After sitting on the fence for far too long, I’m getting the test done to treat my exercise-induced palpitations. The technical term for the test is cardiac electrophysiology study with the possibility of an ablation. Quite a mouthful, that probably doesn’t mean much to anyone (apart from the cardiac team).
The test requires the cardiologist to thread a catheter through my groin into my heart. Once there, he will use a drug to try to stimulate my heart to get the palpitations started. This part should be interesting since I’ll be sedated and I only get my palpitations at heart rates of 150 or more. How can I be relaxed and my heart beating rapidly at the same time?In a normal healthy heart, the heart beat begins by an electrical pulse in the right atrium (the sinoatrial node in the top chamber of the heart). The electrical pulse travels throughout the heart (like a tidal wave) causing it to contract and pump blood out. In between electrical pulses, the heart relaxes allowing more blood to fill it. And the cycle repeats itself.
While every heart cell can initiate an electrical pulse (just in case the sinoatrial node fails), the cells usually work together and everything runs smoothly. That isn’t the case with me. When I get these palpitations (called supraventricular tachycardia) it is due to some heart cells above the ventricle, most likely in the atria, which are causing the problems. It’s these problem heart cells (I like to call them rogue cells, as they’ve gone off on their own) the cardiologist is trying to identify.
If successful, the cardiologist will conduct an ablation in which the rogue heart cells are either frozen or burned, effectively killing them. Having done that, my palpitations shouldn’t happen again, I can stop taking my beta blocker medication and I am essentially cured. This is unusual in the world of heart disease where most conditions are never cured. Things such as bypass surgery or angioplasty, are band-aid treatments; never really addressing the actual disease process, just alleviating the symptoms. But ablation has a 95% success rate and my cardiologist is considered to be the best at this in the area.
That all sounds great, and it could possibly be, however it took me months to decide whether to go ahead with it or not.
First off there’s no guarantee this will work. While 95% is pretty good odds, this depends on whether the cardiologist can stimulate my heart enough to get the palpitations started. Since they happen at a high heart rate and I’ll be sedated, even he admitted it will be challenging.
It’s also possible that the rogue cells may not even be in the atria. My cardiologist spent a good amount of time explaining the possible scenarios to me and even drew the cool diagram above. This was helpful not only to me, but when I had to explain it to my wife as to what he said (although I’m sure I forgot to tell her everything; oh well). In it he indicates the rogue cells could also be in the pulmonary vein. If this is the case, he can’t do the ablation and I’ll need to undergo a more elaborate procedure to get it treated.
Now if you’re like some of my friends, you’re probably wondering what happens in the other 5% of cases. A large portion of the possible complications comes from the actual insertion of the catheter; where the entry site could become infected, so nothing to do with the heart. If something goes wrong with the heart, it could require a pacemaker. This occurs in about 1% of cases. I just hope I’m not in that 1%.
But probably the biggest concern of mine was the recovery period. The heart itself has no nerves so even when the cardiologist is burning (or freezing) the heart cells, I won’t feel anything. No, it’s the incision of putting the catheter in the body that’s the problem. This requires time to heal. With that, I will have to take a few days to a week of rest with limited or no physical exertion (meaning no exercise).
Because of needing to take time off from work, my exercise and life in general, I was wondering how I could fit the test in. Did I have the time to do it? Could I take time off work? What about my exercise?
As I’m used to being active every day, the thought of taking a few days off makes me anxious. What will I do? Will my fitness go down? Perhaps being a bit obsessive compulsive, I phoned the nurse to grill her whether I really needed a week of no activity. Appears at least a few days of rest are recommended. So with this in mind, I’ve planned my workouts just before the procedure to be quite hard so that I can take advantage of the recovery time.
Trying to lower my expectations of what I can do during the recovery, I’m also looking on the bright side, and catch up on some reading and maybe some Netflix shows. Plus I’ve arranged for my students to hand in their paper on the same day as my test so I can sit at home and mark them while I recover.
I’m sure this all sounds crazy. Here I have a potential cure available to me and these are the thoughts swirling in my head. It is crazy. But at the same time, I’ve learned I’m not alone in this type of thinking. We don’t think rationally at the best of times and when it’s about our health, it seems to get even worse.
I can recall a number of patients I’ve worked with who mentioned about delaying life-improving treatments because it didn’t fit into their schedule. Of course I told them they should go ahead with it as soon as possible, not really understanding where they were coming from. That is until now.
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