Paul Joel of Sheffield, England noticed that his heart seemed to be racing when he was lying still in his bed at night. At first, he did not think much of it. The 53-year-old machine worker led an active life in his home town in northern England. He worked full time, sailed regularly, and was an avid cyclist.
One day shortly after that at work, he experienced such a severe dizzy spell that he fell over backward. He was working on a piece of heavy machinery at the time.
“It’s a good thing I fell backward rather than forward, into the machine,” he commented. “Otherwise, it could have been quite bad.”
That first major episode of dizziness occurred in October 2006. Paul Joel had no history of cardiac arrhythmias, and he had scarcely heard of atrial fibrillation. His physician told him to go home and to call emergency care if another episode occurred.
It did not take long. Within a couple of days, the emergency department had determined from Paul Joel’s electrocardiogram (ECG) that he had atrial fibrillation. Specifically, he was diagnosed with paroxysmal atrial fibrillation, which starts suddenly and can go away without medical intervention.
Like most patients with a new diagnosis of atrial fibrillation, he was given drug therapy, specifically a beta-blocker.
“The side effects from the beta-blocker were worse than the palpitations, because I was so drowsy all the time,” he remembered. Beta-blockers are effective at slowing the heart rate, but fatigue is a well documented side effect.
Several more episodes followed with another trip to the hospital, three more doctor visits, adjustments to his medications, and finally an appointment with a cardiologist. Although he was given state-of-the-art drug therapy, he experienced severe side effects plus the symptoms of atrial fibrillation. He knew that he needed a heart specialist.
“I didn’t see a cardiologist at first,” he reported. This path through the healthcare system is not at all unusual. “I was told that atrial fibrillation was something that I would always have, that I had to live with it. I was told that drugs would help me. The side effects from the drugs were very bad and they did not alleviate my symptoms.”
Meanwhile, Paul Joel went on the Internet, determined to educate himself about atrial fibrillation.
“I just Googled ‘atrial fibrillation.’ The Internet has everything. I had access to information, medical articles,” he recalled. One of the things he learned online was that a new approach to atrial fibrillation involved ablation, which destroyed a very small section of tissue that was thought to cause the atrial fibrillation. Unlike drugs which tried to manage atrial fibrillation, catheter ablation proposed to cure it.
While the use of ablation for the treatment of atrial fibrillation is relatively new, Paul Joel did his homework. “Ablation has been used quite a while for cancer and it’s been shown to be safe.”
For ablation of atrial fibrillation, a catheter is inserted into the body and maneuvered into the heart where it pinpoints the area of tissue associated with the rhythm disorder. Electrodes on the catheter create heat to destroy that small section of tissue. Catheter ablation of atrial fibrillation is theoretically based on established ablation techniques, but using such techniques in the heart’s upper chambers and around the area of the pulmonary veins was new territory. In fact, in some parts of the world, this technique is so new that it is considered experimental.
“I asked my doctor about ablation, which I had read about on the Internet, and he said that my Primary Healthcare Trust did not perform these types of procedures.” Instead of being discouraged, Paul Joel took the necessary steps to have a cardiology consultation in the town of Newcastle.
Meanwhile, in May 2007, Paul Joel had a mild ocular stroke which impaired vision in his left eye. “We don’t know if it was related to the atrial fibrillation or not,” he said. He now takes a blood thinner to deal with the risk of stroke. “It may have been a clot or it may have been a piece of cholesterol that lodged in my eye.”
According to the American Heart Association, people with atrial fibrillation have five times the risk of having a stroke compared to people without atrial fibrillation.
Paul Joel continued his quest to find out all he could about ablation with the goal of having the procedure himself. “My wife and I even thought of financing it ourselves,” he said, when it appeared that his health insurance would not cover it. He joked that as he learned more online about ablation procedures, he found some ablation equipment on Ebay.
He finally connected with Dr. Steve Furniss, whom he saw in July 2007. Dr. Furniss was performing catheter ablation for the treatment of atrial fibrillation and agreed that Paul Joel was a good candidate for the new procedure. Unfortunately, the waiting list for the procedure was “about three months.”
During this time, Paul Joel’s life “was turned upside down.” He could no longer work, he frequently had severe symptoms, and he curtailed many of his recreational pursuits for fear of what might happen if he had a dizzy spell that could put him in harm’s way. “I still kept sailing,” he admitted, but he took the sensible precaution of never sailing alone. “I just couldn’t be sure what would happen.”
Circumstances finally intervened in Paul Joel’s favor when he was bumped up on the waiting list and could finally have atrial fibrillation ablation on August 13, 2007. Although it might have normally been done on an outpatient basis, he opted to spend the night in hospital simply because the operation performed at a facility that was several hours’ drive from his home.
“Overall, it was a very positive and interesting experience,” he said. Like most ablation patients, Mr. Joel was under only local anesthesia and was conscious for most of the procedure. He had studied the subject enough to know what to expect. At some points, he could observe the catheter in his heart on the fluoroscopic monitor in the room. When the actual ablation was performed, he knew that he was going to feel it.
“Indeed, I could feel warming or heat in my chest—but it was not so unpleasant.” He said the sensation was not painful. “After the procedure, I did not experience bruising or complications where they had inserted the catheters.” His recovery was virtually immediate. The next morning, he drove home.
Since that time, Paul Joel has not had one single episode of dizziness or symptoms from atrial fibrillation. He was able to reduce and finally discontinue his atrial fibrillation medications (although he still has prescriptions to address high cholesterol and his prior stroke).
Today, Paul Joel is back at work as a field service engineer for a mobility company and he has returned to his sailing and cycling. “I am still not at anything like the fitness levels I was before, but I now feel confident I can slowly work towards full fitness,” he said.
“I think I have the perfect cure.”
Disclaimer: Results to AF treatment can vary
This story reflects one person's experience. Not every person will receive the same results. Talk to your doctor about your treatment options.