not one but two

The past week's worth of days have been so busy what with working on the mold (of which all forward progress came to a screeching halt last Sunday morning and has yet to resume) and the visit from Kathy and the appointment with the electrophysiologist and a surprise visit from grandgirl Autumn just a bit ago that here it is late afternoon or early evening depending on where you live and how you measure such things and still so many chores to take care of, a big one of which is to start putting up some of the three bags of tomatoes I have in the refrigerator but it's too late in the day to start something like that. I should have finished that mold on Tuesday after Kathy headed home but I didn't, instead being lazy all day. Wednesday was all about the doctor's appointment and today was all about absorbing that.

So, yes, I finally had my appointment with the electrophysiologist, the cardiac specialist that specializes in heart rhythms. My appointment was at 11:15, I finally got in sometime shortly after noon. The cardiac RNP had sent my file over previously so basically all they did was take my blood pressure and do another EKG, since I was having an episode while I was there, before the doctor came in. So it turns out I have two different heart rhythm abnormalities, atrial flutter and atrial fibrillation. You can have one without the other but if you start with flutter you generally develop afib and the older you are, the more likely you are to develop it. He wants to do a catheter ablation  now for the flutter and then try and treat the afib with drugs before considering the ablation for afib as that is a more invasive and difficult procedure so since the drugs I've been on aren't doing the job he wants to try a different one, sotalol, that requires keeping me in the hospital for a few days while he monitors its effect on the afib and for any of the side effects that apparently can be bad. So they are contacting my insurance company and checking doctor and hospital schedules and will call me with the appointment.

Of course as soon as I got home I'm trying to explain to Marc what he said and I'm all over the internet reading about this med and the procedure and flutter vs afib and I'm even more confused. So I called the doctor's office with a long list of questions this morning.

Atrial flutter is rapid, but even, heartbeat defined as having 150 and up beats per minute. The highest mine has been is 125, that I'm aware of, and that was before any medication. Atrial fibrillation is irregular heartbeat with or without it speeding up. So how do they know I have flutter when the rapid beating part could be caused by afib especially since my heart rate has never been that high? When both conditions are present they interfere with each other so the typical bpm no longer applies but atrial flutter also has a very distinct 'sawtooth' pattern that shows up on the EKG and it's all over my tests.

Do I have to be having an episode to have the ablation? No. I actually asked the doctor this and when I asked how then does he know where to zap my heart he sort of chuckled and said it was his secret power, and then he answered my question. The process involves a way through tests conducted during the procedure in the heart to pinpoint the rogue spot that is sending out the signals.

If both conditions are caused by faulty electrical impulses why is ablation for afib considered more invasive? With flutter, there are only one or a few spots in the muscle tissue of the heart in the upper chambers and they can be pinpointed and eliminated. 

Ablation for afib involves all 4 of the pulmonary veins (the veins that bring oxygen rich blood from your lungs to your heart) and as they can't pinpoint the exact spots, it involves a process called pulmonary vein isolation which causes scar tissue around the veins near where they connect to your heart because that's where the chaotic signals originate for afib.

So then I got a call to pick a date, the three soonest dates were June 21, 24, 28. I picked Monday the 24^th so I'll have an echocardiogram on the 24^th and then go back the next day for the ablation and a couple more days while he tries the different medication so I'll be at or in the hospital most of that week. Oh joy. I barely accepted the possibility of the ablation as outpatient procedure and now I'm going to be in the hospital, the place I avoid at all costs and haven't been in a hospital as a 'patient' since 1979 when my son was born.

I am not looking forward to this.