Ablation #2

On July 1, 2013 I had an ablation for paroxysmal atrial fibrillation. I wrote about it, here. On November 25, 2013 I had ablation #2. Here's an update:

The first time I had this procedure, called an ablation, the doctor, an electrophysiologist, used balloons filled with liquid nitrogen to burn rings in the entryways of the four pulmonary veins, or he tried to. He had to skip one vein, because an important nerve - the phrenic nerve that controls my diaphragm, AKA breathing - was nearby. He told me the next morning, on July 2nd, that there was a good chance he'd have to do a do-over. The morning after the first ablation they almost had to put me under to do a cardioversion on me, the thing with the paddles, because my heart was going crazy. I felt like crap! He told me to start taking the heart-control drugs that I wanted to avoid in the first place, as well as blood thinners for six months. I could tell that he knew the first one hadn't worked, and was preparing me for the second ablation, the day after the first ablation. 

Since that July 1 procedure, the afib was worse, even with the heart-control drugs. He had to bump up the dosage on one of the heart-control drugs until the afib calmed down, but the flip side is that the heart-control drugs made me super slow. Training was out of the question, all I could do was casual riding. I felt tired a lot, and more lethargic than I used to be. Monday's (11/25/13) ablation apparently went much better. He said that he moved a catheter into one of the veins he'd already ablated in July, and I immediately went into afib, in other words the first ablation hadn't worked. This time he used a tiny radio-frequency tip that burned with heat, and he carefully drew lines around the places from where the 'bad' electrical signal was coming. 

After this second ablation my heart was in sinus rhythm. That is, it was beating normally. That was markedly different from last time, in a good way! The doctor told me he'd gotten it this time. He said I could stop the heart-control drugs immediately, and I only had to take the blood thinner for one more month. He explained that there's one place in a heart that should be sending the electrical pulse that tells the heart to beat. Special muscle cells do that job, and the rest of the muscle cells act like an electrical wire, distributing the pulse. For some reason, on some people, some cells near the four pulmonary veins start trying to send their own signal. He drew me a picture, and explained how the fetal heart develops from just a wide spot in a pipe, to a wide spot with a membrane dividing it, to a heart, and that the theory is that some people's hearts keep a remnant of the pulse-creating cells on the wrong side of the heart. Why it takes until middle-age, and why it's so much more prevalent in endurance athletes - and especially cyclists - that these wayward pulse-creating cells start messing with the heart beat isn't understood. 

He cautioned me that this ablation might last five years, and that I might have to do it again. He said that this is a brute-force method, burning cells like a fire line around the spots where the 'bad' signals originate. He said that ideally they'll figure out how and why the errant pulse-creating cells form and operate, and turn off their signal. Maybe if I'm lucky they figure it out before my afib returns. 

I'll update this blog with my progress. It's now two days after the procedure and I'm on the mend. I can ride in a week. I'm taking it easy now. The entry point for the catheters was two holes in my groin, so I am walking slowly and my heart is kind of angry / sore, so I'm not doing much at first.