself one injection, because sometimes you are discharged before the last shot is due. I was kept two extra days, so self injection was not necessary. I had given myself allergy injections years ago so it was not much different from those. The needle is very small, and the needle slides in with hardly any sensation. The injection is a good amount though and it mildly stings for a minute or so once injected. On a scale of 1-10 it was a minor irritation at a 2 or 3 at most. These belly bruises were slowest to fade and left a tiny knot where the needle was inserted.

I don't know if it was the Foley Catheter for urine, or just the effects of anesthesia, but I did not start producing large amounts of urine, and I really had to strain to urinate. I am not sure how much saline I got during the procedure, but I figure it was at least 5-7 liters. When I entered the hospital I weighed around 165 in shorts and T shirt, and by Thursday morning I was weighting in at 187 pounds. Anyway the excess fluid diluted my potassium. Since oral lasix was not working as well as expected, I was put on 80 mg IV Lasix as a diuretic, and potassium was added to replace what I lost. Man did that lasix work. I got the injection at 6 am and by 8 am I had produced 2 liters of urine and lost 4 pounds in 2 hours. I could almost hear the water filling my bladder. The Sodium is not excreted as much, so as I lost fluid my sodium level rose to normal. According to Dr. Mounsey, the saline IV helped keep my heart plump and stable to facilitate better ablation isolations. I have to stay on Lasix because the HCTZ (Hydrochlorothiazidg for fluid retention) I had been taking cannot be taken with my new antiarrhythmic medicine Tikosyn.

Ibutilide, Tikosyn and the Recovery Plan

My ablations alone did not return me to normal sinus rhythm, so Ibutilide (Corvert) was used to convert me. At my follow-up visit I asked if it was preferable to an Electrical Cardioversion, and decided that considering all the ablations it was probably better to get the drug instead of a shock to the heart. Dr. Mounsey also wants to keep me on Tikosyn for 6 months to give the heart a chance to relearn a normal rhythm. I plan to stop it after 6 months to see if I can stay in normal rhythm on my own, but I may have to remain on Tikosyn if I revert. Either that or another ablation. I have 6 months to think about it and I am hopeful I will not need it.

I was started on the largest dose of Tikosyn 500 mcg; but my Q-T interval got too long that they cut the medication down to 125 mcg. I don't think I was ever on 250 mcg. Going to that level got the Q-T interval back in control. Tikosyn must be taken at fairly strict 12 hours intervals (8 am and 8 pm is my schedule), so I use several alarms to remind me---two cordless phones, the cell phone and a watch with alarm. It works so far. I missed only one dose. I had to modify my rules to take the pill before turning off any of the alarms. One evening I got so obsessed with resetting the alarms that I forgot to take the darn pill. I keep a glass of water ready so all I have to do is grab the pill and swallow it. I was supposed to be released on Friday, but I did not get released until Sunday. After 3 doses of Tikosyn at 125 mcg, my Q-T interval was steady and at an acceptable value.

The Hospital Stay

I ended up being in the hospital five nights instead of the originally planned 3 nights. Because of the two extra nights, I ended up celebrating my 62nd birthday in the hospital. All the hospital personnel were great. The food was institutional though. What really got me was the "standard diet" breakfast meal was eggs, hash-browns, 2 sausage patties and a plain white flour biscuit with white gravy. Not even a whole wheat biscuit! I have to put in a jibe that this was a substandard not a standard diet.

Another aggravation was the mattresses were very uncomfortable, and the bedsore prevention made for random compressor noises all night. Fortunately one nurse told me where the switch was to stop that aggravation. If I have to return to that hospital for any reason, I will be taking my own memory foam mattress topper with me unless the hospital provides a better mattress. Lying on my back, and I think the lack of give in the mattress gave me back spasms that have not totally healed yet. The cure has always been hamstring stretches on my left hip; but that was the leg where most of the catheters were located, so stretching was limited until the catheter punctures healed.

Groin Bruising from the Ablation Catheters

I knew my groin was going to be quite bruised, but I did not really understand how sore it was until it actually happened. The left side was dark purple, and there were some small knots where the catheters were inserted. 7 years earlier I had a catheter experience about 7 years and I kind of knew what to expect. There was pain - spasm like - that I attribute to the bruising, but ice-packs, warm packs and Tylenol kept the pain bearable. The spasms were not constant, but correlated to the amount of time I was not lying fairly flat. Once I got rid of all the fluid, then being on my sides was preferable to my back.   After the procedure I had to be careful to not sit or stand too long. Getting horizontal at regular intervals helps. I also found this thermal pad that uses some kind of clay encased in plastic, then fabric that works well to apply heat - much better than a heating pad. You microwave it for about a minute and a half and it stays warm for around 2 hours.
    I went on a 4 hour car trip 17 days after the procedure and did not walk much that weekend, so I ended up with fluid retention and some shortness or breath.
    Before the ablation I did have hamstring problems in my left leg. The bruising aggravated the hamstring and contributed to my discomfort. Most of it is gone now. The bruising slowly drifted to my inner thigh, calf and down to my ankle as it slowly faded. The bruise was the size of my hand on my thigh, but down to the size of my index finger after it reached my ankle.
    (Author's Note: It's somewhat unusual to have this much bruising and pain at the catheter ablation site.)

One personal account said they were up mowing the lawn in 3 days. I read more accounts and the worst case was about 3.5 weeks to get back on a bike, so I knew the range of recovery was wide. After about 8 days I felt well enough to slowly take a mile walk at about 2 mph. from my house I can walk a gentle grade about half a mile and then turn around and the rest of the mile is down hill. I have been trying to maintain two round trips each day. I was progressively getting better when all of a sudden I started getting a mix of fast and slow beats. I was relieved when they told me that part of the variation is the heart tissue healing after the ablations. That can take a month or so to get back to "normal". Last Friday I checked with Dr. Mounsey to reassure myself that the fast and slow beats were normal to the healing process.
    On day 13 after the procedure, I went to get my electrolytes checked with my GP and my BP was 140/86 and my heart-rate 106. My GP took an ECG, and the rate was a normal sinus rhythm. A call to the cardiologist reassured me that this was part of the healing process. After a nap it dropped back to the 85-90 level. So the range of heartbeat since the ablation has been as low as 55 and as high as 103. Later that third week my heart rate dropped back to the 64 to 72 range which is when I took the car trip.
I have randomly checked my heart rate since the procedure, and it has been from 55 to 115.   This cuff can detect irregular heartbeats, but not NSR. The last reading of over 100 was on day 24 following the procedure. The last day over 80 was day 26. I am now at day 30 and my goal is to walk 3 miles per day at 3 mph. I will break that into two walks. For the past 4 days my rates have measured 63-68. For as long as I can remember I have a rate in that range (lower when I was still jogging). I will warn you that it is easy to get obsessed with taking your BP and pulse. I logged mine. Some days I didn't take any measurements, on other days I measured my pulse and BP 25 times per day depending on how concerned I was.
I was never given specifics on how to regain conditioning after an ablation, but I have listened to my body. I go for my one month follow up next week and will ask for more exercise specifics then. I really thought I would be back 100% pre-A-Fib by now, but I feel I am more like 80% but feel poised to get back to being in condition. I asked Dr. Mounsey how to best condition myself, and he told me that what I was doing was fine.   He said to compare my current capability to walk that half mile grade to how I walked it while I was in A-Fib. That was a reassuring measure since my first walk after the procedure was so much better than during A-Fib. During A-Fib I would have to rest once or twice in that half mile.

Follow-up Meeting with Dr. Mounsey

I had my follow-up on Oct 15 which was 5 weeks and one day after the procedure. I think I got most of my questions built up over the last 30 days answered to my satisfaction. Dr. Mounsey said that my procedure was not the most extensive he has done but it was on the extensive end of the scale. He said I was still healing, and it may take a few more weeks. He explained that some of the isolations may cause irritation on the outside of the heart wall which may cause the heart to rub against the containing membrane and cause brief discomfort. I had experienced some of this soreness in my chest over my heart - it seldom lasted more than 10-15 seconds. It no longer seems to happen when I walk, but I do notice some if I use my upper body more.
    My arms and chest are out of condition but I am regaining conditioning by doing 10-15 minutes of yoga and stretching each day. I will add some weight lifting beginning tomorrow (Oct 20) to build upper body strength gradually. I have done some house projects that required lifting enough to get a bit sore, but I am not ready to hammer re-bar in landscaping timbers or dig post holes yet.

At 7 weeks, I have not done weight lifting regularly, but my house projects and chores cause me to use my upper arms more and more. Today I did 25 minutes of yoga stretches and poses that exercise the upper and lower body. I walk 3 miles per day.

In the last 10 days I have had two episodes of rapid heart beats which lasted an hour or two. Both incidents coincided with drinking at least 16 ounces of southern style iced tea. Since backing off on such jolts of caffeine I have not had a recurrence.

Conclusions

So far I have not regretted the procedure and am optimistic that the odds of reverting to A-Fib are low but realize it could happen. I would go back and have a second ablation if necessary. It has taken me longer to get to this point of recovery than I had initially hoped, but I feel so much better than when I was in persistent A-Fib. While in A-Fib I estimate I was at 50% of my pre-A-Fib condition and was moderately depressed for 3 months. Now I estimate I am at 80+% of pre-A-Fib and the blahs are going away. I feel feisty enough to argue with the insurance company over the statements and to check the hospital bills versus the statement. You will find errors, so monitoring the hospital bills and insurance statements is essential.

Wesley Dukes
Email: dwdukes661(at)gmail.com (When typing this email address, substitute an "@" for the "(at)"---this substitution is necessary to prevent automatic search engines from sending spam to this email address.)

Ablation for V-Tach (Ventricular Tachycardia) at Mass. General by Dr. Vivek Reddy---Coping with ICD Shock

    (Ryan Townsend is a firefighter/paramedic with V-Tach due to a special type of Cardiomyopathy in which the septum between his ventricles is very thick. He nearly died from Sudden Cardiac Death when he was 30 years old, and had to have an ICD (Implantable Cardioverter-Defibrillator) installed. The shocks saved his life, but were hard to put up with. The ablation procedure he experienced is similar to that for A-Fib. [It's been suggested that A-Fib.com should investigate and write about V-Tach, since it is so similar to A-Fib and is often treated by the same doctors.] )

   I had an ablation performed at Mass General in Boston, MA by Dr. Vivek Reddy. The procedure that was performed on 4/25/08 was not viewed by my specialists down in Miami as very promising; however, it was worth a shot. They were skeptical due to the type of Cardiomyopathy that I have which basically is that my septum is very thick between the ventricles, and that my particular ventricular tachycardia "VT" was too fast. The last two EP studies revealed a VT that was too fast to map because it did not support a blood pressure and did not allow enough time to see the problematic circuits. I had tried several med which didn't work
    Well I pressed on. I researched through the internet, Google, and other patients that have had successful ablations. The most important thing I did is put it in God's hands, and let him guide me to the answer to my prayers.

EXPLORING OPTIONS WITH DR. REDDY
    I felt pretty confident despite the negative outlook I received from my doctors and found myself in Boston. I went in for my consultation and was told the many different ways my problem can be ablated. They use radio frequency, cryoablation (freezing), or an alcohol injection in your coronary arteries that is basically a controlled heart attack which kills the muscle where the bad circuit lives. All these methods are typically done through the groin vessels. Another approach is to pierce the skin above the sternum allowing access to the sac surrounding your heart through which the doctors can introduce their instruments and ablate circuits on the surface of the heart if necessary. This is known as the percutaneous (through the skin) approach which is not done by your "average" EP doctor. I'm not sure how many doctors practice this particular procedure; but after researching on the internet, it seems to be very few.

ABLATING THE V-TACH
    My ablation lasted 10 hours. I woke up and heard the wonderful news that it went extremely well. I was in pain, but it was tolerable and extremely worth it. My heart had a total of 8 circuits which could cause VT, two of which were extremely active causing me to get defibrillated or "shocked". Four to five hours of the procedure consisted of mapping the heart and finding the problems. They used a balloon pump to keep my blood pressure up while VT was induced, which is typically used in Open Heart operations.
    They ablated with radio frequencies and hit one of the worst ones on the surface of the heart by the percutaneous (through the skin) approach.
The outcome, according to Dr. Reddy, was an 8 out of 10. There were two circuits deep in the ventricular septum which they left alone, because they believed they were not of significance. And they did not want to damage any more of the heart then needed. I later read the procedure summary in which there was also a notation stating that the coronary vessel supplying the area was not easily identified. This meant that Dr. Reddy was considering an alcohol injection; however, he was not certain about the outcome.

AFTER THE ABLATION
    The first week and a half I felt pain in my groin. I also had some chest discomfort the first few days. It became worse as the Madrol, a corticosteroid used for inflammation, was stopped. I was extremely uncomfortable. I tried my best to "deal with it," however I couldn't handle it any longer. I knew it was pain from the burn on the surface of the heart and not a heart attack. The doctor then put me on the Madrol again. This time instead of a few days, I was on it for a month.

LIFE AFTER V-TACK
    Do I feel a difference? Yes, absolutely. Before this I could barely walk at a normal pace without feeling dizzy. This is my second miracle! (My first miracle was surviving a cardiac arrest when I was 30. No personal history to explain it. I was in top physical condition. I survived because of 10 minutes of CPR provided by my best friend until EMS arrived. I read somewhere that only 10% survive sudden cardiac death.)
    Before this in December of 2007 an ICD device had been inserted in my heart which shocked me an average of once a month to get me out of a V-Tech attack. Once it shocked me 28 times in 14 minutes. An ICD shock feels like a kick in the chest. The worst part of the whole thing is feeling your heart start to go crazy and anticipating the shock. It beats dying. But going through a V-Tach storm is like being on the edge of life. All I can say it was the worst experience of my life. Now my life is totally changed.
    Almost two months have passed. My activity level has been much better. The PVCs were quite frequent at the beginning but have decreased once I passed the 1 month mark. Just recently while recovering from a chest cold, I became extremely flush and my right arm went numb. I decided to get checked out at the hospital; however, it had diminished by the time I was evaluated. Was it an anxiety attack from a short run of V tach? I don't know. All I could tell you is that I felt that same way right before I used to get shocked. According to what I've read on ablations, it can take months to a year before the PVCs calm down and in some cases even disappear.
    Over the past 6 months I had spent 35 days in the hospital with 7 invasive procedures and 7 noninvasive procedures and who knows how many doctor visits. I had been shocked 4 times. Once I was shocked multiple times, as i mentioned earlier. I have 4 cardiologists caring for me now.

CONCLUSION
    This story is my testimony that God is real and he listens to his children's prayers. I never lost faith in all of this. And I pray that if you are in the shadows of fear, call on the name of the Lord to give you the light of hope.
    I have learned a lot about ablation and medication options. Please look into getting your arrhythmia fixed. Devices are a "God send." However, ablation can CURE the problem for many people. At the very least, it will decrease or even eliminate future shocks. I pray for the day that ablation eliminates the need for ICD therapy.
    I hope this finds patients, family or friends of ICD patient's well and full of hope.
    Contact me with any questions. I will help you find whatever I can with the resources that are available to me.
God Bless
Ryan Townsend
Lieutenant/Paramedic 6 years
E-mail: ryanmtown(at)hotmail.com (the "@" is written as "at" to prevent access by spam)
Hopefully a CryoCor Success

    I am a 44 year old male who has been managing A-Fib for 4 years via Sotalol and Coumadin. Some doctors have told me that Coumadin is not necessary since my heart is otherwise healthy. However, I chose to play it safe, since my father died from A-Fib at age 66. It was his first known episode. He came back early from traveling through Europe because "he didn't feel like himself". He saw a doctor who prescribed drugs including Coumadin. He suffered a stroke that evening.
    In recent years, my episodes have become more frequent, occurring every two months on average and lasting between half a day and 9 days.  I have always been able to return to normal sinus rhythm on my own. I reached a max dose of Sotalol (240 mg twice a day), so it was now time to pursue a fix.
    I chose CryoCor because I think it is safer and should be as effective. I feel I owe it to my wife and three young children to take the safest route. I live near Albany NY and regularly travel 3 &1/2 hours to the University of Rochester, NY to participate in the FDA Clinical Trial. I was very comfortable meeting Dr. Daubert. I was randomly placed in the "control" group and had to wait to "cross over" into treatment.
    After 7 months, I qualified to cross over and I had my CryoCor ablation on 10/8/07. The procedure lasted 6 hours. Unfortunately, I had a complication at the very end and I had to be admitted for a few days. Somehow, a small hole formed that allowed blood to leave the heart and fill the sack that surrounds the heart (tamponade). Fortunately, they were able to remove the blood from the sack before the sack became completely full and stopped the heart. The hole healed on its own.
    I continued antibiotics for 14 days to ensure that an infection did not occur. While recovering from the complication, I slipped into A-Fib and was not able to restart Coumadin for 2 weeks to ensure that the hole was fully healed. My QTc was longer than desired, so no Sotalol was prescribed, just Toprol. This was a very stressful time, being in A-Fib without Coumadin.
    (The QT interval represents points on the EKG signal. The "c" stands for "corrected," which means it is adjusted for heart rate. The QT interval is affected by the heart rate.)
    A week after restarting the Coumadin and going back on a low dosage (120 mg twice a day) of Sotalol, I went back into NSR. It had been a very difficult three weeks, but life was now good again!
    I have been in NSR since then (4 months now). We have decreased the Sotalol dosage to 80 mg twice a day for the last month.  Today is my last day of Sotalol. Hopefully I will be able to maintain NSR without any Sotalol. If I can't, I'll be going back to Dr. Daubert for Round 2. Despite the complication, I am very happy with the wonderful care I received from Dr. Daubert and Strong Memorial Hospital. I have no regrets. Eventually, I will be cured of A-Fib and off of Sotalol and Coumadin.
    Good luck to everyone and a special thanks to Steve and his website for helping so many.
Ted
E-mail: TedAF(at)nycap.rr.com (The "@" is written at "at" to avoid access by automated spam mailings)

    (Update from Ted June 9, 2008): Twice I have stopped the low dosage of sotalol but I had flutter and fib problems so I am back on it. Although I am vastly improved, I am not fully cured. I will have a second CryoCor ablation in August.

    (Updated from Ted 4/12/2011):

    In August 2008 I had a second ablation. CryoCor had been bought-out and the study stopped, so I had an RF ablation. This time everything went well, and the AF was gone. After about a year, I started having infrequent brief moments of arrhythmia. After 6 months it was becoming more frequent, so I needed to see a doctor - I saw a new doctor George A. Vassolas in Schenectady, NY. During my first meeting with him he asked me about sleep apnea. I told him that I have never been diagnosed but I know I have it (for 20 years or so).
    He strongly suggested I get the apnea diagnosed and treated first – then he would treat the new arrhythmia (PSVT-a milder arrhythmia than A-Fib), if still needed. I did so and was diagnosed with severe sleep apnea (60 apnea events per hour). I have been sleeping with a mask now for 1 year and I feel great – rested and no more arrhythmias. It took me a few months to get used to the mask, but it is worth it!

Like so many others who have shared their experiences, I have found the experience of A-Fib to be life altering in many ways. While A-Fib presented a variety of challenges, it also provided an opportunity to learn of the kindness of others. I am particularly indebted to Steve Ryan for this amazing web site, but also for the many words of encouragement and insight that he provided to me during my journey in dealing with A-Fib.

I was initially diagnosed with A-Fib in May of 2006. I had experienced a particularly stressful week at work and was trying to enjoy the weekend respite. On Sunday I began to mow the lawn with the mindset that I would go fast to finish sooner than usual. However, I quickly noticed that I was becoming unusually tired and took a break. When I returned to the mowing, I quickly became tired again. I took my pulse and noticed that it was not an even beat, but was beating irregularly. Although I had been diagnosed with PAC’s, I had never experienced a heart beat like this. Since my daughter is a medical assistant, I asked her to check my pulse. She confirmed that it was not a normal heart beat.

My wife and I drove to Hershey Medical Center which was only a short drive from our home. When I arrived, they performed an EKG, which verified that I had an irregular heart beat. They put me on an IV drip of a drug designed to restore the heart rate, but also scheduled me for a Cardioversion the next day in case it didn’t work. The next morning, I was still in A-Fib, and I was just beginning to learn what the term Atrial Fibrillation meant. Thankfully, my heart rate returned to normal that morning.

At the hospital, I was told to avoid caffeine and to take Flecainide twice a day. Since they had given me blood thinners during my stay at the hospital, I asked when they could be discontinued. It came as an incredible shock to learn that I would need to stay on Coumadin indefinitely. At this point, the true gravity of the situation became quite real.

LEARNING ABOUT A-FIB

I desperately began to learn everything I could about Atrial Fibrillation and buried myself in the internet. As I learned more about the condition, I also learned more about the possible treatments. I was disturbed and confused about the outlook regarding medications to hold the A-Fib at bay. Flecainide was said to have an effective percentage of approximately 50 percent, which I did not find reassuring. I was also confused about how to interpret the meaning of 50 percent. Did that mean that Flecainide was effective in 50 percent of patients or did it mean that patients experienced 50 percent fewer episodes? My experience made this a moot point, as I continued to have A-Fib episodes. However, the Flecainide was proving to be effective in limiting the duration of the A-Fib events, at least initially, to around an hour.

Around this time, I began to learn more about catheter ablation. I also discovered this web site, which proved to be an amazing resource of information regarding the disease and treatment options. I went from feeling that I had a life sentence of A-Fib to feeling that a cure might be possible via catheter ablation.
As I continued my education, I experienced what perhaps many have experienced. I soon was affected by paralysis of analysis and often went from hopeful to fearful with each new piece of information. At these points (this occurred several times), I found that personal dialogue with knowledgeable people helped to provide a more balanced understanding. This occurred when I put these questions to Steve Ryan as well as to the doctors and nurses at Johns Hopkins and Hershey Medical Center. Information alone is one thing, but a continuing dialogue with real people helped me immensely in this regard. Their kindness and expertise went a long way in helping me deal with this condition. Another thing which helped was realizing at some point that there is an element of faith in moving forward. This is hard, because we all like to be in control; but putting this in God's hands and in the people who are providing the care is invaluable in moving forward.

I asked my cardiologist about having a catheter ablation. While I was ready to jump head first into this procedure, he was much more conservative and encouraged me to give the medications a chance first. I was somewhat frustrated, although I now understand and appreciate his rational. After much thought and prayer, I decided to begin the search for a doctor who performed such procedures. This web site was very helpful, and I soon had a top three list of doctors who were well respected for their skill and expertise. Those three included Dr. Marchlinski at the University of Pennsylvania, Dr. Calkins at Johns Hopkins and Dr. Natale at the Cleveland Clinic. I was particularly interested in doctors with the most experience and the best success rates.

During an emotional down period with multiple concerns about this conditions, I contacted the Arrhythmia hot line service at Johns Hopkins. I spoke with a wonderful person named Pat Adams, who provided me with more information about A-Fib as well as some information about Johns Hopkins treatment of A-Fib. Pat also suggested that I speak with Valerie Barron, the nurse case manager of Electrophysiology. She provided information about my condition like no other person had done before. I asked a ton of questions, and she provided a wonderfully balanced understanding of my condition. Although my condition remained, I felt like a burden had lifted.

MEETING WITH DR. CALKINS AT JOHNS HOPKINS

The next step was a consultation with Dr. Calkins at Johns Hopkins in September. Incredibly, Dr. Calkins spent the first several minutes getting to know me, asking me about my work and learning more about me as a person. He then provided a very realistic picture of A-Fib and catheter ablation. I quickly learned that Dr. Calkins does an outstanding job of helping patients understand their options and make their own informed choices. Since I was only recently diagnosed with A-Fib, I left with the sense that catheter ablation was a serious option, but also that I had time to consider and see how things developed.

I discussed this with Dr. Naccarelli, my cardiologist at Hershey Medical Center. We discussed my visit with Dr. Calkins, and he again encouraged me to give this some time and changed the dosage of my medication. After several weeks, it was becoming clear that this A-Fib thing was not going to respond very well to this particular medication. In light of this, Dr. Naccarelli advised that a catheter ablation may possibly be in order. He also advised that Hershey Medical Center had recently hired Dr. Gonzales, who specialized in this procedure. Since this was in a nearby town, I felt that it made sense to meet with Dr. Gonzales as well. I felt comfortable discussing my condition with him and asked many of the questions suggested on this web site. He was quite knowledgeable regarding A-Fib and in fact held similar views as Dr. Calkins. After this, I had a decision to make.

It was tempting to go with the closest hospital for the procedure (since Johns Hopkins is about 1-1/2 hours away and Hershey Med Center is only a few short minutes). I was initially unsure, but after praying about it, I felt a peace about going with Dr. Calkins despite the extra traveling distance. I believe it was early December when my ablation was officially scheduled for January 30^th, 2007.

As the days went by, any doubts about having this procedure were removed by worsening A-Fib episodes. The incidents occurred more frequently and also lasted longer as time went on. Valerie Barron, the electrophysiology coordinator at Johns Hopkins, was helpful as always by helping me understand my condition as well as manage changes in medications.

CATHETER ABLATION AT JOHNS HOPKINS

Finally, the day arrived for my wife and I to travel to Johns Hopkins. Prior to most ablations, it is typically necessary to have a TEE as well as a CT scan performed prior to the ablation. These were performed the day before the procedure on an outpatient basis. I can’t say enough regarding the kindness and expertise of the various health care providers.

The morning of the ablation arrived, and my wife and I walked from our place of housing to the hospital at around 6:00 AM. Everything went according to schedule, and I soon found myself saying goodbye to my wife as they wheeled me to the electrophysiology lab for the ablation. Although I was a bit nervous, I mostly felt a sense of peace, knowing that many were praying for me and also seeing the cast of professionals who were so highly qualified to perform this procedure. It was also reassuring to have my wife, Ruth, with me during this stay. Her kindness and strength made such a difference.

After a 5-1/2 hour procedure, I woke up in the recovery room. My heart was beating in a normal sinus rhythm. I enjoyed a light lunch and was moved to my room for an overnight stay. Everything went well, and I was told that I may experience some arrhythmias over the next few months as my heart healed. I also experienced some slight pain in my chest, due to the burning that is performed in an ablation.

I was released the next day. It felt good to be in normal sinus rhythm, despite catching a cold in the days leading up to the procedure. Over the next several weeks, I used the portable EKG device that I was given as part of a research study. It was an impressive piece of equipment that allowed me to easily check my heart rhythm each day. I had a few bouts of irregular beats, but they quickly reverted to normal. At this point, I was confident that I was moving in the right direction and anticipated improvement as my heart continued to heal from the ablation.

Unfortunately, after several weeks I began to develop episodes of Atrial Flutter. I wasn’t too concerned initially, but the episodes soon began to last longer. Around this time, I had a one month follow-up visit with Dr. Calkins.

The events surrounding this appointment were truly extraordinary. As a Christian, I have tried to seek God’s guidance through life’s various twists and turns. However, I am not the kind of person who typically seeks guidance through signs and wonders. So I found the following experience to be quite profound. A week or so before my 1 month appointment, I had a vivid dream about a visit to Johns Hopkins. In this dream, I had traveled to Johns Hopkins for a routine office visit. Instead of experiencing a routine exam, however, I soon found myself in a hospital bed. As I lay in the bed, I awoke to see catheters being removed from my upper leg region. I was told that another ablation had been performed.

SECOND ABLATION---FOR ATRIAL FLUTTER

A few weeks later, my wife and I traveled to Baltimore for my scheduled one month follow-up exam with Dr. Calkins. We arrived early, and my wife had an early lunch in the cafeteria. For my appointment, I received an EKG (which showed continued Atrial Flutter) and soon was greeted by Dr. Calkins in his office. He told us that the EKG suggested that the Flutter could be caused by activity on the right atrium (which had not been the subject of my first ablation).
He gave us 3 options to consider, one of which was Right Atrium Flutter Ablation. The others involved changes in medications, but they did not seem as promising. When we said that we would rather have the ablation, Dr. Calkins confirmed that he also felt that this was the best option. He then said that it was unfortunate that we would have to travel all the way back to Hershey and then return at a later date. He then gave a look that suggested that another idea had crossed his mind. He asked if I had eaten that morning and I stated that I had not (despite the fact that I normally eat breakfast). The next thing I knew, Dr. Calkins was having the schedule checked for the possibility of squeezing me in for an ablation that very day. He returned to his office and advised that one of his associates would be able to perform the procedure the same day. As this plan materialized, I couldn’t help but recall my vivid dream of a few weeks prior. The events had transpired exactly as shown in my dream!

Not only did Dr. Calkins arrange for everything, he also personally walked us from his office in the physicians' wing all the way through winding corridors to the hospital wing. As we sat in the waiting room, we were in awe of how things had transpired and appreciative of Dr. Calkins' kindness.

(Editor's Note: A right Atrium A-Flutter ablation is generally easier and simpler than a left Atrium Pulmonary Vein Ablation. The ablation catheter does not have to be passed through the Transseptal wall separating the right and left Atria. A full left and right Atria ablation could not be performed at this time, because it had only been one month since Mr. Aiello's first PVA.)

The ablation was performed on the right atrium, and I awoke in normal sinus rhythm. I appeared that my battle with A-Fib was over. However, a few days later I began to have more episodes of Atrial Flutter. They became more persistent as time went on, and it became necessary to have a cardioversion to restore my heart to a normal rhythm. Although a cardioversion is not usually curative, it was hoped that this could provide the extra push to help my heart remain in a normal rhythm. Sadly, this did not occur, and it became necessary to go on Amiodarone. This was not a happy day, as I had always had concerns about going on this medication.

Over the next few months, I needed to have two more cardioversions, one at Johns Hopkins and the other at Hershey Medical Center. During this time, I had appointments with both Dr. Naccarelli at Hershey Medical Center and Dr. Calkins at Johns Hopkins. I was impressed with how well these two doctors communicated with each other regarding my condition. It was so reassuring to know that both of these men were consulting with each other after all of my check-ups in an effort to address my condition.

By early May 2007, it became clear that another ablation procedure would be necessary. Dr. Calkins felt that it was important to have another procedure sooner rather than later. Because there was a longer wait time for Dr. Calkins, he offered to refer the procedure to one of his colleagues. But promised to arrange the schedule so that he would available for any problems that might arise.

As I awaited a specific date for the procedure, I continued to deal with atrial flutter and was feeling quite stressed out with everything. During a routine trip to my chiropractor, I ran into some friends who were incredibly supportive. They all gathered together to say a prayer for me, and I felt encouraged by their prayers and support. Having A-Fib can be discouraging, but it was good to be reminded that God hadn’t forgot about me.

A day or two later, I received a call from Dr. Calkins' case manager Valerie Barron. She told me that Dr. Calkins decided to forgo one of his days off to perform the procedure himself. She said that he mentioned that I had gone through enough already and that he wanted to do this for me. My wife and I were so appreciative of Dr. Calkins' kindness and also thankful to God for answered prayer. The date was set for June 7^th, and I looked forward to that day with great anticipation. The only change from the previously scheduled procedures was that I would be under general anesthesia this time, due to some breathing difficulties with the sedative used in the earlier procedures.

THIRD ABLATION (SECOND PULMONARY VEIN ABLATION)

My wife and left for Baltimore on June 6^th, the day before the procedure. Finally, the morning of June 7^th came along, and we arrived at the hospital at around 6:00 AM for the CT scan and preparation for the ablation procedure. Once again, everyone at Johns Hopkins was wonderful in both their professionalism and in the care they showed to me and my wife. Finally after all the waiting, they wheeled me to the electrophysiology lab, and I said goodbye to my wife.

After the 5-1/2 hour procedure, I awoke in the recovery room. My memory is usually a bit fuzzy after this type of procedure, but I remember that my wife was there and I remember speaking with one of the attending physicians. Everyone seemed very optimistic about the success of the procedure. I was moved to my overnight room, and Dr. Calkins spoke with me and my wife about the procedure. He was very positive about the results and explained the steps that were taken during the procedure. If I recall correctly, he told us that they located and ablated some specific areas that were showing as hot spots for existing electrical activity. They also re-ablated all of the lines from the prior PVI and then ablated various “potentials” that were discovered during this time.
(Editor's Note: The O.R. [Operating Room] report indicated that some of Mr. Aiello's A-Flutter may have come from gaps in the previous PVI ablation lines. Some current PVI procedures leave gaps, but they usually are filled in as the heart heals. Mr. Aiello needed a touch-up ablation to fill in these gaps and ablate other areas of the heart with A-Fib potentials.)

IN SINUS RHYTHM, BUT POST-ABLATION SCARE

I was released from the hospital the following day in normal sinus rhythm and hoped for the best. I felt fine, although I noticed some swelling in my legs and began go have some rattling sounds when I breathed. To be on the safe side, I went to my local hospital’s ER and was given a chest x-ray. They discussed fluid in my lungs and discussed the possibility of congestive heart failure, which I found to be particularly devastating. They put me on a diuretic and advised that they would be sending a report to Johns Hopkins. Early the next day, Dr. Calkins called me on his cell phone on his way to the hospital. He put my mind at ease with more details concerning these medical issues. Although I knew that they used a lot of fluid to deal with the heat used in this procedure, I didn’t fully realize that it was an amount of fluid that could occasionally cause swelling in the legs and fluid in the lungs. I felt so much better after Dr. Calkins' explanation and looked forward to continued recovery. It seemed like A-Fib was acting like the month of March in that it was going out like a lion.

I had a follow-up visit with my local cardiologist a week later, and I was pleased that he dropped the beta blocker. About a month later, I was taken off the Amiodarone per Dr. Calkins' instructions.

By the time my three month check-up with Dr. Calkins came around, I had not experienced any A-Fib or A-Flutter to my knowledge. I had an EKG at this check-up which also showed normal. Dr. Calkins was very pleased that I had not had any episodes and advised that I no longer had to take any medications for A-Fib and would only need to remain on blood pressure medication. I was thrilled with the news and took the opportunity to express my appreciation to Dr. Calkins for using his talents to help me.

Five months later, I had another appointment with Dr. Naccarelli, my cardiologist in Hershey, PA. I was happy to tell him that I had not had any recurrences of A-Fib or A-Flutter since the ablation in June. After the examination, he gave me a good report that was in line with Dr. Calkins' report during my three month check-up. He advised that I would not need to see him for another year.

CONCLUSIONS

This experience has focused my attention on my overall heart health, as there is some history of heart issues in my family. As a result, I am taking steps to eat a heart healthy diet, take supplements, get regular exercise and try to deal with stress more effectively. Dealing with stress is probably the most difficult area, and I continue to try to learn better ways to handle it. I still have periodic PAC’s, but otherwise things have continued to go well.

Although this experience has been very difficult, it has also served to expose me to some of the most wonderful people in the world. There have been so many times that I have been encouraged by Steve Ryan, who patiently answered my many questions and provided helpful information and reassurance. I have also been blessed by an incredible cast of professionals who have dedicated their talents and efforts toward helping others, including Dr. Calkins, Dr. Naccarelli, and Valerie Barron. My wife, Ruth, has been a constant source of strength and compassion in dealing with this condition, and having her with me at Johns Hopkins meant so much to me. Most importantly, I thank God for all of these individuals and ultimately for His healing touch.
Lou
E-mail: aiellol(at)mhs-pa.org (the "@" is written as "at" to prevent access by automated spam mailing lists)

In a later E-mail Lou writes: "I am happy to report that I am still in normal sinus rhythm which is almost one year since my last ablation by Dr. Calkins at Johns Hopkins. It is a wonderful feeling to have a normal heart beat each day, and it makes me count my blessings."

    My Pulmonary Vein Ablation (Isolation) was a painless procedure. I could hear Dr. Gerstenfeld talking with his associates while identifying and then mapping the areas that needed to be ablated. After the procedure when I was returned to my room, Dr. Gerstenfeld came in and said he thought they had found and ablated the areas that were responsible for my symptoms. I said, "I could hear you discussing the procedure the entire time." He smiled and said, "If that is so, why were you snoring at times?" He did say it may be necessary for me to return for what he called "a touch-up," but I left feeling good about the experience and the professionalism I experienced at Penn Medical Center.
    Before leaving Penn, I was cardioverted and referred to Dr. Robert Brewer at the Lexington Clinic. He prescribed 225 MG of Rythmol three times daily, but I went back into A-Fib. Dr. Brewer then prescribed 250 MG of TIKOSYN twice daily, cardioverted me once again; and for the past six months I have been in sinus rhythm.
    I over-exerted myself once with aerobics and I went into A-Fib. But within two days of taking it easy, I was once again back in sinus rhythm.
    I discussed this with Dr. Brewer, and he advised me to ease into aerobics. "Don't try to keep up with those 30 year old girls who have been doing aerobics for five to seven years." I went into the class saying, "Okay girls you can kick, I'll just kick higher and longer." You know that man thing, "Anything you can do I can do better." Dr. Brewer added that this indicates that TIKOSYN is doing what it should do---keep you in sinus rhythm.

    I am going to a class reunion in Florida the second week in March. I will be riding my Honda Rebel. If all goes well, I may go to Sturgis, South Dakota this summer for a big bike rally.
    I will be happy to answer any questions anyone has about my A-Fib history, and I thank you so very much for your good advice.
                            Regards,
                            Bill
                            E-mail: Justbillone (at) aol.com (the "@" is written as "at" to prevent access by spam mailing lists)

(Update 3/2/11)
    This past year I allowed myself to become de-conditioned ( gained 30 lbs. and discontinued daily exercise) which most likely contributed to being back in A-Fib. My recent visit to a heart clinic in Asheville, NC, shed little light on this issue. Only that since I have been in and out of A-Fib for two years now, it is unlikely I will be able to get back in sinus rhythm. I am no longer taking Tikosyn which apparently did not contribute to keeping me in sinus rhythm. So I am no longer the "poster child" for the PVA procedure.

I am writing this story about my mother’s long struggle with atrial fibrillation (A-Fib) and the treatment she received recently with two main purposes—first, to sincerely thank the creators of the A-Fib.com website, without which my mother would be living a miserable life with her persistent A-Fib; and second, to share our long and torturous but learning experience with those suffering from this disease and their families, especially in our part of the world (Nepal) and give them hope that there is an effective treatment available, which many, including doctors, are unaware of.

My mother (Basundhara Tuladhar),

currently 70 years of age, has been suffering from some sort of arrhythmia for more than 50 years. In those days, her arrhythmia was diagnosed as Paroxysmal Supraventricular Tachycardia (PSVT?). I question the diagnosis because I do not have the ECG copies to confirm with present day specialists. I remember from my childhood days the occasional and unpredictable SVT attacks she used to have, sometimes lasting for several days. We could see the right side of her neck and upper part of her chest pulsating rapidly; and as the episodes lasted longer, she became more and more symptomatic. Her physicians in those days were unable to do much to stop the SVT episodes. The medicines they prescribed such as Isoptin and Verapamil were ineffective. She therefore lived with her SVT in this manner more than 2 decades.

Then in 1974, our family physician prescribed her Amiodarone, which controlled her SVT very effectively, almost like a miracle. However, after taking this medication for about 12 years, she developed a blood disorder—sudden reduction of platelets (thrombocytopenia). Suspecting it as drug-induced, Amiodarone was substituted with other drugs such as Inderal, Sotalol, etc. none of which were as effective as Amiodarone. The arrhythmias still occurred unpredictably anytime and anywhere without any pre-warnings, creating a lot of anxiety and stress for her and the family as we would not know when these episodes would stop.

Subsequently, since around 2002 my mother started experiencing some ‘modification’ of her arrhythmias, which started becoming more ‘silent,’ and the rapid palpitations could not be seen by an outside observer. However, she was still very symptomatic as before during such attacks. These events were diagnosed as A-Fib, and we were able to have these properly documented in an ECG.

I was very disturbed by my mother’s illness since my childhood days. Therefore, as I grew up, I tried very hard to find a lasting treatment for my mother. We visited heart centers in India, Thailand, Japan and the UK, but the only advice we got was to continue with the medication. As a result, my mother and the family learned to live with her paroxysmal SVT/A-Fib as is. But on July 12, 2006, something unusual happened. She went into A-Fib as usual, which we expected to stop at some point as in the past. However, to our dismay, the A-Fib would not stop even after several days. Weeks passed, but it just would not stop. As this point, our cardiologist informed us that the A-Fib has set in permanently, which was difficult to believe. It was however true. Various cardiologists we consulted explained to us the treatment options—electrocardioversion, radiofrequency ablation, or accepting and learning to live with the permanent A-Fib. They were not too keen on electrocardioversion as they were sure about relapse in no time. They were also unsure about RF ablation as it is not available in our part of the world, and we would most probably have to go to some specialized centers in the US. They were also doubtful if RF ablation would be effective on my mother as her left atrium was dilated. Therefore, their suggestion was for her to be on medication that would prevent stroke (warfarin) and control the heart rate (beta blocker) and ‘learn’ to live with the persistent A-Fib. This was difficult for my mother as well as the family to accept. While my mother could not simply imagine living with the A-Fib, I could not imagine putting her on warfarin long term given her Idiopathic Thrombocytopenia (ITP) complication. This was the most dreadful nightmare we faced in my mother’s 50-plus years’ history of SVT/A-Fib.

I did not know what to do. All I knew was I had to find a way out. I started researching extensively on my own, mostly on the internet. This was when I came across A-Fib.com which not only fully educated us on what A-Fib is all about but also gave us some encouragement and hope that there is a way out. I got the impression from this website that the A-Fib center in Bordeaux is one of the most experienced in the world and decided to take my mother there immediately.

However, my hope was soon dashed as the earliest appointment the Bordeaux hospital could offer us was almost a year later—May 2007 (I had contacted them in August 2006) because of a long waiting list. The hospital later advanced the appointment to February 2007 after my constant plea explaining my mother’s persistent A-Fib and the ITP complication. This was however still too far away for us given my mother’s condition. While we gratefully accepted the February 2007 appointment, we continued to follow up with the hospital for an earlier appointment. Fortunately, a few weeks later, I received an email from the hospital advising that our appointment could be advanced to the end of October, 2006 because of a cancellation by another patient. We were extremely delighted and accepted the appointment without any hesitation.

My mother continued to have persistent A-Fib, but we managed to take her to Bordeaux around October 20, 2006, a few days before her ablation appointment, to allow time for a transesophaegal echocardiogram (TEE) and other tests. To our relief, the TEE showed no clots and she was cleared to have the ablation on October 24, 2006. Dr. Haïssaguerre and Dr. Jaïs came to meet with us the day before in our room and explained the procedure. The next day, my mother was taken away for the procedure around 7:00 am and brought back to the room around 3:00 pm, in normal sinus rhythm for the first time in nearly 4 months!! We could not contain our joy and immediately called our family in Nepal to share the good news.

Prof. Haïssaguerre and Dr. Jaïs later explained to us that the procedure was quite long (nearly 5 hours) and difficult given her chronic case. They had to ablate several locations of the heart tissue—the openings of all 4 pulmonary veins, mitral isthmus, left atrial roof, and the cavotricuspid isthmus. They were however very pleased with the outcome and the fact that electrocardioversion was not necessary to restore sinus rhythm. The next few days of our stay in the hospital were uneventful, and my mother felt so much better for the first time since the onset of the persistent A-Fib nearly 4 months ago.

However, our euphoria was short-lived as my mother experienced several episodes of brief arrhythmias during our stay in a nearby hotel over the following weekend. As we returned to the hospital for a follow-up the following week, the episodes became more frequent and longer. Prof. Haïssaguerre was fortunately around to observe the episodes ‘live’ and on ECG. He explained that this was atrial tachycardia triggered by some very discrete points in the heart tissue and missed by the ablation procedure. He therefore decided to redo the procedure the next day to eliminate these points. The second procedure performed at the ostia of the left pulmonary vein was much simpler and shorter, and my mother was discharged from the hospital 2 days later without any complication. We subsequently returned to Nepal on November 12, 2006.

My mother was free from further arrhythmias for the next 6 months or so, but to our disappointment, she again developed some sort of arrhythmias—initially brief episodes which subsequently developed into 7-8 hour long episodes. I quickly wrote to Dr. Jaïs in June 2007 with copies of the ECG, to which he promptly responded explaining that the arrhythmias were no longer A-Fib and that these were atrial tachycardia. He suggested a repeat ablation on July 31, 2007 as the anti-arrhythmic medications (Flecainide and Bisoprolol) my mother was taking were no longer effective.

While this was a big disappointment for us, I was aware of the fact, from the information in A-Fib.com and other sources, that it is difficult to treat chronic A-Fib cases. Therefore, I gathered up my courage once more and convinced my family, especially my mother, to go for a repeat (a third) ablation. Fortunately, the third ablation, also performed by Prof. Haïssaguerra and Dr. Jaïs, was almost like the second one—simpler and briefer. We were out of the hospital after 3 days. This third procedure involved an electrophysiological study which showed that previously ablated locations in the heart remained completely isolated, and an aggressive pacing which induced an A-Fib. Mapping showed fractionation relatively localized in the posterior right atrium, which was successfully ablated, and A-Fib was no more inducible even using Isoproterenol.

At the time of this writing (August 30, 2007), my mother continues to remain free from any form of arrhythmias. As Prof. Haïssaguerra and Dr. Jaïs were quite optimistic about the long term result, we keep our fingers crossed.

While I had promised Mr. Steve Ryan a write-up about our experience much earlier—soon after my mother’s first and second ablation earlier this year, I decided to defer it in view of the reoccurrence of my mother’s arrhythmias. I was somewhat disappointed and felt I did not have a success story to tell. However, after having gone through the ordeal of the third ablation, I have realized that despite Prof. Haïssaguerra’s and Dr. Jaïs’ optimism, it is still possible that my mother’s A-Fib/tachycardia is still not fully cured. But this does not mean that I should not share our experience with others. I have greatly benefited from the personal experience stories by various individuals in this forum, who had successful as well as not-so-successful stories to tell. I am very grateful to them for inspiring me to write my own story.

While the long-term outcome of my mother’s third ablation remains to be seen, I personally consider the treatment my mother received at Bordeaux hospital as a success. This is because I compare my mother’s situation during July-October 2006 when she was in persistent A-Fib and her present condition, free from A-Fib so far. I vividly recall how miserable she was and how helpless the whole family was during the period of her persistent A-Fib. Even if she is not fully cured, we hope her arrhythmias would be paroxysmal at worst.

In conclusion, I would like to share an important lesson that I have learned over the years while dealing with my mother’s A-Fib. Never give up hope and explore as widely as possible to find a way out. There will be a way out however imperfect it may be. I have experienced first hand how true one of the key messages in A-Fib.com is; i.e., one needs to go beyond the doctors who are ignorant about A-Fib-ablation and advise patients to live with A-Fib. In our own experience, I had consulted quite a number of cardiologists in Nepal, India, Thailand, and the UK all along, trying to find a permanent cure for my mother’s SVT/A-Fib, as I was not comfortable with long-term medication. However, none of them pointed us to the direction of A-Fib ablation as a possibility.

I would also like to share our experience with Amiodarone, a very effective anti-arrhythmic drug which my mother took for over 12 years. While fortunately my mother did not develop some of the deadly side effects I have read about (e.g., pulmonary fibrosis), she did develop several other side effects—ITP, dysfunctional thyroid gland and corneal deposits in the eye.

Please feel free to contact me with any questions or suggestions you may have. My email address is: peanuts@mos.com.np Raju Tuladhar, Kathmandu, Nepal.

MY A-FIB
    If you take a bucket of water and pour it down a sink, that's how a normal heart operates. If you take a five-gallon water dispenser bottle, hold it upside down, and pour it into the sink, the water flows unevenly, gurgles, bubbles up, etc. That’s what an A-Fib attack is like to me. The higher the fibrillation rate, the worse it feels.
    The term Ejection Fraction (EF) refers to the efficiency of the heart. It basically refers to the percentage amount of blood in the Left Ventricle that is pumped out at every beat. Normal Ejection Fractions are between 55% and 75%. Anything above or below these figures indicates a problem. Hearts tend to deteriorate with age, leading to lower EFs. Doctors become concerned when EFs get around 30%.
    My EF was 67% at 55 BPM normal rhythm, and 60% at an average 110 BPM in the early stages of an A-Fib attack. That’s probably why I usually didn’t feel an A-Fib attack when it started. My EF then would get worse depending on the severity of the A-Fib attack. Any attempt to walk brought on instant dizziness. Eventually I’d get dizzy and lightheaded even when sitting down. The only good thing is that, when the A-Fib attack stopped, the effect was always dramatic. Within minutes I’d be back to normal, especially with clarity of thought.
    I have now reluctantly accepted that my A-Fib is probably due to a genetic fault, and that an A-Fib ablation procedure is the final answer. Fortunately medical science today is moving rapidly to stem the flood of A-Fib cases that for some reason is hitting the baby boomer generation.

FROM MACAU TO ESCORTS HOSPITAL IN NEW DELHI, INDIA
    After leaving Macau where I live, I arrived at Escorts hospital in New Delhi, India around 11.30 pm on June 11, 2007. Within one hour I was in A-Fib. This didn’t surprise me. My A-Fib attacks had become so frequent that I was getting them every 12 hours. They lasted between 36 to 48 hrs. I was rapidly approaching permanent Atrial Fibrillation.
    My heart rate bounced between 110 BPM to 150 BPM with spikes up to 178 BPM. (My resting heart rate is relatively low at between 52 - 58 BPM, probably due to years of exercising.) A-Fib heart rates this high are relatively uncommon. There are heart drugs (rate control drugs) that can be used to lower the general heart rate, thereby minimizing the damage to the heart in general.
    I managed to get to sleep that night. When I awoke I was still in A-Fib. But I almost welcomed the A-Fib. The doctors would actually be able to witness my A-Fib as it happened, and could map out the errant signals with all the new technology. They could ablate the actual sources of the errant signs which greatly helps chances of success.
    I went through the day being processed and prepped. (By now needles and tests no longer bothered me.) By far the worst test was the camera pushed down your throat so they can check for blood clots in the heart. The worry here was that I may have a clot in the heart due to the A-Fib. This would cancel all further tests, and the whole ablation procedure would be called off. I had heard this two minute test was pretty bad. Many people have to be put under as their throat naturally rejects the tube. I couldn’t help retching and gagging as that tube was forced down my throat. But, determined not to make one sound whatever happened, I got it down at the second attempt.
    Escorts hospital in India is good at resolving plumbing problems of the heart. It has virtually a moving conveyer belt of major heart cases being resolved every day, with very importantly a very low incidence of infection, which I hear is prevalent in the NHS. However, no one knows much about the electrical side of the heart, and why people like me who are otherwise perfectly healthy get A-Fib. This is called Lone A-Fib with no known cause. Most cases of A-Fib happen due to other faults in the heart such as Coronary Heart Disease.
    The easiest way to stop the errant signals that cause all the A-Fib problems is to have that part of the two Pulmonary Veins that enter the left side of the heart ablated - destroyed - around the joint where the veins are glued to the heart. This is done by entering the heart and causing a series of burns all around the joint. These many burns are like circular spot welds, like constructing a Fire Wall. Think of trying to stop a stream with round stones. Chances of success on the first try are around 50% -70% tops.

THE ABLATION PROCEDURE
    My doctors at Escorts Hospital were Drs. Anil Saxena and T. S. Kler. They said they might perform my ablation procedure this very afternoon rather than the next day as I was originally scheduled. So, re-adjusting myself and knowing they would catch the A-Fib attack in full flow, I waited in what was now becoming a bit a of a dull headache blur. My heart rate was around 110 BPM. But no one came for me.
    There was nothing to do but wait for the next day as originally planned. Expecting to be in the lab very soon, I actually welcomed another day in A-Fib. I was even more eager to get the ablation over with. But at 12.40 pm while I was staring at the TV, my ears suddenly 'popped' and instantly my thoughts were clear again. I got that indescribable feeling you get when coming out of A-Fib back to the land of the living. This feeling of euphoria was soon lost as, along with the feeling of relief at being out of A-Fib, I also lost a bit of the cast iron resolve I had saved up. But fortunately I still had some in reserve. At 12.50 pm, just ten minutes after the ear 'popping' which had never happened before in my approximately 50 previous A-Fib episodes, in came the nurse and said, "Lets go, Mr. Gordon."
    Being wheeled into the catheter lab was like entering a spaceship. .About six doctors or technicians were looking out from behind a wall-to-wall, floor-to-ceiling sheet of glass in what I presumed was the command center, a similar set up to the 'Electric Chair.'
    I had only one fear. I hate needles, etc. The thought of them cutting a slit in my groin and then pushing in 'sheaths' to get the catheters into the body and then manually on up into the heart itself was very scary. Just the nurse cleaning the area had me turning into an iron bar. Still not a sound sneaked out. After they inserted the catheters (think cables in push bike breaks), my main fear was now over; and, feeling OK, I started to relax. I had no fear whatsoever about the welding torch going into my heart. So for me, the worst was over with, thank God.
    All this feeling good about myself was brought crashing down as they proceeded to cut into a vein in my throat to push in yet another 'sheath.' I became an iron bar again, quiet as a mouse. I was after all an Englishman abroad, and it wouldn't do to let the good people of the colonies see any sign of weakness in a former soldier of the Queen.
    I was by now covered head to foot in heavy 'lead blankets' to fend off the radiation, but I could clearly hear my regular heart beat on a nearby monitor. That sound, and the feeling of someone pushing in the cables were my only sensations, easily tolerated.
    The catheters enter the heart via the right Atrium, which is where Atrial Flutter skulks in the shadows. Having both Atrial Flutter and Atrial Fibrillation I had discussed zapping the Flutter as well while inside the right side of the heart. The doctor had already decided that was going to happen after reading the many ECG printouts I had brought along with me.
    So, now for the welding bit. I could hear someone saying "this point," after which I got a small burning feeling in my chest. Not a sound out of my lips. I was going to get through this without even a squeak. I settled down for the expected next six hours on the block. The ablation burning went on for about thirty minutes with the "this point" followed by a burning sensation every few minutes, as the guy at my right side manually maneuvered the catheter via the brake cable.
    Drifting off to sleep I suddenly heard, "Ok, Mr. Gordon. We are going to enter the left side of the heart now." "So the Flutter’s gone." I said, thankful the Flutter ablation was done. A-Flutter sometimes triggers its big brother A-Fib but is easily cured 100%. "No, we will get that on our way out." This clearly threw me. What were the burning sensations for the last 30 minutes????
    To get to the left side of the heart where most A-Fib originates, there is no alternative but to puncture the dividing heart wall (the Septum) (for a further explanation of this part of the ablation procedure, see The Transseptal Wall Puncture).. This is what makes the procedure a bit risky. Also they now have to maneuver the catheter cables through a wall of muscle which is a far more tricky situation."
    We are through now, and we will start on the ablation process." Expecting the preceding burning sensations, I wasn't bothered and decided to sleep through it all. This was a big mistake. The first burn give me what a mega heart burn must feel like (no pun intended). This immediately made me turn from a ton of lead into a flying carpet. But not one murmur. However, the sound and sight of my clenched teeth cracking and shattering made the doctors decide to bring on the Panadol.
AFTER THE ABLATION
    I finally woke up at about midnight in the recovery room with my back absolutely killing me, but it was more of an ache than a pain.
    Fast forward about nine hours. Waking from a deep sleep I noticed the beating of my heart. It was a bit fast but in perfect NSR! I got myself out of bed and checked the heart rate on my athletes H/R monitor. It showed a perfect heart beat of 76 BPM, not even a missed beat every now and again. Around 30 minutes later the nurse came in with my first meal in the last 24 hrs. I wolfed the lot down (which wasn’t a lot), then sat on the sofa to watch TV, although I was really listening to my heart beat. "Could this really be true? I've beat it and got my life back!"
    Never being one to enjoy success knowing there's always a price to pay, I remained cautiously confident just sitting there.
    Then it happened. I could feel the A-Fib trying to start up again, but I was hoping the Fire Wall would hold it back. But no. On feeling my pulse I knew I was in A-Fib again. There can't be many greater depths of despair than a failed ablation for A-Fib and a possible future of no future. I already knew many ablations can start unraveling after about three months and required further 'touch up,' but 12 hours?????????.
    The only good thing was the H/R was bouncing around between 75 to 90 BPM. With my apparently mechanically sound heart I could tolerate this slower speed A-Fib, although my quality of life would still be drastically reduced. An hour later the doctor came in with a smile on his face. "The procedure went well. How are you feeling?" he asked. "Not too bad, but I'm still in A-Fib." He couldn't believe it, but on checking he confirmed the A-Fib. I said "You did the spot welding bit at the Fire Wall, yes?". He answered, "Yes, it was all OK."
    "Did you get the guys with the black hats that were causing the problem in the first place?"
    "We couldn't find them, and we paced your heart up to over 171 BPM for as long as we could, and not a spark in there."
    What he probably didn't know, but I do from experience, is that after an A-Fib attack your body seems to know it will destroy itself if it goes into A-Fib again too soon. So, you enter a period where you are somehow protected against any more A-Fib for whatever is your AF schedule at that moment in time. My schedule had dropped steadily from once every two weeks last August to every twelve hours before I’d go into an A-Fib 48 hour nightmare.
    The doctor told me not to give up hope, because he had done a good job. And it takes three months before the ablation procedure can be classified a success or a failure. They decided to monitor me for a further 24 hours rather than discharge me. 24 hours later there was no change. So I asked if they could hit me with the two electric irons (Electrocardioversion) and get me back into NSR, so that I might enjoy the next 4 days in Delhi. For some reason in our many discussions the doctor had gotten the impression that I did not want to be shocked. But then he said, "OK, let’s go."
    One hour later I recovered from the Electrocardioversion to find I was still in A-Fib. Talk about being pi**ed off.
    I spent the next 24 hours trying to come to terms with all this. There are other hospitals that do the same ablation treatment with perhaps higher success rates, but the top ones are in Cleveland, Ohio America, Bordeaux in France, and Milan in Italy. And they all have long waiting lists and are expensive. Even in England which is a relative novice in the procedure, it costs at least $20,000. And they are on a steep learning curve compared to the top 3.
    The only nearly 100% cure is via major open heart surgery, which is obviously the last resort, costs a bundle, and has long waiting lists.
RELEASED FROM THE HOSPITAL
    I went to a 3 star hotel that night at about ten bells to wait out the next three days before my flight home.
    Feeling pretty down on waking the next day, I could feel the pulse at my heart against the pillow. I heard 6 clear bumps before I pulled away as I decided to try to accept this A-Fib thing, and stop checking my pulse whenever an episode was kicking off. A similar thing happened later in the afternoon as I lay watching CNN, but not hearing a word.
    To lift my head higher so that I could see the TV I had put my right hand under the pillow and subconsciously must have started counting my heart beats. I realized I had got to 13 solid beats before I felt the rhythm go wrong. 13 solid beats wouldn’t seem like a big deal, but to me they gave me a bit of relief. I was definitely feeling a bit better each day and more focused mentally.
    I traveled everywhere around Delhi in a Tut Tut the next day, no walking. I decided I was possibly strong enough to make the 4 hour car journey to see the Taj Mahal, but just before the evening meal I felt strange things going on inside which resembled A-Fib trying to start. I struggled through the next 6 or 7 hours trying to keep my mind off the possible A-Fib which at least I knew was much weaker than before the ablation. Unlike before, I had no profuse sweating and continuous trips to the bathroom, followed by having to drink a lot of water.
    I awoke the next morning sleeping on my left side, something I had stopped doing at least 6 months ago because of the A-Fib. Too tired to carry out my promise to not count heart beats any more, I could hear a steady bump, bump until I stopped counting. This was a good sign. That's were I am now as I sit at the computer not knowing whether I am in A-Fib or not.
    What I forgot to mention is that starting on the 18th of June I started taking the dreaded Amiodarone which burns out your thyroid gland over time. But the doctor asked me to take the tablets for the next two months to give my heart a break, and to possibly help it remodel itself for the good. Hopefully my heart would start getting in the habit of not being in A-Fib.
    I'm feeling a bit stronger each day, but not taking it for granted. I'm taking two weeks off, although I can function like anybody else as long as I take my time.
    (Writing a month later Barry adds,) I am off of Amiodarone now and just take a small dosage of warfarin which I hope to stop taking in approximately one month’s time. I have been A-Fib free for at least a month now with no palpitations or "rumblings" since I stopped the Amiodarone. I feel normal again and can have a few beers in peace.

Barry Gordon, E-mail: barrythuy(at)macau.ctm.net (The "@" is written out at "at" to prevent access by automated spam search engines.)

Escorts Heart Institute & Research Center
Okhla Road
New Delhi - 110 025
India
Contact Dr. Sanjay for reservations.
Phones: 26825000, 26825001
Fax: 26825013
Grams: ESHEARTINS
E-mail: ehirc(at)vsnl.com (the "@" is written as "at" to prevent access by spam mailing engines)
Web site: http://www.ehirc.com

On July 11, 2007, I had a Cryoablation at Massachusetts General Hospital by Dr. Vivek Reddy. I participated in the pivotal Stop AF trial using CryoCath’s Arctic Front balloon catheter for pulmonary vein isolation. Dr Reddy also used the CryoCath Freezor Max catheter for treatment of my atrial flutter.

    I’d like to tell you about my recent Cryoablation, as well as the events leading up to it. I’ve benefited greatly from the wise counsel on this site and hope my story will be helpful to others. I apologize in advance for the length. I’ll discuss my experience with A-Fib first and Cryo second.

MY HISTORY OF A-FIB

    I was diagnosed with A-Fib almost a year ago exactly, at age 43. Once I knew what A-Fib felt like, I could see that I had been having events since the late 1990s and maybe earlier. I would often wake up in the middle of the night short of breath and had several episodes during athletic activities as well. Prior to my diagnosis I had thought these events were anxiety or asthma attacks. Consequently, I was seeing a therapist and had been on Klonopin (anxiety medication) for 4 years. I also was on maintenance doses of Flovent (asthma medication) which I took daily, and carried another inhaler for use during my attacks.
    I have been an avid endurance athlete since I rowed crew at Harvard. In 2001, I participated for the second time in the Canadian Cross-country Ski Marathon which is 100 miles over 2 days, the longest cross-country skiing event in the world. The first day was canceled due to high winds. Early the next morning while taking the bus to the start for the second day, I noticed that my heart rate monitor read 120 bpm just sitting there on the bus. “Boy, am I excited about this race!” I said to myself. Well, once the race started I knew differently! Everyone passed me. I must have fallen down 15 times due to weakness in my legs. Thinking my shortness of breath was due to asthma or lack of training, I kept going eventually and painfully finishing the 50 mile day. It never occurred to me it could be my heart!
    So a year later I was finally diagnosed. Initially no medication was prescribed as I went through the battery of tests: Holter monitor, chemical stress test, echocardiogram. Then one episode put me in the emergency room, and I was put on Norpace.
    Following several A-Fib breakthroughs, I was put on Pindolol, and the Norpace was replaced by Flecainide in September. The medication succeeded in stopping my A-Fib, but I had difficulty tolerating the side effects: shortness of breath, dizziness, low energy, heavy legs, night sweats, yuck!
    While all this was going on, I enrolled myself in the Cardiac Wellness Program at Dr. Herb Benson’s Mind Body Medical Institute to focus on heart health via meditation, relaxation, nutrition, and light exercise. Their program helped me, but was more focused on heart disease than arrhythmia. At this point I limited myself to walking on a treadmill a half hour a day at 8 degrees tilt and lifting moderate weights at 15 reps twice a week. I meditated 20 minutes a day.
    In December I replaced the Pindolol with Metoprolol to no large improvement in side effects. In February, I replaced the Metoprolol with Cartia XT and saw some side effect improvement but also started having A-Fib events again. In early March I replaced the Flecainide with Rythmol and saw additional side effect improvements, but also started having A-Fib breakthroughs more often and of longer duration.

CRYOBALLOON ABLATION CLINICAL TRIAL

    I had been considering having an ablation since December but wanted to try out all my chemical options first. I knew I could continue on medication for several years, but my quality of life was definitely suffering. I was having difficulty concentrating at work, and all I wanted to do was sit in front of the TV at home. I was having breakthroughs every week or two, and I was concerned about the remodeling of my heart. I decided this had to change and that, although it had risks, ablation was a route I had to try. It seemed I would need an ablation sooner or later; and sooner, when my heart was still strong and I was still paroxysmal, seemed better.
    I chose Dr. Vivek Reddy at MGH (Massachusetts General Hospital) as the best guy in New England. My insurance would only cover me if I stayed in New England. We set a date for the procedure, and then I got a call from him offering me a chance to participate in a clinical trial for Cryoablation. The trial was such that, if I agreed to participate, I would have a 2/3 chance of getting the Cryoablation procedure immediately. I had a 1/3 chance of being placed in the control group and would have to take medications for 6 more months, then I could have the Cryoablation. (See CryoCath Balloon Catheter Clinical Trials.)
    I was naturally concerned about participating in a clinical trial. Ablations have enough risk as it is. I was cautious about adding more. But the more I learned about Cryo, the more I realized that it was theoretically safer than radio frequency energy. Cryo does less damage to tissue than RF and consequently is less likely to create problems like esophageal fistula, pulmonary vein stenosis, stroke, etc. And rather than using a pencil type catheter, in Cryo you can use a balloon catheter which theoretically can produce a more uniform ablation.
    While the CryoCath Arctic Front balloon catheter is newly approved in Europe, it was not yet approved in the US. Dr. Reddy was one of 2 doctors in the country to perform the first stage of the trial, with 20 patients each. Success rate with no medication was about 75%, comparable to RF ablation. Dr. Reddy had also performed another 20 in Eastern Europe. He had also demonstrated a Cryoablation at the Boston Atrial Fibrillation Symposium.
    Because of the success of the initial trial, the FDA approved the second “pivotal trial” of some 200 patients in many more centers across the country. This trial would use the next generation CryoCath Arctic Front balloon catheter with 2 balloon sizes instead of 1 and a more flexible sheath.
    When I spoke with Dr Reddy about my participation in the trial, he said I could expect a comparable success rate to RF, but with less risk. I asked him if it was his family member who had the choice, what would he do? He said he would choose the Cryo, even if he had to wait the 6 months extra to get it. He was convinced it was safer due to the reduced tissue damage. The real question according to him was whether the Cryo lesions would be effective for as long as RF lesions. Since this is new, no one knows the answer to that yet.
    Needless to say I decided to do the Cryo, constantly reading all I could to find a reason not to believe my doctor. Beyond the obvious conflict of interest, everything I read said that Cryo had the most promise of being the next generation technique for A-Fib ablation, because it was likely to be safer. And I knew I had the most experienced Cryo guy in the country as my doctor.
    Just before my procedure, CryoCath published an article covering a study of over 300 cryoablations presented at the European Society of Cardiology (Europace) Conference in Lisbon. They reported an 84% success rate with paroxysmal patients. They also reported a 7.5% incident of phrenic nerve injury, which is high; although all of them resolved on their own in less than a year. The article noted that no esophageal fistula or pulmonary vein stenosis was reported.

MY CRYOBALLOON ABLATION PROCEDURE

My procedure took place on July 11, 2007. Due to unrelated back pain which made it painful for me to lie flat, I had general anesthesia rather than the normal sedation. As a result, I can’t tell you much about the procedure experience since I was asleep. One thing I do know was that it took a long time, due to the study protocols. I was put under around 8 am and woke up around 3:30 pm for a total time of about 7 ½ hours.

    Following the procedure I was told that they successful isolated the pulmonary veins but that there was some phrenic nerve damage. The phrenic nerve helps the diaphragm expand so you can take in air into your lungs. Apparently they make you hiccup to be sure the phrenic nerve is not harmed. When I stopped hiccupping, they immediately stopped ablating and I resumed hiccupping about 10 minutes later. Upon examination, I was taking air into both lungs, but the chest X-ray did show one side of my diaphragm noticeably higher than the left. I was told this almost always resolves within a year, and they plan to follow this closely.
    During recovery in the hospital the same day and next day, I definitely felt discomfort in my chest---kind of a burning and heaviness that was worse when I lay down. I had no noticeable trouble breathing at all. I also noticed a sore throat that made it difficult to eat anything but soft foods.
    I went home on schedule the day after the procedure. 2 days later I called my doctor as he instructed because I was still having some chest pain and wanted pain medication. When I mentioned I was still having pain when swallowing food, he decided to readmit me to be extra sure there was no damage to my esophagus (scary!). He told me he was very sure all was fine but wanted to be safe. First I had a chest CT scan that didn’t show anything definitive about my esophagus, but did show moderate fluid around my heart and a bit of fluid also in my lungs. Apparently no big deal other than to monitor (I had no fever). The next day they put a camera down my throat under sedation and discovered that I had an infection which could be treated with an antibiotic. Apparently the instruments they put down your throat with anesthesia had disrupted an infection already brewing, or perhaps created one. Either way it was easily treated, to my relief.

    I am now about 3 weeks post ablation and am back at work full time. I can function around the office pretty well, and I took a half hour slow walk yesterday that definitely taxed me but was doable. I still have some mild chest discomfort when I walk up stairs or otherwise exert myself, but it is tolerable and getting better steadily. I still don’t notice any breathing issues. This may change when I am able to do more rigorous activity, but we’ll see. I have my 1 month follow up appointment next week and will certainly know more then.
    I am very happy to have emerged relatively unscathed from the procedure, and I have been in sinus rhythm steadily since. I have great faith in Dr Reddy and feel I was well served under his care. I feel better and stronger every day, and I look forward to a full recovery. So far I am very glad I pursued the ablation option and the Cryo option as well.
    Again, I apologize for the length of my account. I hope you found it interesting and useful. Please let me know if I can answer any questions.
    Thanks.
    Terry
E-mail address: terrydewitt1(at)gmail.com (the "@" is written as "at" to prevent access by automated spam mailing lists.)

UPDATE AT FOUR MONTHS AFTER CRYO ABLATION:

    I am doing very well, feeling strong and have not had an AF event since my procedure.
    At my 1 month check-up, the phrenic nerve damage had completely resolved. Dr. Reddy discontinued my Rythmol at that appointment, and my Cartia XT two weeks later. Once I stopped taking those medications, I felt my energy returning, my head clearing up, and most of the side effects I'd been experiencing vanished. The next month or so were spent taking half hour walks at lunch and slowly increasing my activity level. I had some persistent discomfort in my chest, particularly upon exertion, that seemed to be due to some lingering inflammation around my heart. A few days of Motrin cleared that up.
    I now do about 30 minutes of aerobic exercise 5 days a week at a heart rate of about 125 bpm. I also try to do weights (high reps) 2 or 3 times a week for about 20 minutes. This level of activity seems about right without pushing it too hard.
    Last Friday, following 2 holters 2 weeks apart, I was allowed to stop taking Coumadin. I am now completely off all of my meds and I feel better than I have in a long time. I can't tell you how optimistic I feel about my future and how bright my mood is compared to 6 months ago.
    I am very glad I pursued the Cryoablation.
Terry (November 7, 2007)

Update February 18, 2011
As I have heard that the FDA recently approved Cryo-balloons for pulmonary vein ablations, I want to update you all on my health status. It is now 3 ½ years since I participated in the pivotal Stop AF trial using CryoCath’s Arctic Front balloon catheter for pulmonary vein isolation with Dr. Vivek Reddy and Massachusetts General Hospital.

I am very happy to report that I have not had a single AF event since my procedure. I now exercise 1 to 1 ½ hours per day, 6 days per week and feel great. I honestly feel as good as I did before all the AF episodes started. I’m truly as good as new. Well, maybe a few years older!

In speaking with Jeremy Ruskin, head of the program at Mass General (Vivek Reddy is now at Mount Sinai in NY), the patients that participated in the cryo-balloon trial have responded particularly well, with relatively low relapse and good recovery.

I would recommend that everyone consider cryo, in addition to radio frequency. Generally, it is safer and has as good or better outcomes. But I would also suggest finding a doctor who has experience using cryo. A list of doctors who participated in the STOP AF trial should be available online if you search.

Please feel free to reach out to me if you have questions about the cryo. I would be happy to share my positive experience.

Update July 19, 2011
I recently took my 8 year old daughter hiking for 2 days up Mount Adams, the second highest peak in the Eastern US. We had a wonderful time, and it was a great reminder of how thankful I am for my experience with Cryoablation.

Aug 7 was the big day, but I had to go in 3 days early to be taken off of Coumadin and started on Heparin. During the procedure, my EP did:

Following the procedure, my cardiologist was a little surprised that I did not have a little more chest discomfort. Apparently, he uses that as a gauge of how deep the RF burns were. He spent five hours doing the procedure which he indicated was normal.
    [NOTE: You read on some web sites that the procedure takes as little as 1 to 1 and half hours.]
    Other than starting back up on Coumadin, I wasn’t put on any medication. I remained in the hospital another 3 days, for a total of 6, awaiting my Coumadin level to rise to an acceptable range. [NOTE: Going into the ablation procedure, I had no idea I would be in the hospital 6 days. You can be in and out for a heart transplant in 6 days!]

    My cardiologist indicated I could resume normal physical activity 4 days after the procedure. Wanting to play it safe, my plan was to go cold Turkey for several weeks to give the scarring plenty of time to heal. However, on Day 5 (Aug 12) after the procedure I was doing a little light work outside—it was particularly hot and humid—with my heart rate running around 85 when I reverted to A-Fib. I saw my cardiologist Aug 14 where he started me on Toprol to see if that would have any effect. It did not, and he cardioverted me on Aug 17. Six days later, I was once again outside doing some light work when the same thing happened. Brought me in the next day—I was becoming a regular around the corridors of Northridge Medical Center in Fort Lauderdale—for my 4^th cardioversion. This time he started me on Rhythmol SR. At this point, 18 days after the ablation, he was becoming concerned that the ablation procedure was not a success---even to the point of discussing my follow-on procedure where he would plan to use a new catheter tip which had just recently received FDA approval (a cooled tip which allows more energy to be dispersed over a wider area as I understand it).
    Now I didn’t just fall off the turnip truck, so I stopped going outside for anything for the next week! Then I started a very easy regimen of walking knowing my wife and I were going to be spending 3 weeks in Europe, so I wanted to get in some semblance of walking shape. By this point I was really gun shy and was particularly anal about watching my heart rate monitor in the days and weeks ahead. (He uses two monitors, the Polar S510 and a backup Timex which doesn't record data. He wears a monitor for all cycling workouts, and also when running.)
    I started my walking regimen on Sep 4, 2006 at a heart rate of 78, building by 1 beat per day. I started riding the Lifecycle while still in Europe building to a steady heart rate of 105. I should also point out that my cardiologist advised NO caffeine and only 1 glass of red wine per day allowed. He wasn’t too keen on decaf coffee even, but accepted that I would be drinking 1 cup of decaf a day. This of course meant I also had to switch to caffeine free coke which the Europeans haven't discovered!
    Dr. Zilo wanted me to accelerate my workout efforts. After nearly two months of being in normal sinus rhythm, he felt it was time to determine if the procedure was a success, especially given the two episodes of A-Fib post procedure. I was probably the best conditioned persistent A-Fib cyclist going into the procedure, so the time off the bike (I had hung up my bathing suit in the Spring for the time being) was probably a welcome rest. I felt really fresh, especially given that I was in normal sinus rhythm.
    Nov 5, 2006, I completed a century ride (100 miles) on my bike at an average heart rate of 127 and a max of 151. My previous LT (lactate threshold) was 148 which I have been able to successfully maintain for intervals of 5 minutes and longer as I look to regain my previous cycling form. My cardiologist seems to be as surprised as anyone about my turnaround. (I had actually done a couple of centuries during the Summer while still in A-Fib, and maybe that helped a little with muscle learning. Surprisingly I never felt any muscle fatigue during these rides in A-Fib, but simply ran out of gas at about the 75 mile point when I fell off the lead pack.)

    I have had several hard rides in the week following and feel as though with another month I will be ready to resume racing. FYI, when I do race, I'll ride with 35+/45+ groups for crits rather than with my age group just to push myself.

    I feel great right now as though nothing ever happened. The next event, provided everything stays normal, will be to discontinue the Rhythmol SR. However, I’m kind of thinking right now that “if it ain’t broke, don’t fix it”!
Ed Webb
    (Ed recently wrote that he is off of the Rhythmol SR and in sinus rhythm, but then he was hit by a truck (broken ribs, contusions)! He recovered, is doing fine, and is racing again.) I am feeling better then ever and am thankful that the ablation procedure was a success after all.

    (Ed included the following update 12/29/08.) I took the better part of a year off to swim (went to World Masters Swimming Championships on a lark). I got back on the bike this past summer only to have my A-Fib problem pop up out of nowhere again in August. Just like before, it was like you flipped a switch and, voila, I was in A-Fib full time (persistent). Fortunately, I was able to get in to see my cardiologist within 2 days for another cardioversion. Four weeks later, I had another ablation procedure (my second and hopefully last). That was the end of September. Following the procedure, I didn't do a thing for four weeks and then slowly started getting back into some physical activity. I started with easy walks and got back on the bike the beginning of November, still taking it very easy. My first time around, I had a couple of episodes of A-Fib (both required cardioversions to get me out) and I attribute that to trying to do too much too soon (before the scarring had a chance to heal).
    At the end of November my cardiologist cleared me to resume unrestricted physical activity. As luck would have it, the first week of December I got involved in a big cycling pile up (kind of like a NASCAR wreck) and really screwed up my shoulder and back--nothing broken but painful muscle strains and bruising. I took 2 weeks off and only began to get back into it right before Christmas.
    So, bottom line, and aside from the lingering aches and bruises (combined with old age!), I'm actually doing great.
Regards,

E-mail: Edandlindafll (at) aol.com (the @ is written out as "at" to prevent access by spam mailing lists)

    My journey through arrhythmia (Atrial Flutter and then A-Fib) began in the summer of 1996 when I was 60 years young. I was diagnosed with atrial flutter. Atrial flutter made my heart rate extremely high, and I had difficulty breathing and a tight chest. I was also extremely nervous and sensitive. As time went on the episodes became closer and closer. My cardiologist tried many of the antiarrhythmic drugs on me, but I could not tolerate any of them. I was terribly sick and had hives with Quinidine. Rythmol made my mouth, eyes and sinuses so dry that I had sores in my mouth and finally could hardly swallow food, plus nausea, headaches and my breathing was becoming more difficult each day. Neither of these antiarrhythmic drugs abated the flutter. Finally, I tried Verapamil to just keep my heart rate down. My body was so overtaxed that my general health was really bad.
    During this time I had many medical cardioversions and finally several electrical conversions.
    My cardiologist believed that my flutter came from my having had a pericardiectomy (surgical removal or stripping of part of the Pericardium, the membrane surrounding the heart, to remove calcium deposits) 36 years earlier. The pericardium had calcified, probably from a virus, and did not allow my heart room to beat properly.

My insurance company is Kaiser, and during this period Kaiser did not do Pulmonary Vein Radio Frequency ablations. I kept reading about flutter and researching the internet where I found an article about ablation and requested that I be referred to the University of Colorado Medical Center. My cardiologist was reluctant, but I had run out of options. So, in June 1999 I had a right atrial RF ablation. There were some tough weeks following this six hour procedure (rapid HR, very slow HR and irregular beats), but by September I once again had good BP and a 77 HR. The university doctors said I was cured!!!

My next episode with a rapid heart rate began six years later. This time I was diagnosed with A-Fib in September 2005. What a disappointment! However, I was very thankful for the six years of relative good health. I knew going in that I would not be able to tolerate the antiarrhythmic drugs; but in order to be referred to a clinic that performed PVI ablations for AF, I first had to satisfy Kaiser that my A-Fib could not be controlled with antiarrhythmic drugs. This time I tried Flecainide, but after a week it gave me a headache that was unbearable. Finally I was able to take 360 mg of Diltiazem that did not keep me out of A-Fib, but kept my heart rate down. I also took Coumadin, Digitalis, and Maxide that helped me with the edema, a side effect of the Diltiazem. I was very symptomatic, and by the beginning of May 2006 I was in persistent A-Fib. Again I tried a cardioversion, but it only lasted 2 days.

I started searching the Internet again where I found Steve Ryan’s site, which was a Godsend as it armed me with the information I needed to convince my Kaiser EP doctor to again refer me outside the Kaiser system. Must comment that my Kaiser EP doctor took a lot of time with me, but was very much against my wish to have a PVI ablation and told me all of the terrible things that could happen during this procedure. This did bother me, but I kept searching the Internet, received many encouraging emails from Steve and finally picked Dr. Chris Cole in Colorado Springs to do my PVI ablation. I really wanted to go to Bordeaux, France, but the waiting list is long – as it is most places, and Kaiser will not cover medical expenses outside of the US. I read and heard many good things about the Cleveland Clinic and a Dr. Natale, but again the wait was too long as I was beginning to feel desperate. I felt that my heart was getting worse each day. I was finally able to get the Diltiazem down to 240 mg a day and that really helped the edema. Dr. Cole worked directly with Dr. Natale in Cleveland before coming to Colorado. Also, Dr. Cole is on the leading edge of the Cryo-Cath ablation and has begun a two-year study of the Cryo-Cath Balloon catheter. I was not eligible for this procedure as I was in persistent AF and also have a prolapsed Mitral Valve.
In September 2006 I was referred and contacted Dr. Cole’s office to scheduled an appointed. He told me that he could definitely improve my A-Fib; but because of the complications I had, he would only give me a 50-60% chance of a cure with the first PVIA, but that I would at least be able to control the A-Fib with medications. This seemed reasonable to me, and the fact that he said the procedure would only last about 3 hours was the deciding factor for me. However, I had to wait until December 12, 2006 for the procedure. Those three months seemed like they lasted forever, because I was losing ground each and every day. During this waiting period I had many moments of indecision. The only thing that made me go through with it was I could no longer tolerate the A-Fib.

Three days before the procedure I stopped taking Coumadin and instead injected myself with Lovenox 60 mg (an anticoagulant) each day. My husband (who also has A-Fib and takes Amiodarone) and I arrived in Colorado Springs from Denver, the afternoon prior to the scheduled procedure. At 6am on the 12^th I was admitted and prepped for the ablation which began at 8 am. The EP room looks like something from Star Wars with many TV monitors and weird looking equipment everywhere. I asked to be put to sleep during the procedure. I was not completely out, but I remember very little until being taken back to my room with all of my family following. I was in my room by 11:30am. Dr. Cole did tell my family that he had a hard time getting me back in sinus rhythm and then my HR was only 35. Also that my heart was scarred from the A-Fib, but hopefully in the next few months it would “remodel” itself. At first he was concerned that I might need a pacemaker.
I was given medication to irritate the heart to see if I would go back into AF. It did not, but began uncontrollable shaking. As soon as the medication was discontinued, I was fine except for a very dry mouth, and my HR continued to go up. About 2 pm, two technicians arrived to pull out the tubes from both sides of my groin. I also had a tube in my neck and several IVs. The tubes were about 11 inches long, and then pressure was applied for 15 minutes per side until they were sure I would not bleed. Then began the long hours I had to lie perfectly flat. About 10:30 pm I was finally able to sit up a bit and move my legs. What a relief! I had some bruising where they inserted the tubes.

Dr. Cole and I had decided to try me on Tikosyn (a newer antiarrhythmic drug – 250 mg twice a day) after the procedure. This required staying in the hospital an additional two days to monitor the effects of the drug. The day after the procedure I was feeling tired, but great just being out of A-Fib. About 9 pm though I began to have tachycardia and was feeling quite uncomfortable with a 120+ HR. I asked if they could give me something to lower the HR. That was a big mistake! Also, about this time the hospital staff decided it needed my private room and began moving me to a double room. Then I was given three different medications for the high HR (Diltiazem, Lopressor and ?) As I mentioned earlier, I am very sensitive to medications; and, if I had been more lucid, I would not have taken all three drugs. Very quickly my blood pressure dropped to 40/30 and 35 HR. I had many nurses working on me trying to get my BP and HR up. I was given more medications by IV to counteract the prior meds. Quickly I got very ill and had the dry heaves. I am not a moaner, but that night I really thought it was curtains for me. This went on all night, but by morning I was once again recovering. I do not believe that I ever went into A-Fib during all this time. When Dr. Cole finally checked on me about 11am, I was doing okay and he decided I could be released that afternoon. I cannot tell you how relieved I was to leave that hospital (which incidentally was very dirty too.) I know they over-dosed me, and my roommate confirmed this by saying she heard everything and how concerned they were over my reactions to the medications. I do not know what all I was given, but I was not a happy camper. Dr. Cole reviewed my monitoring strips the next morning and thought they were okay.

1/15/2007 – My one month follow up exam. Had to wait a couple of extra days because of all the blizzards Colorado is having this winter. I saw Dr. Cole’s PA. My electrocardiogram was very good. I did have some breathing problems earlier (I also have asthma - controlled), so I needed to have a CT scan of my heart and a “Sniff” test – to make sure my diaphragm was not injured during the procedure. All turned out fine.
I have been back on the weight machines (3 times a week for 30 mins.), but get pretty tired out by evening; so I guess I need to cut back to a shorter time and increase exercise gradually. I tend to forget that my heart was over-taxed for so many months and that it will take time – 6 months to a year.

My next checkup is in March and I’ll be sending an update. Meanwhile we are going on a cruise to Hawaii, and I’m sure this will be a complete cure for me!!!
E-mail: bevrey (at) comcast.net (the @ is written as "at" to prevent access by spam mailing lists)

Michael Waring
Palma de Mallorca, Spain
September, 2006
michael-waring (at) msn.com (the "@" is written out at "at" to prevent access by spam mailing lists)

Steve asked me if I would write about my ablation with Dr. Natale. I am honored to do so, because Steve's site was the first I found on the net after I was diagnosed with A-Fib. His description of his own ablation in France, and the excellent information he gave, as well as links to other websites, were very helpful to me.

I was diagnosed with A-Fib on October 23, 2001 at age 51. The trigger for me was the events of September 11. I had a very bad anxiety reaction to those events---not helped at all by the fact that my husband had left the evening of Sept.10 for a business trip to Europe, and couldn't get back for some time. I started having episodes of breathlessness and a pounding heart. I thought I was having panic attacks. Most people who know me well would describe me as being a strong person, and I have always thought of myself as a person who could handle crises without becoming unglued. So, stupidly, I waited until my scheduled check-up appointment with my PCP, Dr. D. in October. Meanwhile, I tried to exercise myself out of these "panic attacks". I went to work as usual, did all my normal activities, but I knew I was in trouble.

When I went for my appointment with Dr. D in October, I didn't want to tell him about the symptoms I had been having, because my husband and I were planning on leaving the following day for a relaxing road trip through Vermont, and I desperately wanted to go on that trip. For some reason, he took one look at me, and checked my pulse rate. It was too high for him to count. He listened to my chest and said, "You are in atrial fibrillation. Can't you feel that?" An EKG confirmed the A-Fib, and I had to come clean about the symptoms I had been having.

He sent me directly to the hospital to be admitted by a cardiologist he knew, Joseph Pennington here in Wilmington, DE. Dr. P turned out to be a young cardiologist who had only been in private practice for two years, after completing his EP fellowship with Frank Marchlinski at the University of PA. Dr. P has taken excellent care of me ever since.

My heart rate was over 200 bpm in the ER. Dr. P put me on Cardizem and heparin drips, and ordered the normal tests, echo, nuclear stress test, blood work. Everything checked out well, except for some enlargement of my left atrium. He offered to do a TEE and cardioversion before I left the hospital, but I just couldn't get my mind around all of that. I needed time to think. So I went on Coumadin, to be cardioverted a few weeks later.

Two cardioversions in the month of December only lasted for a few days. So I went back to the hospital to start sotalol. Dr. P tried sotalol first, because I was having a problem keeping my heart rate down. After two days in the hospital and a number of doses of sotalol failed to convert me, my EP performed another cardioversion before I was discharged. This CV only kept me in sinus rhythm for a few hours. But I kept taking the sotalol; and within 10 day, I was converting on my own.

To make a long story short, Sotalol kept me in NSR only a few days out of a week. I was grateful even for that, but I felt like a zombie on Sotalol. We tried Rythmol, which seemed to make me worse and caused severe GI distress. I then went off all drugs except Coumadin for a period of about 6 months and had an episode only 3 or 4 times a month. When my episodes and heart rate started to increase again, we tried flecainide in March of 2003, and that worked best for me. Unfortunately, I developed A-Flutter in late 2003, probably caused by the flecainide, and my EP performed a successful right sided A-Flutter ablation in October of 2003.

But despite the drugs, I never went without an A-Fib episode for longer than two weeks.

Fortunately for me, My EP had been trained to do PVIs during his fellowship with Dr. Marchlinski. He and another former fellow were the first to do them here in Delaware. He had only done 10 in private practice the day I met him. He told me that I was an excellent candidate for the procedure which, he said was new and revolutionary, but not experimental. And he offered to do one for me. His success rate then was 60%, that is 6 out of his 10 patients were cured, and he described each one of them to me. Or, he said, you can go up to Penn and have it done by Dr. Marchlinski.

I decided to go for a consult with Dr. M. in March of 2003. He agreed that I was an excellent candidate, and I got on his list.

Meanwhile, I had found my way onto these A-Fib websites. I was primarily interested in hearing about who had gone for an ablation and where, and who was having success. Not a lot of people were going for ablations back then, but the name that kept coming up was Andrea Natale at the Cleveland Clinic.

I talked this over with Dr. P. He suggested that I might also want to check out Dr. Morady in Michigan, who was having a lot of success with the Pappone procedure. But Dr. Morady was out of network with my insurance company. But I did go down to Baltimore to see Dr. Calkins, who was doing the same Pappone procedure.

But before I went to see Dr. Calkins, I went for a consult with Dr. Natale. Dr. P had written letters with my history to all three of these doctors. Dr. Natale walked into the exam room, and the first thing he said to me was, I am so sorry for your long struggle with atrial fibrillation. My husband was in the room, also Dr. Natale's nurse, Christina, with whom I had talked at length just before. But Dr. Natale never took his eyes off mine, as he answered all of my questions and described his procedure. He called it a pulmonary vein antrum isolation, a PVAI. He stayed far enough away from the openings of the pulmonary veins to try to avoid pulmonary vein stenosis, that is constricture or narrowing of the pulmonary vein. He told me he had done over 1000 ( I later learned that he had done over 2000), and that he did 3 per day, every day. He told me that he would be happy to do an ablation for me if I was agreeable, and I said yes. I went for an echo while I was there, and it showed my left atrium measurement at 5.0. I was worried about this, having heard that the size of the left atrium was a factor in the success of the ablation, and I emailed Christina. She told me, we don't just measure the diameter, we also measure volume (and another measurement that I don't remember), as well as your overall health, and you are well within our parameters.

I did go and see Dr. Calkins. I liked him, but he told me that he had only done 300 A-Fib ablations total. That was in July of 2004. He told me that I should go on amiodarone immediately to prevent any further remodeling of my heart, and he even wrote me a prescription for amiodarone, which I never filled.

    My father, a retired Obstetrician, woke up on January 1 2004, his 69th Birthday, with a temperature of 100 degrees, general malaise, and sore throat. Typical symptoms of the cold that was going around at the Holidays. He stayed in bed and missed his Birthday Party. He felt a little better on the 2nd. On January 3, our nightmare began as a family; my Dad was short of breath and thought that he might have pneumonia. My mom, his wife of 47 years, took him to the urgent care clinic. He had a Chest X-ray and was immediately admitted to the Hospital, with an initial diagnosis of bilateral pneumonia. On January 4, he was transferred to ICU (Intensive Care Unit). He did not respond to antibiotics within 24-48 hours, and his Cardiologist and Pulmonologist put their heads together and feared that he was suffering from Amiodarone Pulmonary Toxicity. He had a lung biopsy shortly thereafter that confirmed their diagnosis.
    My Dad had been on Amiodarone 200mg once a day for 10 months, post ablation for chronic atrial fibrillation. He had no previous lung disease or open-heart surgery.
    He complained of a dry cough for 2-3 months. His primary care doctor thought it was ENT (Ear Nose Throat) related, and referred him to the ENT. The ENT thought it was GI (Gastrointestinal) related and sent him to GI. He never made it to that appointment, as he was in ICU.
    My Father had a normal CT scan of the lungs in the middle of Oct. 2003... Just 8 weeks later, fatal lung damage from Amiodarone.
    His condition continued to get worse. He was put on a ventilator on January 18, 2004, which he was unable to tolerate.
    He had to be put on a drug to paralyze him, in order to tolerate being on the ventilator. His lungs were so severely damaged that they had to force as much oxygen to his lungs as possible, which no one could tolerate without being paralyzed. We had heard that it was like sticking your head out of a moving vehicle traveling 65 miles/hour and trying to breath out of a straw. Could you imagine what my father must have felt? 5 Children and a wife of 47 years, watched over him for 49 days, as his condition deteriorated, and Never improved.
    The half-life of this drug is so dangerous. Once toxicity was diagnosed, it didn't matter that the drug was stopped as it continued to do damage. Steroids did not improve his condition at all.
    It appears that most literature I have read, states concerns with doses over 300mg/day. Well, here is a case where a patient was only on 200mg/day for 10 months, and ended up with Fatal Pulmonary Toxicity. In addition, they underplay the need for close monitoring of the lung status of patients on Amiodarone. They absolutely need to come up with a new protocol, monitoring lung function much more frequently than every    3-6months. A chest x-ray, had it been done even 8 weeks prior to this event, would not have clued anyone into the fact that he was developing Pulmonary Toxicity. He had a CT scan, which was Normal.
    My father passed away, after 7 weeks in ICU, on February 20, 2004.
    Please, do what ever you can to put stronger warnings out, and push the drug companies to "red label" prescriptions, "If a cough or flu symptoms develop, contact your Physician Immediately! These can be signs of Pulmonary Toxicity, which can be Fatal, if left untreated."
    I feel that many patients are dying of “pneumonia.” because once they wake up unable to breathe, which happens suddenly, they go to the Hospital and are so unstable that a lung biopsy cannot be performed. Therefore, I feel that the Doctors are missing that it is really the Amiodarone.
    In addition, I think patients should be required to sign a consent form, notifying them of the warnings.
    Further, more needs to be done in the Medical Community to educate Primary Care Physicians of the severe effects of some drugs.
    Red warning labels should be put on the Patients Medical Chart.
    We experienced first hand, the very slight symptoms of Amiodarone Pulmonary Toxicity. My Dad's symptoms went unnoticed by him, a Physician, as they were so minor. He thought he had developed allergies, or that our air was too dry, and thus the dry cough. He had no other symptoms that would have caused any alarm. Just 2 days prior to be hospitalized he enjoyed a wine tasting gondola cruise through the marina in Long Beach with his entire family. He was running around, getting in out of the boat just fine, no Shortness of Breath. I lived with him, and he presented NO symptoms of concern. He was filled with energy and life, just 2 days before being hospitalized.
    My Dad was a very strong man. He had undergone many procedures and surgeries throughout his life. He was strong and got through it all, BUT not Amiodarone. His death certificate read, “Accidental death due to Amiodarone Induced Pulmonary Toxicity." My Daddy died from an “accident”. Whose accident? That is why this drug is such a concern.
    Thank you for the opportunity to write my story.
Karen Muccino, karenmuccino (at) yahoo.com. (The @ is written out as "at" to prevent access by spam mailing lists.)
    (Author's Note: Could this tragic death have been prevented? If you are taking amiodarone, you should by monitored and tested frequently and scrupulously for damage to your organ systems (your doctor may already be doing this). You should keep copies of any tests. What's important is not so much whether you are within a "normal" range, but whether your measurements are going up and how fast. Note: it's important that baseline values for organ systems should be documented before you start taking amiodarone.
    Contact your doctor immediately if, after taking amiodarone, you experience any new symptoms such as: coughing, wheezing, shortness of breath, visual changes, skin rash, pain, tingling or weakness in the arms or legs, fever, rapid heart beat, fatigue, lethargy, unusual weight gain, swelling, hair loss, cold or heat intolerance, lightheadedness or fainting.
    See the FAQs question on amiodarone testing.
    Be advised that a newer drug dronedarone (brand name Multaq) is now on the market and may be a good substitute for amiodarone. Dronedarone may not be quite as effective as amiodarone, but is much safer.

I have probably run on average about 1500 to 2000 miles a year for the last 20 years. In 2002, I began to notice that sometimes I seemed to be in severe oxygen debt when running. One of the first pieces of advice that we get when we start participating as distance runners is “listen to your body”, but since I was in generally good health I first tried blaming it on going out too fast. Then I tried to convince myself that I was out of shape and needed to work harder. I began to sometimes fall apart, sometimes needing to walk during races; so I decided that age was slowing me down more than the average person.

I started using a heart rate monitor after my daughter got me one for Christmas. When it registered rates of 225 to 250 during some of my workouts, I decided it was obviously defective. So I sent it back. When I got it back, not only did it still register these absurdly high readings; but it also seemed to do it almost every run now. So I sent it back again. Worse yet, it still did the same thing after it came back the second time. Then I started wearing a contact lens so that I could watch it during my run instead of just getting a read out at the end of the workout. I discovered a funny coincidence. The monitor would be rolling along at rates in the 130 to 145 range for a while, then suddenly jump up over 200 shortly before I would begin to feel the oxygen debt set in.

At this point, now the beginning of summer 2003, I finally decided to listen to my body and go see a cardiologist. Unlike many people with Atrial Fibrillation, mine would subside on its own when I stopped running. It got progressively worse during the summer, with me going into A-fib about 4 out of every 5 runs. It was obvious that I had to do something, and I feared that maybe I would have to give up running. Like many other people that I’ve read about on the internet, I didn't know if drugs would work and didn't want to take them for the rest of my life anyway. I was referred to Loyola Medical Center in Chicago. And on August 29, 2003 I had a Radiofrequency Catheter Ablation, which took about 8 hours in my case. The following Wednesday, only 5 days later, I did some light jogging (11 to 12 minutes/mile). Over the next few months, I gradually increased both the duration and pace. In November, I took my heart "on a test drive", running a 10K in 46 minutes and a couple weeks later a 5k in 22 minutes. Both races were full throttle and while the times were not great, they were respectable for a 54-year-old male. By far, the most important thing was that there were no high spikes in my heart rate.
Since then I've had my check for stenosis, and Dr. Lin thinks I'm cured. He told me to simply take myself off the low dose of Toprol and the Coumadin after 6 months, so I’m now off the drugs. On January 10, while still on the medication, I completed my 49th marathon in 3:44 with no problems, this less than 4.5 months after the procedure. A couple of weeks after stopping the medications, I finished my 50^th marathon at Catalina Island, up and down mountains, again with no problems! While every case is different and there are some minimal risks, the ablation procedure has certainly worked for me. If anyone would like more information you can email me at jallanach(at)att.net (the @ is written as "at" in order to prevent access by spam mailing lists). .
Jerry

In November of 2002 I had just turned 54 & was in great health as far as I knew. I had been running & cycling for 8 or 9 years, including 10 marathons. I cycled sometimes as much as 200 miles in a weekend. In general, I felt great. But there had been a few occasions in the previous couple of years when I had not felt so good. There had been a few times when I went out for an easy run but just had no energy. I chalked it up to over-training, took a day off, & forgot about it. There had also been a couple of occasions when I felt a bit light-headed at work. I went to the local med center where they found nothing. My heart rate was in the 80's which they said was normal, even though I told them my resting heart rate was usually in the low 50's.

Then, on the day before Thanksgiving, I had another light-headed episode which was somewhat more severe. I called my family doctor who told me to come to his office immediately. An EKG revealed that I was in A-Fib. I was sent to the hospital where I spontaneously converted to sinus rhythm before my admission was completed. I was sent home & scheduled for a thallium stress test in 2 weeks.

I knew nothing about A-Fib at this point, but tended to believe that it was probably a transitory thing that would not have any lasting effect on my life. I was just too healthy, I thought, to have any serious heart problems.

In 2 weeks I had the stress test & everything looked fine until after the test had been completed & the technicians were starting to remove the electrodes. At that point I went back into A-Fib & was sent back to the hospital. This time I was converted with Corvert. That was the beginning of a string of 12 hospitalizations over the next 4 months. I was converted with Corvert several more times & with an electronic defibrillator on 2 occasions. During this time I was prescribed a wide variety of antiarrhythmic drugs, none of which were effective. I was beginning to understand the truth about A-Fib: it can have a severe impact on one’s lifestyle.

I consulted with the local cardiac electrophysiologist who recommended flutter ablation (right atrium only) with continuous medication to moderate the fibrillation to flutter. This was not particularly appealing to me since I did not like the effects of the drugs I had been taking. I wanted to get back to my active lifestyle, & to me this meant getting off medications.

Meanwhile my wife & I had been searching the Internet to find as much about A-Fib as we could. A-Fib.com provided us with the most comprehensive source of information, especially about physicians who perform ablation procedures. As soon as I learned about catheter ablation, I believed that this was the treatment for me. My local cardiologist & electrophysiologist recommended against it, saying that the procedure was too experimental & that I was not an appropriate candidate.

By March of 2003 I was in persistent A-Fib, & no further attempts were made to convert me to sinus rhythm. I communicated with several of the physicians listed at A-Fib.com, & decided that Dr. Andrea Natale at the Cleveland Clinic was my first choice. I visited the Cleveland Clinic in March & was scheduled for an ablation in October. I went home & tried to wait patiently, still in A-Fib. But my quality of life had deteriorated enough to make me impatient to get the ablation done sooner. When I pleaded my case to the Cleveland Clinic, I was offered a July ablation date with Dr. Walid Saliba; I accepted.

It seemed like an eternity, but July finally arrived, & I went to Cleveland. Dr. Saliba performed the procedure assisted by Dr. Khajkin, a fellow. I was awake during much of the 6.5 hour procedure & aware that Dr. Natale, the department head, was called in for consultation more than once during the procedure. I did not know whether to be glad that he was available, or worried that he was needed. The procedure was not painful at all, but I would describe it as uncomfortable. I was extremely hot & drenched in sweat because of the lead blanket used to protect me from the X-ray which was used to guide the catheters. I could not feel the catheters at all except when the doctors called for RF energy to be applied. Then I could feel a slow warming in my chest which stopped before it actually felt hot.

After the procedure Dr. Saliba said that it had been a difficult procedure, but everything went fine. They performed circumferential ablation around all 4 pulmonary veins as well as focal point ablation at several other points.

I was allowed to get out of bed after about 6 hours of recuperation. I felt some tightness in my chest, & some minor discomfort at the sites of the catheter insertions. But I was elated to be back in sinus rhythm for the first time in over 4 months. I was released from the hospital the next day, & went home the following day. I was still feeling some tightness in my chest & shortness of breath, but I understood that this was to be expected immediately after the procedure. I had been told that I could expect to return to normal activities after 48 hours. I knew that running was not considered to be a “normal activity” so I did not expect to resume that for a while yet.

After 72 hours, however, I was still feeling pronounced shortness of breath with mild exertion, like climbing a flight of stairs. This frightened me, so I made an appointment to return to Cleveland to get checked out. They found no problems & suggested that I give it more time. Within 2 weeks I felt substantially improved, & in 3 weeks I was ready to return to light exercise. In retrospect, I believe that my procedure may have been somewhat more extensive than the norm, requiring proportionately greater time for recovery.

I started biking again about 3.5 weeks after the procedure. After biking one day I experienced a brief (1 hour) A-Fib episode, but this did not recur. I continued to take Rythmol for 60 days after the ablation. Just after the Rythmol was discontinued, I set out on a 10 mile run. After about 2.5 miles my heart rate jumped suddenly from about 120 to 160 (I was wearing a heart rate monitor). This lasted 15 or 20 seconds & returned to normal after walking a few paces. This sequence repeated itself 3 times within the space of about 5 minutes. After that I completed the 10 miles with no further problems. Since that time I have been in normal sinus rhythm with a full exercise schedule.

In October I returned to the Cleveland Clinic for one final visit, the primary purpose being a catscan to check for pulmonary vein stenosis. No problems were detected & I was unconditionally released. Dr. Saliba said that the success rate of A-Fib ablations has increased dramatically in the past 2 years. I suspect that this is true primarily at facilities like the Cleveland Clinic that perform a lot of the procedures. Dr. Saliba also reminded me that there are no studies yet on the long-term effects of A-Fib ablations, since the procedure is still quite new. We don’t really know what to expect after 10 years or more.

But I know that I’m glad to have my life back. I just completed a 100 mile bike ride this Saturday, & plan to run a half-marathon in January. Regardless of what the future brings, I am confident that I made the right choice in going for the ablation.

I would highly recommend Dr. Saliba & the Cleveland Clinic to anyone considering this procedure. And I would like to express sincere gratitude to Steve Ryan for the web site A-Fib.com. My wife & I relied heavily on this site as we searched for the best treatment for me. I know it represents a significant expenditure of time & effort, & it is greatly appreciated.

(Earl and Flo recently (April, 2006) wrote me that Earl is now running marathons!)

My husband, Earl Tyler, had a successful ablation (normal sinus rhythm, no medications) for atrial fibrillation in July of 2003. Afterward I emailed Steve Ryan, creator of this web site, to thank him for the invaluable information he supplies. He asked that my husband, Earl Tyler, and I share our stories which we are happy to do.

Earl and I were active 55 year olds in the fall of 2002. We generally biked over a hundred miles a week and would run between 20 - 30 miles a week. We loved our active lifestyle until Earl was diagnosed with atrial fibrillation in November of 2002. We immediately began researching on the internet and found this web site (A-Fib.com). The information and resources here guided our interaction with our local doctors. If we had relied on their advice and not done the research ourselves, my husband could have been relegated to a greatly diminished quality of life.

Earl was in the hospital 12 times between November 2002 and February 2003 with extensive testing, cardioversions and medicine changes which had to be supervised during hospital stays.

As this web site had warned, the electrophysiologist wanted to do a flutter ablation though Earl only presented with flutter when on medications. (This doctor only performed flutter ablations - not atrial fibrillation ablations.) Earl asked about the left atrium procedure. The doctor highly discouraged it saying the procedure was too risky, and Earl was not a good candidate. This information was not consistent with the considerable research we had done by this point, so we parted ways with this doctor and proceeded basically on our own to try to find the best treatment. Our local doctors did not seem to have accurate and current information on the details of the atrial fibrillation ablation methods and success rates.

Medications were ineffective for Earl, and finally the cardiologists refused to do another cardioversion at which time Earl was left in persistent atrial fibrillation. Earl was symptomatic when he was in A-Fib. His thinking was fuzzy. He could feel the palpitations, and his stamina was gone. He was sure he did not want to live in this state if treatment was possible. By this time (and again thanks to this web site [A-Fib.com]) we had contacted Dr. Marcus Wharton in South Carolina, electrophysiologists at Massachusetts General, Dr. Neal Kay at UAB, and Dr. Andrea Natale at Cleveland Clinic. Earl was evaluated by several of these doctors; and when the dust settled, we decided on Cleveland Clinic. Our original appointment for ablation was in October 2003 with the department head, Dr. Andrea Natale; but since Earl could not be kept in normal sinus rhythm, we opted for an earlier July appointment with Dr. Saliba at Cleveland Clinic.

On a personal note, all of this decision making was very difficult for us. We are non-medical people and had to undertake this most life changing decision about what treatment to choose and where to go basically without the help of our local physicians. We educated ourselves about each of the doctors and facilities as best we could and made trips to several of them for evaluations. Repeatedly we read that the procedure was “operator dependant,” so we wanted to get the best “operator” we could find.

My life changed dramatically. I had been used to Earl being physically strong and mentally very adept. We have a small business which he and I run. During the time he was in A-Fib, I felt I had to take over as much responsibility as I could - at work, in the medical solution search, physically, and emotionally. It was very, very hard as crisis periods tend to be.

So to make a long story short. He had the six and a half hour atrial fibrillation ablation done at Cleveland Clinic in July of 2003. This is November 2003, and he’s in normal sinus rhythm. He’s biking over 100 miles a week and running over 20 miles a week. He has his life back. We have our lives back, and we are very, very grateful.

We have great confidence in Dr. Saliba and in Cleveland Clinic. They have been specializing in this procedure for a number of years, and their success rates (normal rhythm, no medications) are getting quite good. That said, I must note that while we were so careful getting the right doctor because of the “operator dependant” issue, Earl ended up with a “fellow” doing his procedure under the supervision of Dr. Saliba. Though we should have anticipated this since Cleveland is a teaching hospital, we were surprised and somewhat frightened by it. Of course all’s well that ends well, and we are convinced now that Cleveland has very strict control over these ablations. Still, it is something one would do well to discuss with the doctor in advance to avoid surprises.

This excellent website (A-Fib.com) was invaluable to us when, of necessity, we had to take on the responsibility of finding the best treatment available. We are very fortunate that this treatment was available and successful, and we are especially fortunate that we were able to find it.

Thanks, Steve, for this website which provided us with so much help, and for your gracious responses to e-mails. Your work has made a great difference in our lives.

    From my reading of bulletin boards on the web and speaking with cardiologists, I was not always encouraged to go ahead with an ablation. Most people recommended waiting another two years. This was unacceptable to me. Even if it had a 50% chance of success, I was willing to get the procedure done. I thought that if the ablation failed, I could always get a MAZE operation.

    In this state of mind I flew to Paris, took the bullet train to Bordeaux, spent two days in a motel near the hospital. There I read the book "The Healer Within" by Roger Jahnke. This book was a real help during those lonely days full of uncertainty in the motel room.

    On March 24th I bravely walked down the road from the hotel to the hospital with my suitcase rolling behind. Shortly after being admitted, Dr. Haïssaguerre kindly came to meet me in my room. We exchanged a few words, but what I remember most is having to hide my deep admiration for him.
    Later that day the ablation procedure was performed by Dr. Jaïs. The procedure was not simple. It lasted four hours instead of the expected two and a half. One good thing was that he did not have to puncture the wall between the atria. (Editor's note: Doctors usually have to pass the catheter from the right atrium to the left through a membrane called the foramen ovale formed early in life as the heart develops. In early fetal development the left and right atria aren't completely separate. As the transseptal wall forms between the two atria, this foramen ovale opening usually closes up. But in Mirjana Clark's case, the foramen ovale membrane never closed up completely.)
    A second good thing was that the sources of A-Fib were close to the surface, so they were easy to ablate. The problem was there were many of them. I had to receive eleven electrical shocks, and I really felt the last ones. (Editor's note: According to Dr. Jaïs the electrical shocks were necessary to reestablish sinus rhythm in order to evaluate the ablations that were made and to complete them if necessary. Ms. Clark also had a source or focus of A-Fib that didn't come from the Pulmonary Vein openings where most A-Fib originates. Cardioversion was necessary to find this non venous focal point. "This was really a difficult case.")

    When I first felt that my heart had returned to normal rhythm, I was exhilarated. I did not know how to express my gratitude to Dr. Jaïs.
    But two days later I developed AV Tachycardia (right atrium) (Junctional Tachycardia, AVNRT) and had to have a second ablation. This was a tricky procedure because of the risk of damaging the AV node which would have required the implantation of a pacemaker. Dr. Haïssaguerre performed the procedure, which was quick and successful. He also verified that the sources of fibrillation had previously been successfully ablated.

    Then I left for Paris to celebrate my recovery. One week later, walking down the Seine river I had another attack of tachycardia and had to return to Pessac-Bordeaux. This time the problem was in the left atrium. Dr. Jaïs successfully performed this third ablation and also checked everywhere for possible sources of A-Fib, and found none. Apparently, both sources of tachycardia had been present for many years. I had not been aware of them, because tachycardia usually rapidly turns into A-Fib. (Editor's note: According to Dr. Jaïs Ms. Clark had a small reentrant circuit in the anterior left atrium, a relatively rare condition. He has seen only six cases of this.)

    During my seven days in the hospital, Dr. Jaïs visited me daily. During his visits he gave me his full attention, listening, explaining procedures, drawing sketches. He did not show the least urgency to leave, although the nurse told me in the procedure room that they were very busy performing three to four ablations a day. The last time I saw Dr. Jaïs that day, he was going to perform an ablation on a pregnant woman. I had full confidence in him and in Dr. Haïssaguerre. It was a pleasure and a privilege to meet them both.
    (Editor's note: The doctors at Bordeaux advise patients with Persistent and/or Chronic A-Fib to schedule a three to four week period in France if coming for treatment from overseas. Patients with Chronic A-Fib are more difficult to cure and usually require more than one ablation procedure. )

    It has been two months since I had the ablation, and I still do not know if I will stay permanently free of A-Fib. I am still not taking any medications. Regardless of the outcome, I know I made the right decision.
    Now I still experience occasional PACs (Premature Atrial Contractions, extra heart beats) which are sometimes uncomfortable, especially at night. I hope this will improve, as the heart fully heals. However, I much prefer having these than A-Fib.

    In conclusion I am pleased that I made the decision to have this procedure. If I had to, I would certainly do it again.
    Mirjana

Steve Ryan had his first A-Fib attack in the beginning of 1997. He was 56-years-old and was in apparent good health (5'10", 185 lbs). He trained for and ran 400 meter dashes and 5K's. He was married and resided in Los Angeles. He worked on the camera crew of the NBC soap opera "Days Of Our Lives" which involved frequent late nights and overtime. Cured of A-Fib in April, 1998, he has been symptom free to this date. The following is his story in his own words. He writes A-Fib.com and his wife, Patti, edits it.

The first time I had a noticeable attack of A-Fib was Sunday evening January 19, 1997. It felt like I had mice running around in my heart. My pulse would get weird and irregular, then start racing. Just days earlier I had undergone laser surgery on my face and was in a lot of pain. I can't think of anything else that might have triggered the A-Fib.
By the time I got to a hospital emergency room that Sunday evening, my pulse was nearly back to normal and I was sent home. My physician, Dr. Glenn Gorlitski, sent me to a specialist EKG Signal

t, Dr. Robert Levin with Cardi

Marathon Runner’s A-Fib Story---"This Heart Rate Monitor must be Defective. It's Reading 225-250 during my Workouts! I'm sending it back."