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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, December 21, 2008

Fixed! Round 2: 12-hour light-sabre throw-down in my heart


heart catheterization (artist's rendering)

The human body objects to all puncture. After being opened and reopened for medical purposes with small, considerate needles and scalpels, it defies my imagination how a human could endure arrows, bullets, swords, or spears. What seems to be the end game in my battle with Ventricular Tachycardia began with a duel between my left arm and a nurse who managed to roll all the useful veins in it while trying to install an IV. It ended with my much-more-proficient Doctor Francis Marchlinski light-sabreing his way around my pericardial sac, routing out insurgent electrical circuits. It was his third visit to my heart; almost as if the epic quality of this adventure was deserving of a trilogy.

As I explained before, an epicardial ablation is not the walk-in-the-park an endocardial ablation is. The chest is entered with a large, hollow hook-shaped needle (the same one used for epidurals), the heart is reached through the pericardium and a catheter threaded in the opened channel; other catheters are passed through the femoral arteries reaching the heart from the inside. The heart is mapped, the dangerous circuits identified and eliminated internally and externally. Endocardial ablations are completely internal and thus less invasive.

Dr. Marchlinski found himself in a spot of trouble upon sitting down to work. Apparently I had been so drugged up the previous days that my heart would not produce any V-Tach on the table. The first step in ablation is to incite the heart into its bad behavior, find the locus and zap it. But my heart, despite all the previous drama, was behaving itself. I was sedated but awake when they discovered this, strapped to the table and fully cathetered. The epicardial catheter had not yet gone in -they knock you out for that- but I could sense some frustration in the room as I was loaded with adrenaline and electronically pulsed to high speed. All told, I was on the table for twelve hours; it seemed I was awake for the first three. Marchlinski took a bunch of educated guesses as to the locus of my circuits. As a consequence many of my PVCs were also eliminated by the end of the day. The main culprit, the original V-Tach-creating-scar, was already well-known and identified through prior mappings, and although it wasn't producing V-Tach now Marchlinski spent extra time going over it. In the end the diligence seemed to work. I was Dr. Marchlinski's first repeat customer for epicardial ablation for V-Tach, and, I'm sure, we both hope, his last.

I emerged from surgery in much better shape than my previous epicardial. I spent 24hrs on my back in a Dilaudid haze, unable to move because of the holes in my chest and groin. But I wasn't a paranoid mess like last time. It was all fine. My heart was utterly steady. I couldn't remember the last time it had been that way. The 12 hours on the table, the repeat surgeries, the cardiac breakdowns, were all worth it for this.

In a matter of days I could tell things were going to stay stable. While my body recovered from the surgery the soreness and sleepiness overshadowed the great feeling of a heart beating just like everyone else's. But after two weeks I was ready to declare myself victorious. I introduced a couple caffeinated beans to my morning brew. No worries. I had a sip of wine. No worries. A few days later 2 glasses of red wine. Nada. More caffeinated beans. Finally, three weeks out, I reintroduced exercise...

5 comments:

Daniel P. Johnston said...

Well, it's looking like 2009 really will be the year of the comeback! You know, you've been a pretty successful racer, but I think now you've finally laid the foundation for becoming an American cycling legend. Just look at your predecessors:

Greg LeMond: gets shot (with a shotgun), wins the World Championships and the Tour de France (twice) afterward, body still full of lead.

Tyler Hamilton: breaks several bones, races with them broken (and perhaps someone else's blood, but anyway...), wins Liege Bastogne Liege and stages in Giro d'Italia.

Floyd Landis: turns hip socket into dust after crash, essentially races the Tour de France on one leg (and perhaps someone else's testosterone, but anyway...) and wins it.

Dave Zabriske: breaks hip, wins stages in Giro d'Italia and Tour de France.

Lance Armstrong: gets cancer, wins seven Tours de France.

I mean, come on... what is the deal?

Seriously, though, I'm so glad you're feeling better. It's enough to make me want to go for a ride, myself (when it gets a little warmer).

Hope to see you out on the road in NYC sometime soon.

Best,
Dan

TOCQ said...

worth the wait! so glad to hear the good news - even more glad i got to see you the other night! congrats and i hope you have no more news to report for a few months on the Vtach front. you deserve some time off.

best,
- a

Giedrius said...

I think, that Craig had already won his bigest competition. Craig, You are The Man.

dan said...

Hey Craig,

First I would like to say CONGRATULATIONS! I am happy that you can finally put this behind you and move on. Not knowing is probably the worse part. I have been following your blogs, and thank you for them. April 1, 2008 I passed out from VT, and since been trying to find the "short". Two ablations later still no answer, My doctor has gave up and referred me to a doctor in Chicago for a epicardial procedure. So right now its flecainide and metoprolol. LOL still having VT episodes. Craig any advice right now if you can would be a tremendous help.

c2 said...

DPJ, TOCQ, Giedrius, thanks for the words of support. All I've really done is endure, a "come back" is well beyond my age, ability, and performance-enhancing predilections at this point.
dan (small d) sorry to hear about your troubles. I'm glad they've decided to go epicardial on you though. From what I've read many people with VT (idiopathic, RVOT or ARVC) have gone through countless endocardials to no success because they were unfortunate enough to be diagnosed before the epicardial procedure arrived on these shores (Greg Welch for example). As I understand it there are very few EPs who do epicardials. If you have any trouble or it proves unsuccessful I strongly recommend my EP Dr. Marchlinski at UPenn. Hunker down and make sure to ask for the big drugs when you wake up!
if you have any specific questions feel free to contact me at ccpbackoffice@gmail.com
Best of luck
craig