“I’m in AF” I exclaimed to no one in particular. Atrial Fibrillation For the second time in 12 months. I stood up, confused, and then sat down again, gasping for air. My heart had gone completely haywire, beating super fast for a few beats as if I was sprinting, then stopping for a couple of seconds entirely, then a few weak beats like a dying butterfly flapping its wings feebly, and then super fast again. Because the beats were not terribly effective, the blood flow to my body – and brain – was insufficient to carry enough oxygen to my brain to work anything much at all. Without jet lag or a virus to put it down to the feeling was extremely disconcerting.
After a few minutes of sitting I was able to think with a little more clarity, although feeling my pulse I knew that I was still in AF. This being the second time I had experienced AF, I emailed my cardiologist per her request. I had last seen her for my 6 monthly check up the previous Friday, and she had stated that she wanted me to avoid hospitalization if / when I went back into AF. She had not expected it this quickly, and I sensed a little skepticism of my ability to self diagnose when she said to hold off on the pills for a little while.
The pills in question were beta blockers, anti coagulents and rhythm stabilizers, and I had been carrying these around with me for the best part of a year just in case I went into AF. As I had self diagnosed the first time around I was happy to not have to take pills on a daily basis, as I didn’t feel great when on them – it felt like wearing boots of porridge the whole time.
In constant contact with my cardio, after an hour we tried the pills but they didn’t work and I was told to head to the hospital to be checked out (perhaps that skepticism was still around). Whilst being given a positive AF diagnosis, I was ushered out of the treatment room in Urgences and left on a stretcher in the corridor. Five minutes later five heavy set and heavily armed Monaco police brought in a young chap in handcuffs with a bleeding headwound, and marched him right past my stretcher.
Pleased to be sent home, but disappointed with the positive diagnosis, I tried to sleep that night. AF is a very strange thing – I could feel completely normal one minute, when the heart puts together a nice run of efficient heart beats. And then I could – and did - collapse as the heart stammered and stuttered and blood didn’t make it to my head in sufficient quantity. During the night, because the heart would be pumping super fast – perhaps as fast as 200bpm, followed perhaps by a massive spasm, the whole bed would shake with the force of it, so sleeping became a real issue. Back to the hospital the next day for some uber strength pills, and back home to monitor my pulse which slowed down to 26bpm, but still in AF.
Eventually the cardiologists through in the towel and I was cardio verted again on the Friday – a bit like a mild defibrillator under general anaesthetic, but they still leave quite a burn.
Caffeine – I had given that up when I was last in AF, and had not touched any caffeine of any form since
Booze – definitely a trigger but went through my habits with a fine tooth comb including Gran Prix related consumption and was told that should not be an issue
Stress – lots of stress lately including losing Jack, end of term shenanigans, client visits, long hours at work, and finally my book release (did I mention that I’d written a book?)
Fatigue – see “Stress”
For the avoidance of doubt, sport is not a trigger and actually there is an increasing body of evidence to suggest that endurance sport can help treat AF. I had always used sport as a de-stressing mechanism, and I had not run since the Jerusalem marathon (mid March, and actually had done no running for a month before that either) due to my ongoing knee issue. I had, however, rediscovered cycling and had been doing quite a bit of that, but nothing like the training that I was used to. Perhaps that could have been the issue? Lack of training on one hand and increasing stress on the other. A double whammy AF trigger?
Regardless, I was very keen to try and knock this on the head. Living with a constant sword of Damacles over my head was no fun. We – the Cardiologists and I, decided to go ahead with an ablation at the earliest available opportunity.
This is a nice spot to interject some biology (I hope I get this right). The heart beats are controlled by the right Atrium, which send electrical signals to the Ventricles which then contract in sequence and send the blood around the body, picking up oxygen from the lungs as it goes. When the heart goes into Atrial Fibrillation, the left Atrium in the heart tries to take control as the electrical wires at the base of the pulmonary veins start to misfire. Because the Ventricules are getting competing signals, they don’t work effectively at all. As I have said before, AF in itself is not dangerous, to the extent that I am not swimming in the sea on my own or free climbing up a mountain with no ropes! The danger is that when the heart is not beating efficiently blood starts to coagulate in the heart, and then when the heart starts up again normally these clots go to the brain causing strokes. A large percentage of strokes are caused by undiagnosed AF (and in fact my Aunt suffered from one before Christmas in 2015). However, the vast majority of people with AF find that it cures itself without or with medication. A lie down for a few minutes and / or some beta blockers and the heart restarts itself. My two bouts of AF were “persistent”, and whilst some people can live in mild AF permanently, mine was neither mild nor particularly conducive to working, parenting, and living.
Back to the ablation: an ablation is where the Dr cuts a small incision in the groin and sticks a tube up to the heart through the vein into the right Atrium. A small incision is made in the cardiac wall, the tube passes to the left Atrium, and the electrical nodes at the base of the pulmonary veins are zapped, thus rendering them unable to misfire and to try and control the Ventricules.
With me so far? Ablations are more successful in the young, the fit, and those very early on in their AF “career”. This is because as one experiences more and more AFs, other electrical nodes “catch” the habit of misfiring and thus triggering AF. I think. As it stood, the Dr suggested I had an 80-90% chance of curing my AF with a mild ablation, and we won’t talk about the 1.5% chance of stroke, open heart surgery or worse during the op. I was advised that being fit took the former percentage higher, and the latter percentage lower. I took that advice to heart.
I am therefore booked in for the op the week beginning the 8th August. The wait at first seemed unbearable, but got easier (although no boozing has been very tiresome, particularly in Jamaica). I have been on the darned pills the whole time, but have found that as time went on I got more used to them. My knee recovered enough to start running, and I even completed a mountain trail run – the last 37km of the Cro Trail, and managed to finish bang on the 50th percentile despite a massive lack of training and with the disadvantage of the slowing medication. I had even entered a bike race but was unable to get the medical sign off due to the risk of severe damage if I crashed whilst on anti coagulants. I have been able to maintain the cycling for fun, though, partly to continue the knee rehab and partly for fun.
I will be in and out of medical facilities and hospital next week for lots of tests, CT scan and so on, and then hospitalized for the better part of the week of the 8th August. The week after that is recovery at home, partly for the heart and partly for the groin, and all being well I can ease into sport and normal life the following week. That bit can’t come soon enough!