I hope everyone had a Happy Thanksgiving because I sure didn’t. Let’s just say I’ve had better Thanksgivings.
I had my first ablation back in March 2015. I was tremendously fortunate to get over 7 1/2 years of total AFIB freedom from that one ablation, but as the years passed by, I knew I was on borrowed time. Almost everyone with atrial fibrillation will need a minimum of two ablations to put it to bed for good so the question wasn’t if, but when, I’d need a second ablation.
Still, though, part of me was always hoping I’d be the one guy that would be “one and done,” or at least be the guy that got a solid 10+ years of AFIB freedom after just one ablation. I was hoping I could have the kind of luck that Steve Ryan of a-fib.com had. He had 21+ years of AFIB freedom after his initial ablation before he needed a second ablation (and eventual third ablation) to put it back to bed again.
The other hope I had was that whenever my atrial fibrillation returned, it would be “easy” to deal with. Prior to my ablation, AFIB was easy to manage because I was able to end my AFIB episodes by simply popping 300mg of flecainide. I had the system down pat. Here’s what I would do:
- Episode begins (so does the anger, frustration, and fear!)
- Confirm Atrial Fibrillation using my AliveCor heart monitor
- Once AFIB was confirmed, wait an hour to see if I would miraculously convert to normal sinus rhythm
- No miraculous conversion? Pop 300mg of flecainide
- Rest and wait up to six hours for my heart to convert to normal sinus rhythm
- Heart converts. Rest and be thankful it’s all over!
My biggest fear, my biggest nightmare, was what if my AFIB returned and I couldn’t manage it with flecainide? What if I got persistent AFIB? I could never deal with that.
Well, friends, I actually lived that nightmare for a few days.
Jump Ahead To:
Wednesday, November 23rd
My nightmare started at approximately 11:00 am on Wednesday, November 23rd – the day after I had my annual routine echo where I felt totally fine and assumed they wouldn’t find anything wrong with my echo (still waiting for the results). What are the odds, right?
My daughter and I were on our daily two-mile walk. We started this routine back when the COVID lockdowns started in March 2020.
We were walking along chatting as usual when my left foot slipped from underneath me due to the patches of ice on the walking path. You know how when your foot slips ever so slightly up in the air and then you instinctively slam it back down to prevent you from falling? The minute my foot slammed to the ground it triggered AFIB. I knew it immediately. It might have been almost eight years since I last experienced AFIB, but you never forget what it feels like!
My first instinct was to hold my breath to see if it would stop. I’ve written about these strange “mini AFIB runs” I had been experiencing the past year, so I thought that’s what was going on. I thought it would end as quickly as it started. No such luck. This was the real deal. AFIB was back and it was here to stay.
I didn’t want to freak my daughter out, so I just kept walking and talking like nothing happened. While I knew I was in AFIB, it wasn’t nearly as awful as I remembered it being. In the past when I got AFIB, I was worthless. I couldn’t do anything without feeling dizzy and lightheaded. All I could do was sit or lie down. In my wildest dreams I couldn’t imagine walking two miles during a full blown AFIB episode, but here I was walking and talking with ease. Something strange was going on.
The minute we got back home I started to dust off all my old “AFIB gear” which consisted of the AliveCor heart monitor, pulse oximeter, blood pressure monitor, Eliquis, and flecainide.
I always had these things handy back when I was having regular atrial fibrillation episodes prior to my ablation. It had been almost eight years since I needed any of this gear so it took a little time to find everything to get it all together and ready to go.
I took a couple ECG readings with my AliveCor monitor and sure enough I had AFIB with a heart rate of 143 BPM:
You’ll notice the ECG says, “unclassified.” When the AliveCor device doesn’t have 100% confidence that the reading is atrial fibrillation, it will return “unclassified.” I knew from my past experience with a heart rate that high and with the unclassified classification, this was atrial fibrillation.
To confirm my own diagnosis, I took advantage of AliveCor’s clinician review service. For $25 you can submit your ECG to a clinician through the AliveCor app. Within 24 hours you’ll get an official reading. My experience has been the review comes back within 8-10 hours. Just as I expected, the review came back confirming atrial fibrillation.
I waited an hour as per my old protocol (see above) hoping for a conversion to normal sinus rhythm. During that time, I tried everything under the sun to try to convert naturally. I employed every technique outlined in one of the first articles I wrote on this blog, “Emergency! How to stop an afib attack.”
I even tried a hot shower/cold shower technique. This is where you take a shower as hot as you can stand it for about a minute. Then you quickly crank the water to as cold as you can stand it for another minute. Then you crank it back to as hot as you can stand it for another minute. You do this routine for about five minutes. I had read once somewhere online that this trick works to end atrial fibrillation. It didn’t work for me, and it was the worst shower experience of my life! I was desperate and willing to try anything.
After I hopped out of the shower and got dressed, I came to the realization a natural conversion wasn’t in the cards. I popped 300mg of flecainide and 5mg of Eliquis. I also downed 1,000mg of ReMag. Then I went about my day.
Again, that’s what was so weird this time around. I was able to function, and it wasn’t really that bad. Don’t get me wrong, I could feel my heart pounding away and I definitely felt “weird,” but it wasn’t debilitating.
As I was secretly dealing with my AFIB crisis, the rest of my family was packing the car and getting ready for our trip to my brother’s house that afternoon. Our family always celebrates Thanksgiving with his family, which is about an hour away. We typically head up the night before Thanksgiving to spend a little extra time with them.
I didn’t want to say anything until the last minute just in case I converted to normal sinus rhythm. If I did, then I could tell them what happened, and we could still be on our way. Unfortunately, the conversion never happened. I remained in AFIB.
I gathered the family in the kitchen and broke the news to them. It went something like this:
“Guys, I have some bad news. I don’t think we can go today.”
“Why?” they asked in unison.
“I’m in AFIB.”
They all looked pretty shocked. I know I was! Trust me, this was the last thing I was expecting. How could this be happening, and right before Thanksgiving no less!
We had a quick discussion and we obviously decided not to go. I could tell they were disappointed. I was too. The whole ordeal was a real downer for everyone for a multitude of reasons. Why did this have to happen right before Thanksgiving? Why did it have to happen at all? Why couldn’t I squeeze just a few more years from that first ablation?
I took another ECG reading with my AliveCor and something interesting happened. I apparently wasn’t in atrial fibrillation anymore. I was in tachycardia with a heart rate of “only” 112 bpm.
What the heck is this tachycardia reading? Of all the years I’ve dealt with AFIB, I’ve never had a tachycardia ECG. It threw me for a loop.
I figured tachycardia was better than AFIB because at least I was in normal sinus rhythm. And I’ll take 112 bpm over the 140+ bpm I always experience with AFIB!
I stayed in tachycardia for the rest of the afternoon and evening.
At 7:20am I took another ECG with the AliveCor and it was still showing tachycardia. This time my rate was slightly higher at 118 bpm.
Once again, I took advantage of AliveCor’s clinician review service and paid another $25 to have this reading reviewed and officially classified. It actually came back as sinus tachycardia.
As you can see from the screenshot, sinus tachycardia is a normal heart rhythm with a heart rate greater than 100 beats per minute. I would later discover that I was not in sinus tachycardia. I was actually in atrial flutter! More on that in a future post.
I stayed in sinus tachycardia, or at least what I thought was sinus tachycardia, for the rest of the day and night.
Thursday, November 24th – Thanksgiving
At around 12:30 am I thought I would try to get some sleep, but before going to bed I took my second dose of Eliquis. I don’t know about you, but it’s impossible to sleep when your heart is pounding away at 120 beats per minute. I had to pop 1mg of lorazepam as well to put me to sleep. I managed to string together two three-hour periods of sleep.
I got out of bed and took an ECG reading with my AliveCor monitor. I was still in sinus tachycardia, but now my heart rate had climbed to 133 bpm:
We had a family discussion first thing in the morning to discuss our Thanksgiving plans. I told them I would be fine to be alone for the day so they should go to my brother’s house and celebrate with them. They had tons of food ready to go and all I was going to do anyway was sit around and rest and maybe try to sleep. After a lot of back and forth and debate, I ultimately won. They reluctantly left for my brother’s house but said they would be back immediately after they ate.
To be honest, I wanted to be alone. I hate being around anyone when I’m in AFIB, or when I’m dealing with any illness. And I also wanted them to enjoy Thanksgiving. There was no sense in having their holiday ruined over my stupid heart issue.
After my family left I tried to rest and sleep but it wasn’t happening. I was too restless.
I got off the couch and started to do a bunch of stuff around the house. I found that if I kept active, I felt pretty good (almost normal). I did laundry, took the trash out, swept and vacuumed the floors, hung a shelf in my office, and did the dishes. As long as I stayed active, I felt fine (as fine as you can feel with your heart pounding away anyway).
During all those activities I stopped to have my Thanksgiving “meal.” I’m not much of a cook and I wasn’t very hungry so my meal was this measly pulled pork sandwich. I thought it was kind of funny so I took a picture of it and texted it to my family as I knew they were enjoying a feast!
After all that activity I sat down and watched my favorite modern TV show, Blue Bloods. Shortly after, my family returned. I had to break the news to them that nothing had changed. My heart was still pounding away.
My wife kept asking, “shouldn’t you go to the hospital at this point?” No, I insisted. Not yet. I’m doing fine, and I’m confident I will eventually convert to normal sinus rhythm. She rolled her eyes but when it comes to my heart, she always defers to me and trusts what I’m doing since I’m knee deep in all this AFIB and heart stuff. She lets me call the shots.
Friday, November 25th
It was the second night now in a row that I was going to have to deal with my heart pounding away. This time I decided to take 10mg of Zolpidem in an attempt to knock me out for the night. It’s been years since I’ve taken zolidem but it worked like a charm. I fell asleep immediately and didn’t wake up until my alarm went off in the morning. It was glorious.
When I woke up Friday morning, I was pretty out of it. That zolpidem did a number on me. I was super groggy and foggy, but I didn’t care. I’d rather deal with that than a restless night of sleep fighting a heart pounding away at 130+ bpm.
I took an ECG with the AliveCor shortly after I got out of bed and I was still in what I thought was tachycardia, but now my heart rate had climbed to 138 bpm:
What the heck? Why haven’t I converted yet? What is this stupid sinus tachycardia? Why does my heart rate continue to climb every 24 hours? I was super frustrated. In fact, I pounded my chest a couple times in anger, hoping it would convert my stupid heart.
The first call I made Friday morning was to my local EP’s office to get some immediate answers and guidance on what I should do. Of course you can never reach a doctor when you need one. All I could do was leave a message with one of the doctor’s staff and wait to hear back.
This was all new to me. I never had to deal with 3 days of persistent AFIB/sinus tachycardia. I was living through my worst nightmare!
But that’s the thing. I was actually surviving the very nightmare I thought I would never be able to handle. God’s grace is amazing. He gives us the strength we couldn’t muster up on our own to get us through difficult times. Praise the Lord!
That’s one of the blessings that came out of this whole ordeal. My faith had been tested and I hadn’t been shaken. I knew the enemy was trying so hard to get me to turn against God, but I never would. I had total faith in God that He would see me through all of this. He would take care of me.
My next call was to Dr. Natale’s office to get the ball rolling on a second ablation. Same thing here. All I could do was leave a detailed message and wait to hear back.
In the meantime, I decided to keep active so once again my daughter and I went for our daily two-mile casual walk despite having a heart rate of 145 bpm. I used my wife’s Apple watch during the walk to keep an eye on my heart rate. I jokingly told my daughter that if I pass out, she’d have to drag me back home…lol.
Everything went fine during the walk. I felt pretty good and surprisingly my heart rate didn’t surpass 145 bpm during the entire walk.
When we got back, I sat around my office to do some things on the computer. Within an hour I could really feel my heart pounding out of my chest. Of the three days, this was definitely the worst. I felt pretty crummy.
In a moment of spontaneity, I decided I needed an Apple watch so I could monitor my heart while I was moving. I love the AliveCor but it’s unfortunate they don’t have a wearable monitor available. Given it was Black Friday, I knew I could probably get a good deal too. I twisted my daughter’s arm and had her drive me to Target so I could pick one up. In case you’re wondering, I got the Apple Watch Series 8 (midnight color) and I love it!
When we got home, I was still feeling like crap so I popped 300mg of flecainide in hopes it would work this time around. I went back to my office to do some work on my computer.
While I was working on my computer I had a lengthy conversation with my good friend, Shannon, from afibbers.org. Since I tried twice to convert with flecainide with no success, he recommended I get an electrical cardioversion (ECV) as soon as possible. That was something I was really hoping to avoid.
Nightmare #2 begins…
I HATE having cardioversions. Not because they’re painful or anything like that, but because the whole process is such a drag. You have to drive to the ER and then deal with the whole ER experience. And who likes to spend a good chunk of their day in the hospital just to have their heart zapped? It just sucks.
Having to rely on cardioversions to get out of AFIB was the thing I hated the most about having AFIB. I’ve had four cardioversions since my AFIB journey started back in 2006. Here is a look at my afib history, broken down by number of episodes and conversions required.
I told my wife that we’ll have to go to the hospital in the morning and have a cardioversion. She was pretty happy and relieved. If it had been up to her, she would have taken me to the hospital on Wednesday when all this started. She was more than happy to get up early with me and drive me to the ER.
With that settled, and the reality of cardioversion #5 sinking in, I started to research online to see what ER departments were best. We live in a large metro area so we have a lot to choose from, fortunately. What I was trying to figure out was which ER departments get the best ratings and which hospitals have the best cardiology departments.
I ultimately chose the hospital my local EP is affiliate with. It turns out his hospital is ranked #2 in the state of Minnesota and ranks nationally for its cardiology department. I also remembered my EP telling me years ago that their ER department are pros when it comes to handling cardioversions or any cardiac emergencies.
My decision was reinforced when I finally got a call back from my local EP’s office. If you recall, I had left them a message earlier in the day. It only took 9 hours to get a return call. I’m glad it wasn’t an emergency, or I would have been dead…lol.
To make matters worse, she had nothing to tell me. She said she put a message into the cardiology team but for some reason nobody got back to her. She felt really bad and wanted to at least call me back so I wasn’t left hanging heading into the weekend. Her only advice was to do what I had already planned on doing – go to the ER in the morning and have a cardioversion.
There is one good thing that came from her call, however. She confirmed my decision to go to their ER because as she said, “they do cardioversions all the time so you’ll be in good hands.” Those words alone made up for the long delay in getting back to me.
Unwisely, I spent the rest of the evening going down a rabbit hole online reading horror story after horror story of people’s experiences in the ER. I also read all the negative reviews of the ER department I was going to go to. By the way, I strongly recommend you don’t do that! It ended up being a waste of time, and did nothing but increase my stress and anxiety, which I didn’t need.
Finally, I ended my night by watching my favorite TV show, Gunsmoke. Yes, I admit I’m a total nerd, but I love watching old TV shows and Gunsmoke is my favorite. I end every night watching Matt Dillon! It always relaxes me and puts me in a good mood before I hit the sack.
Saturday, November 26th
I went to bed around 12:30 am but I tossed and turned until about 1:30 am. I was just dreading the whole ER experience. I was also nervous about the outcome of the cardioversion. What if it doesn’t work? What kind of awful drugs are they going to put me on moving forward? My mind was going to all sorts of dark places.
To shut my brain off and to get at least four hours of sleep before the big day, I got up and popped 1 mg of lorazepam. As always, it did the trick. Within thirty minutes I was totally calm and drifting off to sleep.
The alarm goes off at 6:20 am. I lay in bed for a few minutes before grabbing my AliveCor to make one final ECG reading. I knew the odds were slim, but I was really hoping it was going to show normal sinus rhythm. That wasn’t in the cards. I was still in tachycardia with a heart rate of 130.
My wife asked me, “What’s the status?”
I responded, “Status quo. We’re still heading to the ER for a cardioversion.”
Part 2 of this saga will be published soon.
Why Did I Wait So Long to Go to the ER?
If you’ve read this entire story, I suspect you’ll be wondering why I waited so long to go to the ER. You might be wondering why I didn’t listen to my wife and go to the ER on Wednesday when all this started.
There are a few reasons why I waited as long as I did.
For starters, the longest AFIB episode I ever had in my life was six hours. I figured this episode would be done within six hours. When the sixth hour came and went, it was already evening and I was doing o.k. It wasn’t debilitating and I was on a blood thinner so I knew I was protected from a potential stroke. I figured I could hang in there overnight and see how things would unfold.
Then on Thursday it was Thanksgiving. I really didn’t want to ruin my family’s Thanksgiving. Both my family and my brother’s family had spent a lot of money on food and spent a lot of time cooking and preparing it. Again, because this episode wasn’t debilitating and I was on a blood thinner, I thought I could hang in there some more. Certainly I’ll convert at some point during the day, I thought. Plus, there was no way on God’s green earth I was spending Thanksgiving in an ER!
I contemplated going to the ER on Friday but by the time I was thinking of going, it was already late evening. I didn’t want to go to the ER on a Friday night. The hospital is in the heart of a major urban city and isn’t in the safest area. I knew it would be really busy and I didn’t feel safe driving to the hospital on a Friday night.
I also had just eaten dinner. They don’t like to do cardioversions when you have a full stomach so I would have had to wait a few hours before we could have left for the hospital. Even if everything went perfectly in the ER, we wouldn’t be leaving the ER until well after midnight. I especially didn’t want to be driving through a dangerous part of the city after midnight on a weekend!
In hindsight, I would have gone to the ER on Friday morning, but as they say, hindsight is 20/20. When you’re in the heat of the moment, you don’t always think clearly, and you always have hope that the episode will end on its own. Dealing with persistent atrial flutter was new to me. I was in unchartered waters. Now that I know that any future episodes will likely be persistent, I won’t hesitate to head to the ER sooner. Live and learn, I guess.
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