I apologize for being so quiet lately. I haven’t published anything personally since March when I celebrated four years of afib-freedom! The truth is, my heart (and overall health) couldn’t be any better so I haven’t had anything to report.
Although I will tell you I’ve been extremely busy responding to emails. I get about an email a day from people battling afib that want my advice or simply just want someone to talk to. Because I respond to every single email I receive, it takes up the bulk of my spare time these days so I haven’t had time to post much on this blog.
I had my annual checkup with my local EP on Wednesday, March 23rd so I thought I would take a break from my emails and post an update. Even though I haven’t had a minute of afib since my ablation back in March 2015, I still do an annual check up for a couple reasons.
One, I want the reassurance and peace of mind that my heart is indeed as healthy as I feel. Second, I want to stay “in the system,” which I’ll explain what I mean by that in a minute.
Getting Reassurance & Peace of Mind
I get the reassurance and peace of mind I need by “demanding” an echo every year during my annual checkups with my local EP. My echo results this year were perfectly normal. There weren’t any changes in my heart and I still have a very healthy 60% ejection fraction.
For those of you that might not be familiar with what ejection fraction is, it compares the amount of blood in the heart to the amount of blood pumped out during each contraction. The “fraction,” or percentage, helps describe how well the heart is pumping blood to the body.
Normal ejection fraction is anywhere from 50-70% so at 60% ejection fraction I’m right in the middle of normal.
While it was great to hear my heart was structurally sound, it was equally exciting that they didn’t record a single PVC or PAC when they did the ECG. Normally when I have these annual checkups, they see one or two benign PVCs or PACs. When I had my 2016 checkup they recorded reams of PVCs and PACs during my ECG. This time around it was nothing but solid normal sinus rhythm! This was the first annual checkup since my ablation where they didn’t detect a single PVC or PAC!
Here were my other pertinent vitals at this visit:
Blood Pressure: 108/76 (I have always had low blood pressure numbers so this is normal for me)
Weight:177 lbs. (I’m not happy about this because I’ve gained seven pounds since the beginning of the year)
Heart Rate: 49 bpm
Oxygen Saturation: 99%
As my EP told me, I’m as healthy as can be. It was a great appointment.
“Staying in the System”
You may be wondering why I continue to have annual checkups with my local EP when I haven’t had any afib or heart issues since 2015. As I mentioned previously, I do it for peace of mind, but I also do it to stay “in the system.”
I pray that I won’t have any heart issues for years to come but I always like to prepare for the worst. To that end, I think it’s important to stay in front of my doctor and touch bases with him once year. That way if something does come up, I can call him and hopefully he’ll remember who I am and can get me in quickly.
I believe, or I hope anyway, that I’ll get better care if my doctor knows who I am as opposed to being a patient he hasn’t seen or talked to in years. I essentially want to keep a direct pipeline to my doctor open for the foreseeable future “just in case.”
To that end, it kind of makes me nervous that I haven’t seen or talked to the doctor that did my ablation since 2015. I live in Minnesota and he practices down in Austin, TX so it’s not practical for me to have an annual visit with him especially since I’m doing so well. It would be a waste of time and money for both of us to meet. Still, though, I worry about not being able to get an ablation scheduled quickly in the event afib returns and I need a second one. I guess I’ll cross that bridge when I get there – IF I get there (I’m praying I never do).
Other Tid Bits of Information
I have a very comfortable and open relationship with my EP. I can talk to him about anything and he’ll sincerely listen and give me as much time as I need. Usually what I do during these checkups is ask him a variety of general questions as it pertains to atrial fibrillation and ablations.
One of the requests I ask for every year during these checkups is a prescription to flecainide and metoprolol. Again, I’m always preparing for the worst. I pray that I’ll never need these drugs, but I ask for them as insurance in case afib returns.
I couldn’t remember, however, what the protocol was for taking these drugs if afib returns so I asked him. He said I should take 300mg of flecainide at the onset of an episode and wait 30 minutes or so. If my heart rate is so high that it’s unbearable, then I could take 25mg of metoprolol to help slow down the rate. He said I should wait another 30 minutes or so and see how I feel. If I’m still miserable, then I can take another 25mg of metoprolol.
He said I could safely take up to 100mg of metoprolol if necessary, but he cautioned that if I convert to normal sinus rhythm fairly quickly, say in 6-10 hours, I would likely be very tired and lethargic because of all the metoprolol in my system.
The half-life of metoprolol is around 3-4 hours so if I took 100mg of metoprolol within a couple hours of an episode, I would still have at least 50mg of it in my system if I converted to normal sinus rhythm within 6-8 hours. I suspect I would indeed be very tired, if not knocked on my butt, with that much metoprolol in my system if my heart rate was back to my usual 50 beats per minute!
My game plan is to avoid the metoprolol all together but if the episode is too unbearable, then I’ll probably just stick to 25mg of metoprolol and see how it goes. Again, I hope I don’t have to put any of this to the test anytime soon!
WARNING: The protocol my doctor outlined for me is MY protocol. Don’t copy it without talking to your doctor about your own health situation. I can’t stress this enough as we are all in different situations. I only share the specific details of my protocol to give you some things to talk to your doctor about if you’re interested. This specific protocol is called the “pill in the pocket” protocol.
The other topic my doctor brought up was atrial flutter. This came up as we were discussing my game plan if afib returns. He told me if afib returns there is a chance it won’t be afib at all. He said I may actually experience atrial flutter.
Atrial flutter is very similar to atrial fibrillation with the main difference being the regularity of the irregular heartbeat. With atrial fibrillation, your heartbeat is often all over the place. It can fluctuate between an abnormally low heart rate to an abnormally high heart rate repeatedly. Think of a roller coaster of ups (very high heart rate) and downs (normal heart rate or abnormally low heart rate). That’s afib. Your heart rate is all over the place. Your heart rate can be at 60 bpm one minute and then 170 bpm the next minute.
Atrial flutter, on the other hand, doesn’t have those ups and downs. Instead, it’s a car with the cruise control set to 150+ mph. When you’re in atrial flutter your heart just takes off and doesn’t go up or down. The heart rate just stays elevated – usually around 150 – 170 bpm.
For more information on atrial flutter vs. atrial fibrillation, please read this article on MedicineNet.com.
Let me try to explain why people who have had successful ablations often experience atrial flutter rather than afib when they have an episode. This explanation is based solely on my memory of the conversation and I admittedly didn’t understand it completely so any doctors reading this will have to forgive me for any inaccuracies.
When you have an ablation, scars are left around the pulmonary veins and other trigger sources in the heart. These scars block the errant electrical signals from wreaking havoc on the heart. Over time, these scars change and even heal. This part I know is true and I fully understand.
He had a great analogy. He said if you have a scar from anything – be it a surgery, injury, burn, etc. – it changes over time. Sometimes, the scar will almost completely disappear. Scars on the heart from an ablation are no different. They change over time and sometimes heal.
As the scars change or heal, an errant signal may break through and wreak havoc, but because the break through is isolated to one spot, it results in atrial flutter and not afib. He described the errant signal as circling around the atria in a regular but faster than normal rate, thus atrial flutter. This part of his explanation and illustration (he was actually drawing this on a sheet of paper) was a bit fuzzy, but I think you get the general point.
The main takeaway was that if I experience an episode in the future, I may just as likely experience atrial flutter as I may experience atrial fibrillation. I can’t just assume it’s afib. It could be atrial flutter.
Again, I hope I never have to find out one way or another but it’s good to know. I never even considered experiencing atrial flutter until this conversation so it was enlightening.
That was the gist of my conversation with my EP. Like I said, there just wasn’t much to talk about this time around.
After Visit Summary
My appointment with my doctor this year was very brief given that I didn’t have any issues and I didn’t have a lot of questions. My appointment only lasted about 30 minutes.
My doctor congratulated me on my great heart health and told me to keep doing what I’m doing and that “we’ll do this again next year.” That’s my game plan – to keep doing what I’m doing, which is nothing special by the way, and I’ll see him again next year!