In March of 2008 I began treatment for a potentially fatal heart arrhythmia whose cause was unknown. I was fit and healthy, having spent a good part of my adult life as an elite cyclist, much of it racing in Europe.
After 5 years of fence-sitting on the part of my doctors, I have been given a diagnosis of ARVD/C (Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy). I lack the known genetic markers for the disease as well as some of the structural changes that accompany ARVD/C, and my condition has shown no indication of being progressive (yet).
There is a growing population of current and former endurance athletes who end up with acquired arrhythmias, and a diagnosis of ARVD/C. But by placing these athletes in the ARVD/C patient population, we are potentially ignoring the very real likelihood of an acquired condition, similar, but different, from ARVD/C.
This blog is written as a resource for athletes with acquired arrhythmias, as well as anyone about to undergo endo or epi-cardial ablation, or the implantation of a ICD. It is also written to help generate some critical mass of interest in support of further research into acquired arrhythmias in endurance athletes and others. Feel free to contact me through the comments page if you have any questions or wish to make a written contribution to this blog.
Sunday, April 27, 2008
I Wanna Be Ablated
The day after my treadmill blowout I was prepped, punctured and probed in a procedure known as catheter radio-frequency ablation. At midnight the night before I was not allowed to eat or drink anything until after the procedure. The whole thing seems pretty innocent, and if you peruse the 'net you'll find all manner of happy ablation explanations and stories. I've even read "geting (sic) wisdom teeth pulled is harder". My ablation, however, was epic.
There is probably a vested interest in making the procedure seem benign, hundreds of thousands are performed for all manner of cardiac anomalies, not just ventricular tachycardia. And it is a genuinely advanced, remarkable and relatively less invasive procedure, relative to, say, open heart surgery.
The electrophysiology lab is basically a specialized operating room. There were at least 15 large, flat screened monitors, including a bank of four perched on an arm above the operating table. The CPU power rivals NASA mission control. I'm wheeled in to the sound of classic rock as three technicians and nurses prep me. This involves entry-point hair removal, a gazzilion leads and wires stuck to my front and back (including a defibrillator), and the application of several lovely warm blankets which unfortunately cool down way too quickly. The room is cold, in the low 60s, and little naked me got to shivering almost immediately on the operating table. Prep took a good hour, then sedation was administered and I was vaguely aware of some fiddling in my nethers followed by a sensation of strange worming activity in my chest as the catheters went in. Doctor Marchlinski came into the room and the classic rock changed to easy listening. I drifted off to Sade's Smooth Operator. When I awoke my heart was being run through the gears, electrically stimulated in order to locate the sites of my V-tach. The heart is "mapped" via this process. V-tach is induced and the errant tissue located. It is bizarre, you have no control over your body, your heart is riding up Alp d'Huez but the rest of you is stock still. Full consciousness is required to get a proper cardiac response, so once they started mapping and ablating I wasn't allowed any more drugs. Once the mapping is done the ablation is performed with another catheter, tipped with what I imagine to be ET's finger.
My sites were large and varied. It took 55 "burns", individual ablations, to finish me up. The whole thing lasted 7 hours. Some ablations were without any pain. others felt like getting stabbed from the inside. Early on Dr. Marchlinski discovered that I had a large site on the exterior of my heart. He tried reaching it from the interior by zapping the bejesus out of that spot. That is what hurt the most. I begged for some sedation and got a little reprieve. By this time my back had gone numb from lying there for so long and I was shivering with cold. When it was over I couldn't move for six hours while the entry-point for the catheter closed up. The whole procedure, coupled with the lack of ability to move and thus being unable to pee for a total of 13 hours was, to date, the most uncomfortable thing I have been through. I don't care what the CIA says, there is something called a "stress position", and it can be simply being strapped to a bed for 13 hours.