The Flutter Story

To the left is the picture the doctor drew for me as he explained my "condition".

Essentially the heart functions by controlled electrical impulses that start from the sinus node and process through the AV node. The upper two chambers are the atria and the lower two chambers are the ventricles. Blood travels from the atria into the ventricles and the transport is controlled by the electrical impulses from the sinus and AV nodes (click the links for more in depth info). In the right atria, the pulmonary veins from each lung supply the blood from the lungs to the heart. Apparently, this is where my problem lies.

The doc said that my particular condition is caused by errant electrical pulses that are generated where the pulmonary veins enter the heart. The problem is initiated by atrial fibrillation which then results in atrial flutter. So the atria will beat rapidly and with a consistent rhythm (if it were inconsistent it would be atrial fibrillation).

According to the doc, middle age white males that are typically athletic and have cerebral jobs are more likely to develop this condition. Blacks and asians are much less likely. Also, your average middle aged ditch digger is less likely to develop this condition. He said that he just saw a doctor and lawyer with similar issues and asked what I did for a living. I guess being an engineering manager for a nuclear utility would fall in the cerebral category ;-).

He said there was a Norwegian (or Swedish) study done on cross country skiers using a sedentary group as a control. The skiers were four times more likely to develop this condition than the sedentary group. [So it proves that exercise is BAD for you.] He said that cold drinks, large meals, post-exercise, etc. were typical triggers (yep, I can relate to all three). So how do you fix it?

First he explained that he would like to try a drug therapy. Hence the Flecainide which he said is usually effective 60% of the time. He said that if it works, most other antiarrythmia drugs will work and if it doesn't the others won't either. The Nadolol is a beta blocker to help with rate control (which, if you read my earlier post, you will know it works for me). If the drugs don't work or the side effects are not acceptable, then an alternative is catheter ablation.

For my condition, the procedure will be to insert a catheter into a vein in my groin. The catheter is then snaked up into my heart where the doc would essentially ablate the tissue around each pulmonary vein where it enters the heart. Basically, the intent is to create ring of scar tissue around each opening to prevent the random electrical impulses from disturbing my normal heart rhythm. The procedure, for them, has been 85% effective with 1 in 4 needing a second procedure to close any gaps missed the first time around. So what are the drawbacks?

The doctor laid out 4 negatives. First, bruising is common occurence especially where the catheter is inserted into the vein. Second, there is a possibility of bleeding (or fluid buildup) in the sac around the heart which is removed by using a needle to suck it out (I quiver on that thought). He said that they have not had any bleeding issues for nearly 10 years (over 6000 procedures). Third, there is a possibility of narrowing the area where the pulmonary vein enters the heart. This caused by excessive scar tissue formation which constricts the entry area of the vein. Last, there is a possibility of a stroke caused by the formation of a clot in the right atria during the procedure that gets flushed out during a normal pulse of the chamber.

So that is the story with a pretty picture to go along with it. After the last couple of days on these drugs, the ablation is looking mo' and mo' better. Coincidentally, when I walked out of his office I ran into a guy that worked at one of our nuclear plants. He said that he had been on the drugs for over 10 years and was basically sick of it. So he told his cardiologist it was time to do something different. He was referred to Dr. Kay and had the ablation done earlier this year. He said it was the best thing he could have done and wished he had done it sooner!

So I will suffer through the drugs for the next few weeks. Try to run some and if there is no improvement in quality of life, I will ask for the ablation procedure. I just can't see being on a drug regimen for a long period of time and not being able to exercise.