Cardioversion

Rewind....Last week Sam started to get atrial flutter again and this time it wouldn't go away. His heart rate was over 130 beats a minute and we went into the doctors office last Wednesday, July 18th. Usually an extra dose of medication would bring his heart rate back down but that hasn't been working. Sam had an EKG done and met with Dr. Wong's nurse - Carla (Dr. Wong was out of the office when we went in). She looked over everything, examined Sam and texted Dr. Wong with the details of what was going on with Sam. Dr. Wong believes the atrial flutter is coming from his left side of his heart since he had fixed the right side of the heart in May. Sam was advised to increase his motoporal - taking an extra does if needed and to come back for a cardioversion next week.

[Sam's rhythm and heart rate prior to cardioversion]

A cardioversion is when an abnormal heart rate is converted via electricity (being shocked). Doesn't sound very appealing and I did ask how many shocks one's heart could take in a day.... 12! Unreal right!? One pad is placed in the center of the chest and the other is placed in the center of your back. These are connected by cables to a machine which functions as a electrical defibrillator. A synchronizing function allows the cardioverter to deliver a reversion shock, by way of the pads, of a selected amount of electric current over a predefined number of milliseconds at the optimal moment in the cardiac cycle which corresponds to the R wave converting the heart back into a normal sinus rhythm.

Fast Forward to today... we arrived at Beaumont at 6:30am and checked in for Sam's cardioversion. I started to get flash backs when we entered the waiting room as it was the same waiting room I waited 11 hours in for his ablation back in May. They took him back for prep and I was finally called back at 7:45am to see him. Dr. Wong was running late so I sat their cracking jokes and filling him in on all the other people their and my people watching information from the waiting room. Dr. Wong came in around 8:15am to talk to us and explain what his goal was today and for the future.

They took Sam into the lab and did a TEE first to ensure there were no blood clots around his heart and then performed the cardrioversion (only once) and then he was back in recovery. I made Dr. Wong promise me it would in fact be this short of a procedure given his track record. I went back to the waiting room and after 15 minutes Dr. Wong was already back to see me.. I was shocked! He said he was back in a normal sinus rhythm and in recovery. Music to my ears. Now this is not to say this all happens again but I am remaining positive and calling in a favor to the big guy up stairs to give us a reprieve. We were discharged at 11am and headed home for Sam to nap all afternoon from the anesthesia.

We see Dr. Wong for a follow-up appointment on August 27th and are sticking to the 'original' plan of taking Sam off all of the arrthmya medications and monitoring his heart for a month on a heart monitor. However, Dr. Wong is being proactive and is already requested his 2nd ablation be done in October so that he can ensure the heart doesn't have any other arrthmyia triggers. He is confident

Stay tuned....the beat goes on.

Ablation Updates

Its been almost a month and half post ablation and I am sorry for the delayed update! This thing called life gets kinda crazy at times. Sam's first week home was spent taking it easy as he was very sore from the long procedure and was starting to feel the burning sensation in his chest from all of the ablations. What hurt him the most was his arms/shoulders - since in the operating room they have you flat on the table with your arms out straight the entire time. Dr. Wong had decreased Sam's arrhythmia medications prior to us leaving the hospital.

For a few weeks post ablation Sam didn't feel any arrhythmia issues like the atrial flutter or atrial fibrillation he felt before the procedure. Things didn't feel "normal" but that was due to the trauma his heart had been through and part of the healing process. However, a couple weeks ago Sam started to get atrial fibrillation again. Needless to say it was disappointing for him despite the fact we were told it may take several ablations to fully correct the issue. It was a speed bump in the healing process but luckily Sam was able to take an extra does of his medication and it stopped. Which is a VERY GOOD thing since before the procedure the medication wasn't working anymore and he was on the highest dose he could take.

The goal is for Sam to be on the decreased dose of the arrhythmia medications for 3 months and come in for a check-up at the end of August with Dr. Wong. At that time he will have an evaluation and some standard heart tests run. From there they are going to put him on a 30 day heart monitor (always enjoyable for Sam). They want to see how the heart is doing post-ablation but AFTER its had time to rest. If the monitor shows everything to be in good working order he will be able to stop taking all of the arrhythmia medications and the blood thinner. [Fingers crossed]

 

Sam's birthday is this Saturday so he is currently deeming it his 'Birthday Week'....we are going to enjoy our summer and we will keep you posted during the recovery process.

Day 1 - Post Ablation

Late last night and into this morning Sam and I were rehashing what Dr. Wong told us and going through all of Sam's aches and pains from being on the table for so long. The first thing to really bug him was his arms. His arms were extended and tied down during the procedure making them incredibly sore for him. I would periodically get up and try and massage them to keep them from cramping up. Sam had to lay flat all night in order for his groin to start to heal up before he was able to sit up or walk. 

Sam's nurse would come in every hour and check his catheter site for swelling, make sure a hematoma didn't start to form and checked his blood to see if his level had dropped below 190 in order for the tubes to be removed. He was able to get them removed at 3:45am. A few nurses came in to do this and after the tubes came out the charge nurse had to apply pressure on his groin for 30 minutes to ensure the 3 small holes would clot. However, since Sam was placed back on his blood thinner medication right after he woke up it wasn't that easy for the sites to clot. At 4:30am the nurse was able to alleviate her pressure (her fingers were numb) and place a sandbag on Sam's groin (sounds so great right?). The sand bag had to stay on for at least an hour and then he wasn't able to get up or move his bed until 8:30am.  Needless to say there wasn't much sleeping during all of this as they had to do constant vital checks and incision area checks. I finally fell asleep in my upright hospital chair in the most ridiculous position at about 6am - I think I was annoyed there was nothing going on with Facebook and had run out of things to do. Sam & I both got about an hour of sleep (it felt pretty amazing). 

Just before Sam was able to get out of bed I ran downstairs for some much needed Starbucks and got him some fruit and breakfast items from Papa Joe's. At 8:30am his nurse came in and he was FINALLY able to get out of bed and stretch - he was mad at the midnight nurse for not even letting him move just a pinch. Once he got to finally walk a bit he felt a lot of pressure off of his chest and started to feel a little better. BUT since he was flat on his back from 11:30am 5/31 to 8:30am 6/1 his right butt check was blessed with a sore from not being able to move. This currently hurts Sam more than his groin and made making him comfortable a real challenge.

We got home around 4pm and spent about an hour trying to find the right pillows and positions on the couch for Sam to be comfortable. He finally fell asleep after all of the adjusting and I was able to sneak in a few winks as well. We were told by the discharge nurse that tomorrow will be the peak of his pain - he will start to feel a burning sensation in his chest from the ablations and overall feel like he played in traffic. He isn't allowed to drive until Sunday and isn't allowed to lift anything over 10lbs for a few days. I on the other hand have been building muscle by assisting him up and down.

We have switched sides of the bed to make it easier for Sam to get in/out. His incision sites are occasionally leaking so I have been changing his bandages frequently. Its really difficult when he is on blood thinners and they want these small holes to clot but he has to keep moving... sigh. 

I am currently listening to him snoring so I am going to try and get some sleep before he needs help with something in the middle of the night. Good Night!!

Post Ablation Update

I am not even sure where to begin... I can start with neither of us anticipated what today turned out to be. We arrived at the hospital just after 9:30am and Sam went back for his surgery around 11:30am. It was supposed to be 4-6 hours but turned into 9+ hours of surgery. The staff was fabulous and came out and gave us updates every 1-1.5 hours. Dr. Wong himself even came out around 3pm after he had finished the right side of Sam's heart. Needless to say today has been longer than his open heart surgery was in November. It was just as stressful and I felt less prepared.

They went into the right side of his heart first to correct the atrial flutter that he was currently in. The Dr was successful in ablating part of the circuitry on the right side of his heart. He then continued the ablation until he formed an electrical block around the right side. They look for spaces within his heart (kinda like a where's waldo) and once they find them all they ablate, recheck and repeat.

Then things got tricky... what should have taken 30 seconds for the catheter to get from the right side of the heart over to the left side took 40 minutes!! Sam's heart is still very enlarged which made it difficult for them to go around his atrium along with his veins being very small. (common due to his surgery still being fresh and from the arrhythmia issues he has been having). Dr. Wong tried to use x-rays and other devices to see inside to assist in guiding his instruments however, they didn't give him the clear images he was hoping for. They did however see that his heart is contorted - this could be from being so enlarged or from the trauma of his open heart surgery in November. As Dr. Wong described it to us "I was lost with no map and had a foggy window".... scary to think about when you are talking to someone that was dealing with your husbands heart! Basically when guiding the catheter from the right to the left side he was completely blind and hoping for the best. If he went too far one way he would have made a hole in his heart, if he went too far the other way he would have gone into his aorta and thankfully he went just the right way and got through to the left side. 

Now that they finally made it to the left side....They checked his veins to see if they were the "triggers" for his atrial fibrillation and they all checked out normal. They did however find multiple "hot spots" on the back of his left atrium. Whenever they went over these areas his heart went "CRAZY". Dr. Wong was able to ablate all of the hot spots and also build fences around his veins in hopes he created blockages around them for the future. 

Both atrial flutter and atrial fibrillation can cause your heart to enlarge or stay enlarged until those rhythm issues are fixed. Dr. Wong said 1/3 of heart valve surgery patients have to undergo ablation surgeries. We are hoping in Sam's case over the next three months his heart will finally start to shrink in size and fix its contortion.

After we finally got to speak to Dr. Wong - Bonnie, David (a close family friend) and I headed down for some much needed food making phone calls/texts along the way. We were told Sam wouldn't be awake for at least an hour or so however, my cell phone rang in the elevator on the way up to his room and his little groggy voice was calling me from his room to see if we left him - I don't know if he will remember this later. 

Sam is in pain and still laying flat - we are hoping his catheter tubes can come out of his groin in the next few hours. I am hunkering down for a long night at the hospital in another uncomfortable hospital chair. 

Happiness is hanging out together ... even if its in the hospital on our anniversary :)

(I got the below figurine for Sam and gave it to him in his room after his surgery)

We appreciate everyone's thoughts and prayers - they mean so much to us. I will keep you all updated tomorrow!

Morning Update

This morning we were called and told that we could arrive at the hospital early as the first ablation was postponed. We arrived to Beaumont around 9:45am and they whisked him away the minute we got upstairs. They had to do procedure prep which included some shaving of his fur (i mean chest). His parents (Bonnie & Fred) and I are here today and were able to go back and see him prior to him being taken back.

He was hooked up to all of the monitors and was experiencing atrial flutter and a very high heart rate. Which I think is good in the sense that they can already see the issues he has been experiencing before they go in.

Dr. Wong came in to talk to us before the procedure and explained everything very nicely for Sam's parents and I. Dr. Wong showed us the heart monitor and how the lines were showing his atrial flutter which is like a dog chasing his tail (all I could think about was Baxter and how he LOVES to chase his tail daily).  Atrial fibrillation feeds into atrial flutter - so with that said they are going to do his procedure in a few parts. First they are going to go in and correct the atrial flutter. This will correct the fast heart rate and most of his day-to-day symptoms. The success rate of correcting this today is 95%. However, correcting his atrial fibrillation success rate is only 50-60% the first time. More than likely a second ablation is needed to fully correct the fibrillation. Commonly the second ablation will show flutter in the left upper chamber instead of the right (where his current issues are isolated to) and the success rate jumps up to 80-90%.

After the atrial flutter is corrected and they are working on the atrial fibrillation they can tell if they are correcting it by looking for extra signals through the catheter. These signals can't be seen on an EKG and are easy for the doctors to see through normal signals.

They ordered a TEE test prior to the procedure to ensure there were no blood clots around his heart since he has been off of the pradaxa since Tuesday. The doctors assistant (Scott) came in and told us that the TEE was clear and they were starting the ablation process. It will take between 4-6 hours and he will come back and give us updates throughout. Stay tuned...

Procedure Details

Sam received a call from Beaumont today with all the details for tomorrow's procedure. We need to report to the hospital at 10:30am (much better than the original 6:30am they had him down for). His procedure is slated to last between 4-6 hours and afterwards he will need to lay on his back for up to 8 hours. This is very similar to the catheterization he had done in 2009 at UofM. Unlike the catheterization they will go through a vein in his leg which should be less invasive  - the catheterization went through his groin which took longer to heal and caused some complications.

Sam also received a Beaumont video link with a very informational video for tomorrow - almost too much information! I can't share that one as its through their patient system but I did find one that was shorter and similar that outlines some of the key details.

As you can imagine tomorrow will be a very long day and with that I am off to bed...I will post updates to the blog throughout the day tomorrow.

We appreciate all of your thoughts and prayers!!

Ablation Update

Its been 6 months post-op and we are right around the corner from Sam's heart ablation. For the past few months Sam has been on a few different medications trying to keep his heart rhythm normal. With the right medication combination he has been doing pretty well but recently the medications have started to become less effective causing arrhythmia issues again. In order for this to be corrected and for Sam to get off all of the medications he has to have a cardiac ablation done. Sometimes this procedure corrects the arrhythmia issues the first time and sometimes additional ablations are needed to correct it for good.

A couple months ago Sam met with Dr. Wong and discussed his options for all of his arrhythmia issues [see 4 month post] and set-up his ablation date. Before the ablation can be done he had to have a coronary CT scan and bloodwork done. Last Thursday morning Sam & I went to Beaumont for him to have the Coronary CT Scan to ensure his veins would be good in order to do his ablation this week. Out of all the tests and everything he has been through this was by far one of the easier ones. They took some blood work and after waiting 30 minutes he was ready for his 10 minute test. We even got to watch Ellen like old times while we waited in the prep area for his test.

This Thursday, May 31st (this day may ring a bell for some of you as its our 4 year wedding anniversary) we will be at Royal Oak Beaumont for his heart ablation. The hospital will call us Wednesday with the time of his procedure. Since Sam is only 6 months post-op he will have to stay the night in the hospital to be monitored for any complications. As you can imagine its not our ideal date for our anniversary but I have a feeling this was in our vows somewhere in the "for better or worse and in sickness and in health" part. So we will make the most out of our slumber party at Beaumont!

The past few months have felt like a ride at the fair with doctors appointments, tests, medications etc...hopefully all of this will be behind us soon.

More updates will come throughout the week...stay tuned!