Recovery from Ablation #4 - and some major drama!

 

Recovery from Ablation number four

16 October 2024 – And so I’d had the famous Pulsed-Field Ablation – promising faster recovery! Plus this time I went into this pretty fit – I had trained hard as I could all year – got super fit in the spring, then missed two months with whooping cough, hiking in the summer, three weeks off for my nose op and then trained like a loon for three weeks!

The ablation was as described in my previous post.  The first week was as usual – felt drowsier and more lethargic than I had recalled.  I had all wild plans to STUDY! REVISE GERMAN! AND FRENCH! AND ITALIAN! FINISH MY ON-LINE ADVANCED SPORTS MASSAGE COURSE! UPDATE MY BLOG! DO SOME WRITING! PLAY THE PIANO! In the event I managed a bit of reading, knitted some teddy bears and a bit of a jigsaw puzzle.   No energy to do more.

Slept badly like I always do after an ablation – my shins were just killing me – I’m not sure if this is some sort of referred sciatic pain due to too much sitting.  I really do think my body could not cope with the transition from loads of exercise to doing nothing!

 Because I am a saddo who likes making lists I had previously made myself a list of how long it took me to recovery after each ablation – how long to do my first walk, first electric bike ride, first stretching that sort of thing.  The first ablation had the quickest recovery (shortest surgery time 1.5 hours).  The second was the longest (longest surgery time 6 hours?), #3 was 4 hours and this one about 3.5 hours.  BUT this time they sizzled my Right atrium as well as my Left so I was thinking that I would feel worse because there was double the damage.  BUT then that the recovery time would be the same overall.  I used the theory that if a cut takes a week to get better, two cuts at the same time still only takes a week. 

 It seemed an age before I even had the motivation to study or do any of my self-appointed anti-boredom tasks.  As mentioned, the jigsaw was my go-to for the first two weeks (who knew they were so addictive!)  But other than that, the recovery has been spot on with the others (and I was so hoping it would be quicker, so that’s a shame, but we shall see overall). 

 First walk after five days (three minutes!), felt dreadfully wobbly and weak and lacking zip.

First stretching after five days but very gently due to bruising (ahh the bruising, I’ll come back to that)

First electric bike ride (full power so I was barely doing anything) after 20 days.

 But I got my first episodes of tachycardia (fast Heart rate) after a week – it sped up from 60-80 at rest to 80-100 and then had several hours of bobbing around at 120-150.  It did the same a few days later.  So uncomfortable – breathless and whole body shaking.  Same thing on day 14, 18 and 20, between 30 minutes and five hours of tachycardia.  I checked with the Papworth arrhythmia nurses (fabulous people) and they said it was good news that it was self-correcting; to sit it out unless I felt too ill and not to panic as I was still in the blanking period when this sort of thing can happen and it definitely didn’t mean the ablation had failed..

 Day 21 – As I was studying (see! I did get started eventually!) I realised I was losing my ability to read.  A blob appeared right in the centre of my vision.  I thought it was my grubby glasses and then maybe a floater on my eye.  I considered a detached retina (no, that comes down like a dark curtain) and then twigged it was a post-ablation kaleidoscope migraine (long post on this after ablation #2).  Only lasted ten minutes or so, luckily.

 Day 22 and 23.  Felt good.  Didn’t go mad.  Used the e-bike as mentioned above.  Next day an 8-minute walk plus some stretching and gentle yoga.  Deliberately ignored how good I felt so as not to overdo it.  Told a friend I was feeling “cautiously optimistic” but that I fully expected to get a “slap in the face” before long.

 Which I duly did – next two days felt dreadful.  So weary and tired.  Could barely get up the stairs.  Slept in the afternoon for ages (usually just a 15-20 min nap). Then day 25, just as I was thinking about going to bed at 11 pm, my heart rate shot up to 100.

 It stayed like it all night and 11.5 hours later is still banging along at between 100-135.  Still sitting it out as instructed by by Arrhythmia Nurses but worrying I’m damaging my heart.  Trying to do diaphragmatic breathing; the bearing down technique (though I have to be careful of triggering a nose bleed) and drinking lots…  Should I go to hospital?  I don’t want to be poked full of beta-blocker which even at a mini-dose make me feel like a zombie.  Why can’t it just go back to normal…..?

 

Quick aside - A word about the bruising – a LOT!  I was black across the whole front of my pelvic area and very tender, but I think that was due to the fact I could not stop coughing after the ablation.  There was a huge lump a few days after the ablation, like a sausage shape so I followed the advice in my discharge letter and saw my GP.  He poked and prodded and decided it was a big haematoma (bruise to you and me).  Took nearly four weeks to go completely!

 Written 10 days later

Anyway, back to the Tachycardia – so just after writing the above I decided that 15 hours was probably too long to sit things out so we decided to go to the hospital.  Hubby refused to take me to the “****ing useless local hospital” (very unusually strong words from him!) and instead we drove the hour to the big teaching hospital.  I was pretty sanguine thinking I would be given betablocker and told to speak to the Electrocardiologists on the Monday (this being Saturday lunchtime).  After three hours of waiting in the tiny, packed, chaotic waiting room I was given a bed in the resus.  Then, naturally, my heart calmed down to a usual rate of about 72.  Typical.  Nurse said they would discharge me soon.

 Then it leapt back to 95.  Repeat, normal and repeat.  It was decided to admit me for monitoring and I was given a bed in the EAU (Emergency Admission Unit, a sort of ward for A&E patients).  I was on a cardiac monitor but still had not seen a doctor despite being there about six hours.  Eventually, I went looking for the doctor just as she came looking for me!

She was worried about my blood test results showing anaemia which I was surprised about as I had been feeling fine – usually I start to feel rough even before I hit the lower limit.  I said I had bled after the ablation quite a bit and explained about the haematoma and the nosebleeds. She examined me and said they might do a scan the next day.

 At about 11 pm I settled down to sleep and my heart rate (HR) immediately shot up to 122.  I informed the nurses but they said it was fine and not to worry and not to fixate on the HR monitor.  But I can feel it anyway at that speed.  They did an ECG by which time my HR was 95 only to go back to 120+ every time I laid down. 

 At 3 am after some fitful sleep I went to the toilet and when I got back into bed my HR jumped to 145+.  It felt awful, pains across chest and back and down both arms, which is something I had never experienced before.  I decided I definitely needed to be less stoic and get some medical attention – this being a hospital, after all.  As I went to push the bell the nurse burst in saying that my HR was very high and calling the doctor and another nurse.  I was wracked with pain and writhing on the bed.  A GTN spray was administered which eased the pain and then suddenly there was lots of people there – a critical care nurse, the manager (?) of the EAU, the doctor and nurses, some more nurses and an anaesthetist who was in charge.  Turned out the Crash Team were just in the next ward and were partially diverted to me.  It was all a bit dramatic – they were moving very quickly, talking loudly and very urgently as my Blood Pressure was only 70/50 (Clinical shock sets in at below 90/60).  I was writing about on the bed still and panting while they told me to breathe deeply.  When I told them I was about to pass out they kept shouting my name.  It did cross my mind that I might be dying, but I was quite resigned to it.  More GTN spray which eased the pain and I was able to speak to them a bit.  BP now 53/33!  Or maybe that was earlier, it was all a bit of a blur.

 I remember that I was not at all scared as I knew I would just fall asleep, but I really wanted to hold someone’s hand (preferably mu husbands, but anyone would do)  – I nearly asked for a hand to hold,  but knew they were all too busy.  At different times I did hold the hand of both the doctor and the anaesthetist, but, obviously, they were a bit busy for that!

 I heard the anaesthetist say that he would take me to the theatre and put in a central line in (this is an IV line but directly into the neck.  I had it before at the local hospital after one admission but was told by the big hospital on a later occasion that it is usually only used in emergencies and they were “surprised” it had been used as main treatment).  Anyway, it is a hideous thing and very frightening to have put in (plastic bag over your face to keep it sterile while they put it in, risk of hitting the big veins or arteries)- by far the worst thing I have ever had done.  He told me it was needed in order that they could give me a really big hit of amiodarone much faster than they could through the veins in my arm and so I agreed.

 Next thing he barks that “there is no time for that – we have to do an emergency cardioversion now”.   They were trying to get an ECG, but I was sweating so much they could not fix the stickers!  Lots of running around getting drugs, before knocking me out and zapping me right there in the ward!  I woke myself up from the sedation shouting out as they did the cardioversion, but I didn’t feel any pain.  It righted the HR but it was still over 100+ so they then gave me amiodarone through a vein in my arm.

At 6.30 am I was taken to the High Dependency Unit (HDU) where I had a huge private room with three medics all to myself!  My nurse said later that day “I hear you gave the Crash Team a scare last night!”!

 Funny thing was, it all seemed to last about 20 minutes yet it was over three hours before I went to HDU - I don’t know if I passed out during the drama or I slept after because I cannot remember doing so but I seem to have lost 3 hours somewhere!  It all seemed a bit of a blur the next day – and oddly surreal.

 I was asked if I wanted to call my husband but I thought there was no point in waking him up at 6.30 to tell him I nearly died!  I told him when he called later and he could scarcely believe it.

 Had a little read up on Professor Google and it seemed I was well into clinical shock (the sweating, the losing consciousness) due to the low BP.  Seems the heart was beating so fast it could not deliver enough oxygenated blood to my arms, chest and back (and then my brain hence the passing out).  It is called Afib with RVR (Rapid Ventricular Response according to my letter).

 I wonder if the GTN spray caused the low BP as it widens the blood vessels, but then would lower the BP.  But they had to give me that because I’m sure I was treated as if for a heart attack (though only a few months ago I had a CT scan which showed my heart arteries etc all in fine health).  Also to make sure that during the RVR my brain and heart were getting enough oxygen.

 I was moved the Critical Care Unit (cardiology) later that day (Sunday) where I was kept until Tuesday – I had amiodarone for 30 hours and am now loading Amiodarone orally.  So, I am back to square one – back on the very same toxic drug that the ablation was meant to get me off of!  The plan is to keep me on it for a few months to give the heart a chance to heal from the ablation then we will try coming off it again.  THAT will be scary!  If I get as much as an ectopic heartbeat, I shall be straight to A&E.  Just thank goodness this did not happen at home as it may have had a different outcome…..

 I’ve had Afib as fast as 195 before, but nothing painful like this – I mean it is uncomfortable across the chest and difficult to breathe, but no writhing in pain stuff.  I noticed that usually in Afib my HR swings back and forth – up to 195, down to 120-150 etc.  This stayed at a steady 145+.  It was sort of quite regular.  Be interesting what the EP has to say about it when we have our appointment. 

 

Stay posted.  Stay well.