I am feeling much better again today. Blood pressure back to normal, but pulse still very high. Before diagnosis, my resting HR was 57. With Bisoprolol, it was 45. After the first ablation it was around 75. After the second it was up to 80 and is now at 100. It will take about nine months to come back to normal.
When I started the Bisoprolol, the effects on my fitness were immediate: fatigue, memory/concentration loss and breathlessness on very little exertion. It was worse than the effects of AF. I was looking forward to a world without beta-blockers; I expected to suddenly jump to a higher level of fitness, a reversal of the immediate loss of fitness when I started them. Unfortunately, this has not happened. So far there is very little difference. It looks like a long haul back to fitness. On the plus side, ultimately, I should be much closer to my normal level than I believed possible 18 months ago.
I am not sure whether I have had a bout of withdrawal from the Bisoprolol or whether I have been suffering from stress caused by work and my mother remaining in hospital. I had a permanent headache from Friday until today and generally felt quite tired.
I went to see Bad Manners last night. Quite a jolly atmosphere (the first night of their Xmas tour) but I was too tired to bounce around in the eighties way that most other 55 year olds in the audience were doing. I am feeling much better this morning. Perhaps all the bisoprolol has gone from my system.
After talking to many fellow sufferers over the last two years, I believe my experience was relatively atypical. I have never understood the feeling of “palpitations” or most people’s experiences that lead them to A&E. For a couple of years pre-diagnosis I had assumed my exercise induced attacks were just lack of fitness due to me getting older. Even when I experienced a HR of 250, I assumed that the monitor was faulty. I never felt particularly ill.
After diagnosis, the Bisoprolol I was given had more of an effect on my fitness than the AF; almost immediately, I became breathless on slight exertion.
I was expecting that today, I would be free of both AF and beta-blocker and would feel much better. However, I woke to a racing heart and a feeling of bouncing in my chest. According to the Kardia, my HR was 100 and very regular. After a shower and breakfast, the HR was still the same, but the feeling had gone. I will mention it as I hand back my holter monitor later today.
My mother had a fall and needed the paramedics. They had an ECG from a couple of weeks ago. Fast AF. This trace was very similar to some of mine pre-ablation.
My mother has known she has had an arrhythmia for over 40 years but was told nothing could be done about it. This ECG shows AF meaning she should at least have been on Warfarin years ago, and explains the TIAs that she has recently experienced.
I am also wandering about causology. There are many possible causes or triggers of AF and some of the most likely are: alcohol, endurance exercise, caffeine/stimulants, sleep apnea, obesity, stress and other pre-eisting heart issues. I have a brother and a sister and we all have a lot of these in common, but my mother and I are the only two suffering from AF. My mother doesn’t drink alcohol or coffee, but the rest of us do (a lot). All three of us have demanding stressful jobs. The only factor I have in common with my mother that is not shared by my siblings is bike racing. This looks like confirmation that exercise is the cause.
My boss gave me a call yesterday to brief me on the Restructure meeting. All direct training is to stop before 2020. There was no detail so I am unsure whether our section is to be the first or last to go. A briefing note was to follow, and was delivered at the end of the working day. There was no additional detail. This has got to add to my stress levels, but I am not panicking (yet).
I am still ecstatic over my “cure”. It was wonderful not to have to take tablets this morning.
I missed an important meeting about the future of our organisation today. A major announcement is to be made, and employees are being asked to travel to a hub office on a three line whip. The meeting for my section is in Norfolk, 120 miles away from me. I declined to attend due to a prearranged hospital visit, which ties in with two other hospital appointments on Monday and Friday.
Adding to the stress of the announcement was the journey to the hospital and the difficulty in finding a parking space. My blood pressure was measured at 145/85 as opposed to around 120/75 normally.
The visit to the Cardiologist was short and sweet. He outlined what he and the Electrophysiologist had done and explained how closely the lesion set aligns with the Cox Maze IV. His experience of the Cox Maze in open heart surgery is of a 90% success rate after twenty years (I am not convinced by this statistic, but still, it’s a hope to cling to.) The object of the trial was to prove that a similar rate can be achieved by non-invasive hybrid surgery.
Apparently, he is confident that the procedures have been a success. I can stop the Rivaroxaban and Bisoprolol immediately. I can get slowly get back to proper exercise; I do not have to remain restricted to a HR of less than 130, but no high intensity work for a while. I do not need to keep off alcohol and coffee, just ensure I keep it in moderation; although I will stay off alcohol until Xmas to give the Amiodarone time to dissipate. The ectopics I have been experiencing are most likely harmless; I will have to wear a holter monitor for the next 48 hours to check, but there is no cause for concern.
My next appointment is in six months, I will have to have a TOE to check the Atriclip on my Left Atrial Appendage, but apart from that everything seems fine.
It is very nearly two years since my symptoms appeared, but it finally appears to be sorted.
I am very happy today.
1:15 p.m. appointment for echo-cardiogram at the Northern General. I arrive at a different entrance to normal due to traffic control. I am at the opposite site of the hospital, but see a couple of spaces in the car park and decide a walk would be easier than finding a closer space. I follow the road around the hospital so I am sure of where I am going.
The echo itself was simple, although it took half an hour and I was soon walking back to the car park. I walked through the hospital, looking for a short cut which did not appear to exist.
I am back in two days time to see the cardiologist and have a few more tests: X-ray, ECG, blood pressure and an armful of bloods (wouldn’t it have been better to organise the bloods for today so the results would be available at the consultation?)
Kardia ECG seems a bit wobbly. The first missed beat above is twice the normal length; an ectopic? The second one is a short followed by a long beat, both together are the length of two normal beats; Premature Atrial Contraction? Perhaps this is completely normal and I am just hyper aware at the moment.
Hopefully after Wednesday it will clear whether there is still a problem. I expect to be given a clean bill of health, relatively speaking, and be able to stop the anticoagulants. Then a further six weeks on, I may be able to stop the Bisoprolol.
I decided to plot a graph of drug exposure over the top of my alcohol/GGT graph.
The Rivaroxaban and the Bisoprolol do not seem to be having much of an effect; I experienced a trough in GGT while on both of them. The peak after Xmas would appear to match a rise in alcohol use, and there is a corresponding dip to April after becoming teetotal. This did not continue in July and November, which may correspond to the introduction of Amiodarone, which is only just leaving my body now. I will continue to monitor the Amiodarone line with respect to GGT.
I am now feeling completely recovered. I went out for a ride along the canal; I felt so healthy, I decided to continue through to Rother Valley, even though this would give a total of 25 miles. I arrived there hardly seeing anyone on the trails. When I got back to Staveley, I turned into the headwind along the canal and realised why it was previously so effortless. I peaked at 141 HR while slowly pedalling on the flat into the wind.
GGT now exactly the same as 6 months ago, despite no alcohol and no Amiodarone (although there is probably still 3 grams in my system). Now on 100 with a recommendation of 8 – 61. Not quite sure what this means for me; “Abnormal, but expected, Other (improved on previous results)” according to my medical record.
It is possible that the drugs I am taking are having an effect, but Bisoprolol is not hepatotoxic, and although Rivaroxaban can be, it leads to increased bilirubin and ALT as well as GGT. It is possible to see the GGT as a fall from a high level in early 2016, due to previous excess alcohol working out of my system and then reaching a plateau above normal due to the Rivaroxaban, but this is not really borne out by the other results.
I think I may have to distill this down and ask for advice from Dr. Hunter at my review in a couple of weeks.