A Fib Returns after Ablation

Today, I woke up with a headache. Not a migraine, just an all-over-eye-strain-didn’t-sleep-right headache. With the headache came a bit of nausea. Then my nausea got a bit worse. Then I started to get worried. Last time I had this headache/nausea upon waking it didn’t end well. That morning, back in 2013, ended with vomiting & my second ER visit for A Fib (atrial fibrillation). This morning was eerily similar.

Atrial Fibrillation (A Fib) and I go way back. This all started, probably, in 2008 but wasn’t official until 2012 when I first walked into the ER with “palpitations”. That was an interesting day. I wrote about that and my first nine years of dealing with A Fib in this post back in 2017.

Then, in 2017, I decided to go ahead and have a cardiac ablation. It took me months to finally go through with the procedure. It is a fairly common procedure, usually for people over 60. Having a 41-year-old gal roll on a cart to have this procedure done is somewhat odd. But I felt it needed to be done as the episodes I experienced, while all not ER worthy, were still bothersome for me. The recovery was kind of rocky, and just this past year I finally felt I was gaining some ground on my endurance exercising again with my new year’s resolution/gym membership combo. It had been well over a year and no hint of an arrhythmia had worried me.

Who is at risk for A Fib?

As a Nurse Practitioner, the patients I care for are usually over the age of 65, so I come across many with current or a history of A Fib. When they find out I also have experienced A Fib, they are usually shocked. “You’re too young” is usually the response I get.

I am still a little shocked that I have been dealing with this for as long as I have. I am the opposite of most of the risk factors for A Fib (UptoDate, 2019):

  • Almost 70% of those with A Fib are over the age of 65 (my first episode was in 2008, age 33)
  • A Fib occurs more in men than women (I am the latter)
  • Underlying heart disease (I have no structural defects and always have had low blood pressure)
  • Obesity, diabetes, kidney disease, and family history of A Fib can all increase the risk of A Fib (I also have none of these)
  • The only risk factors I do have are being white & living in North America; these individuals tend to be at higher risk.

Knowing all this made this morning at 6:15 am even more frustrating. After trying to will away the urge to throw up, it happened anyway. Within moments I knew I was back in A Fib. I tried to ignore it for a few minutes, but knew it wasn’t going to go away. Then I was angry. There may have been obscenities murmured. The difference this time is I was alone (my kids were sleeping as it is spring break), my husband was on duty & wouldn’t be home for a few hours and my heart rate was only about 115 beats per minute. Back in 2013, I couldn’t even count it and was short of breath and dizzy. This time, I could at least finish getting dressed as I cursed to myself.

Then I did exactly what you SHOULD NOT DO. Seriously, not my finest moments. First – I drove myself to the hospital. Second – I didn’t tell anyone I was driving myself to the hospital. Probably two of the dumbest things you could do. Thankfully, I live about three minutes (depending on the stoplight timing) from the hospital & arrived safely. By the time I walked in I knew my heart rate was faster. I couldn’t talk in full sentences. I was lightheaded, exhausted and couldn’t keep my focus. Thankfully the staff at the ER desk took me seriously when I told them what was wrong & took me straight back to a room.

Once I was in the room I realized I had no cell service. Oops. I started to panic a bit, no one knew I was in the ER and really was not doing well. I couldn’t focus on answering the questions and was starting to be a bit more short of breath when speaking. I finally connected to wifi so I was able to text my husband, who in turn notified my parents. I was also able to text my co-workers because I was due in to work in about 30 minutes. I usually text in full sentences, use proper grammar & punctuation. All I could muster was:

I threw up. I’m in a fib. I drove myself in the ER

During this pathetic attempt at communicating with family, the ER staff got to work. EKG. IV inserted. Labs drawn. Fluids started. Chest X-ray. After the ER doc examined me, I got a dose of Toradol for the headache that started this all. Within the hour I was feeling much better, but still in A Fib. The ER doc and my cardiologist touched base and after a small cup of magical pills, the wait began. If my heart rhythm didn’t change within a few hours, I would be admitted.

With my last two ER visits, one earned an admission and the other I converted back to normal sinus rhythm and was discharged. I was hopeful that the medication I was given would convert me & I could go home.

So we waited. Every few minutes I would get my hopes up thinking the A Fib had stopped but alas I would feel it and know it was still going on. Finally, after a few hours, I had to go to the bathroom. World’s smallest bladder and a liter of IV fluids will do that for you. Once I returned, I hooked myself back up to the O2 and heart montior and was pleasantly surprised.

Thankfully after this, it wasn’t long till I was on my way home. Overall it took about four hours from start to finish in the ER. I would consider the whole experience very lucky.

Wait, didn’t you have this fixed???

I have some pretty amazing, supporting friends who wished me well after finding out I was back in the ER with A Fib. But most people were thinking the same thing I was, “Didn’t you have this fixed???”

Yes and no. I did have the ablation in 2017 and overall things were normal. I felt better. I was, unfortunately, very deconditioned from the whole experience and then stopped exercising. Immediately after the procedure, my heart rate soared to the 110-120s resting heart rate. That’s way too high. I went on a beta blocker, metoprolol, to help pull the heart rate down. It worked, usually with my rate resting in the 80’s. Small problem was I do not like to take medicine. At some point in 2018 I stopped taking it, had started exercising more and hoped the heart rate would trend down again. Usually, if I checked, it was hovering in the 90s. Not bad, still not good for me.

In early 2019 I realized that I was hovering around 100-105 heart rate. I had reached out to my cardiologist and thought I would try a medication that was only once daily (metoprolol was twice daily). While I had started that and it seemed to help, the heart rate was still in the 90s. Then the latest episode occurred

When you research the effectiveness of cardiac ablation, one would consider my initial procedure a success. I stayed out of A Fib for over 18 months. Since I had been having episodes regularly, this was a good thing. Most the research does mention that some people do have to have two procedures completed before a success rate of 90%. Since I am starting to have more questions then answer, I think the next steps are to seek answers from those who deal with this more than I do.

This week I plan for a second consultation with an Electrophysiologist to really see what my options are. Since the oral medication helped convert the rhythm in the hospital, I have a new medication to carry around with me just in case it happens again.

There still is no clear cut reason on why this is even happening to me, so it is hard to change outside factors to lessen the chance of it occurring again. Until then I plan to focus on exercising more to strengthen this ticker, ear right, stay hydrated – because that I have control over.

*Disclaimer: This blog does not provide medical advice. Be advised information provided is opinion & should not be taken as medical advice. There is no substitute for the face to face relationship between a medical provider and patient. See your physician, osteopath, nurse practitioner, or other qualified and licensed health care provider regarding any questions you have about your personal health or medical condition.

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