2nd overall

The changing of the sprocket on the cross bike has much improved it.  The irritating bearing noise has gone and the bike is practically silent.  Rather than retiring it, I am now looking forward to going out on it.  I tried a relatively short canal trip yesterday, thinking that the constant pedalling may take more out of me than I expect.  It was a wonderful ride, marred only by me arriving at the park to find the Parkrun about to take place.

In spite of this I managed to move up a place on a Strava segment. Now second overall, and I could easily have gained a further minute if the park wasn’t full of runners.

Poolsbrook Canal circuit

I went out today a little later, too many walkers on the trails for any real speed; but I achieved an overall average of 14 mph and felt really good on the clear parts of the path.

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Lack of focus

I have not been focused at work for the last ten days, due to the death my mother and at about the same time, the good news from cardiology.  These two extremes have left me a little conflicted, happy and down at the same time.

I am wary of returning to full gas cycling, I believe the AF was caused by continuous intensive exercise from running, cycling, squash and gym from the mid–eighties to the nineties.  I have long thought that I did not take enough recovery periods during this time, although up until the AF I thought the only issue was my fitness hitting a plateau.  I am continuing to limit my HR to 160, with little spikes up to 165.  I haven’t gone back to the track yet, where efforts are shorter and more intense, as visible monitor screens are not allowed.  I have replaced the freewheel on the singlespeed with a smaller fixed gear, mainly for maintenance reasons, which gives a new gear of 61” instead of 58”.  I am looking forward to trying it out; I am enjoying the bike too much to retire it.

Cardiologist visit at last

I returned to the NGH for my six-monthly review (after seven months).  I experienced the usual production line feel: X-ray, ECG, Blood pressure, halter monitor fitted, but then hit a hiatus as I waited for the Dr.  He was delayed by an hour due to another patient being seen in an emergency due to a suspicious ECG.  This was reassuring as it meant that I had not been brought forward for any particular reason.

The consultation was quite pleasing; my atrium is slowly shrinking back towards normal size, The Left Atrial Appendage is closed and healed, the rhythm is good and so is my reaction to exercise. My HR is still elevated (resting at around 80, where it used to be 57).  Most sources say this should return to normal within 6 to 9 months, but my cardiologist says 12 to 18 months is more realistic.  I showed him some recent Kardia readings which had been highlighted by the app as possible AF.  Apparently, they were not, and are nothing to worry about.

I am now allowed to carry on as normal; I think this means normal for a normal person, not an exercise addict like myself.  No extreme HR (up to 160 and perhaps a little higher is OK, but I have to monitor it and stop if it rises suddenly or does not fall when exertion level is reduced).  He seems confident that my AF will not return, for many years at least.  I have to return the monitor on Monday, but he does not expect it to reveal any problems.  I will need to return in November for another 48 hour monitor, but this is just because I will be subject to the research project for the next three years.  If it had been a normal treatment process, I would have been discharged today.

Mother died

Another difficult time, just adding to the stress.  She had not been well for a while and her perkiness back in the care home was short lived.  She went downhill fast on her return.  It was unpleasant for her and unpleasant to witness.

Two weeks to go

My Cardiology appointment for the 16th May has been brought forward to 10th May.  I have no idea why, he is only supposed to take consultations on Wednesdays.  He has had my results from the Echo and ECG for more than a week, so it is possible that he saw something warranting an early visit, but I doubt it for the sake of 6 days.

I had a few further Kardia diagnosed AF issues in the last week.   On 17th April, I took five tests, one was “unclassified” the rest were “normal” (but with a large number of PACs).  On the following day, I took eight tests:  one possible AF (seems to have a p wave), one unclassified (again with lots of PACs).

My heart has largely settled down again since then.  All readings have been “normal”.  I am not panicking now; at first I thought there was a third ablation on the horizon already, but it is only six months from the conclusion of the treatment, so perhaps I can expect a few blips.  Looking back to before the first op my ECG traces were ridiculous and every time I tried to exercise, my heart would race to above my tested max.  What I have now is so very close to normality in comparison.

I have wondered about my surgeon’s competence with the mini-maze; this is generally touted as near as possible to a cure, and yet mine produced lots of flutter and PACs.  I decided to see if I could find any recent research or articles referring to my situation.

One paper I had not seen before was from Guezebrook et al (2015)   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986569/

The paper suggested that the procedure was very effective with 82% not experiencing more than 30 seconds  of AF after one year and 90% were either drug free or only on anticoagulant.  Unlike catheter ablation, the success rate appears not to be affected by the experience of the surgeon, cardiologists new to arrhythmia are expected to achieve the same success rate.

Unwell mother

My mother has been very unwell recently.  She was working until her late 70s, by choice, not necessity, but her health started to dip a couple of years ago at the age of 84.  We suspect her longstanding AF had something to do with it; perhaps TIAs were caused by AF related clots leading to confusion and inability to walk.

Recently she broke her hip in the care home and was admitted to hospital.  After a couple of weeks of rest she had gone seriously downhill and become unresponsive.  She has deep vein thrombosis causing serious swelling to one arm, a chest infection and they have just discovered and aggressive tumour in her breast.  We were called into hospital yesterday and told that they would not be continuing any treatments and they would “make her comfortable”.  She was on so much morphine that she did not really wake up and we left the hospital that evening expecting to receive a phone call at any time.

I left for work at 6:40 in the morning; there had been no news overnight.

I was working in a secure area and phones were not allowed on site.  At 4:00 I returned to the car and turned on the phone.  There was a text from my sister.  My mother had recovered, was very talkative and was eating.  She had been moved from the hospital back to the care home.  I dropped in on the way home and she was fine; completely unaware of how ill she had been the day before.

Kardia says AF

I went out for a 35 mile road ride yesterday.  I took it quite steady with an average HR of 138 and a max of 160.  Later, I visited my mother in hospital, which was quite stressful; she is recovering from an operation on her broken hip and has just come out of a period of post-op delirium and back into her normal TIA induced mild dementia.  She had fallen out with the staff, and was frustrated that she wasn’t getting any better.  She was also upset with me as I refused to take her home.  She told me I was written out of her will.  This is not really a problem as there won’t be much left after the care home fees, and anyway, she was convinced I was my brother.

While I was waiting outside for the nurses to try to get her to stand for toilet purposes.  I took out my phone and tried the Kardia.  I was shocked that it said possible AF.

18-04-15 AF

Apart from the PAC on the left, this seems normal with a slight P wave.  I took another reading straight after which looked the same, but read as normal, followed by another similar one 20 minutes later which also read as possible AF.  These AF readings actually looked a little better than recent ones, e.g. from a few days previously.

18-04-12

There had been a bit of noise on the trace for the last month, including at about the time I went for my TOE.

18-03-30

Prior to this, there had been the occasional dirty trace, but I wasn’t worried, I thought it could have been interference.

18-01-29

There was some noise on earlier traces, including the one prior to the six week check up.

17-11-14

This was not quite as bad as just after the second ablation.

17-10-06

Something similar can be seen from traces after the blanking period from the first ablation.  Here are two traces from the same day, the morning seems perfect, but the afternoon has a noisy trace.

17-09-27-am

17-09-27-pm

None of this is anywhere near as bad as the pre-ablation trace.

17-04-05 HR

I am not now sure what to make of this; perhaps I just need a new battery in the Kardia.  I called the hospital to find out that they only received my TOE through this morning and my next Cardiology appointment is for 16th May; just four more weeks to wait.

Wobbly ECG revisited

The Cardiologist has been very slow at arranging my appointment for the results.  Its now two weeks since the TOE and still no call; I am assuming he is still golfing after the Easter break.

I have been reflecting on the recent Kardia readings showing activity after the T wave.  I found an interesting book; ECG interpretation made incredibly easy, 5th Edition by Lippincott, Williams and Wilkins.   From this, I have discovered there is such a thing as a U wave, which appears to be caused by either by digitalis use or hypercalcemia, which may by a thyroid issue, potentially a side effect of amiodarone.

U wave

One year after ablation

It is now exactly a year since my first ablation, and 26 months after entering Persistent AF.  I am now due for my next visit to the consultant 6 months after my second (and hopefully final) ablation.  My TOE was over a week ago, but I still haven’t received notification of a date; just before Xmas, I was told that it would be on a Wednesday, the first couple of weeks in April.

Overall, I feel “cured”; I am on no medication, I have no issues with excessive thirst and urination, my blood pressure is normal and my resting HR is steady, although 20 BPM higher than two years ago.  This should return to normal within 9 months of an ablation, but appears to have hit a plateau at the moment.

HR Relaxed 18-04-07

I have returned to the road bike, but heading east for the relatively flat lands; only 60 ft/mile of climbing.  I am staying at an average HR of 145 with a max of 160; I managed my first ride of more than 15 mph this weekend, I am quite pleased with this.

https://www.strava.com/activities/1496085103

I do not want to try any harder without the Cardiologists advice; everything seems OK, but I am just worried about the slightly lumpy ECG on the Kardia.  Hopefully it is nothing unusual.

 

 

 

I am now officially a resource

During a quiet moment, waiting for a return phone call on the first day back after the holiday period I was checking research resources on the American “StopAFib” website.  I noticed that I am now listed as a resource under patient sites.  https://www.stopafib.org/resources.cfm

Stopafib

I wasn’t informed, but I am very pleased and it cheered me up on a dull day.

I am not sure what the status of this website is at the moment; the associated forum seems to have moved over to the American Heart Association.  http://www.heart.org/HEARTORG/   However, the owner of the Stop AFib site is posting on the AHA website as MellanieSAF, so probably still current.