Heart trouble has left me sad AF

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“Your sinus rhythm is shit.” Not the words I was hoping to hear from my cardiologist to kick-off my first check-up after my most recent heart procedure. But as Mick Jagger will tell you, you can’t always get what you want.

So, how did I end up with a shitty sinus rhythm? A bit more than a fortnight ago, I underwent a procedure called an ablation. The aim was to convince my heart to revert from atrial fibrillation (AF), the most common form of abnormal heart rhythm, to a normal sinus rhythm.

(I’ve written about my AF twice before, once when I was first diagnosed and then again when I started treatment.)

I’ve been in “persistent AF” for some time, but I’ve no idea exactly how long for because I’ve had absolutely no symptoms. Usually when a person goes into AF, their heart races and they feel like they’re having a heart attack.

That’s not been the case for me. In fact I’ve been running marathons and ultra marathons while in a state of blissful ignorance about my abnormal heart rhythm. I was diagnosed back in April while being screened for something else entirely.

In May I had a cardioversion. In this process you’re put under a general anaesthetic and your heart is effectively shocked in a similar way to a defibrillator. Two doses couldn’t shock me back to normal, so since then I’ve been waiting to have the ablation.

In the interim, I was still able to run - both my GP and cardiologist figured running hadn’t done me any harm before I knew I was in AF, so I should carry on as normal. So I’ve run both the UTA50 and the Sydney Marathon since then, along with the Big Sipper 22k at the Guzzler and the Sunshine Coast half marathon.

The lesson is, if you’re going to have AF, then have it without symptoms. Just not for a prolonged period… Because as I’m discovering, the longer you are out of sinus rhythm, the harder it is to return.

But, back to this week’s revelations… When you are in AF, the top two chambers of your heart quiver rather than beating. This quivering is what makes some people feel like they’re having a heart attack.

It’s caused when your sinus node, which is your heart’s natural pacemaker, fails to consistently send the electrical signal to tell the heart to beat. Apparently my sinus node has been soundly asleep for so long while I’ve been in AF that it’s taking some time to wake up.

The doc showed me a readout of my electrocardiogram. It showed one normal beat, then a prolonged pause, then another normal beat. Luckily, when this happens, the body has a fall-back mechanism that kicks in.

But it’s a little like having a generator that you run when the power fails at home. It’s enough to power the essentials - fridge, freezer and so on - but not enough to power everything.

“You’ll be tired,” he said. “Check,” I thought. He said the mode I’m in at the moment “is just about enough to keep you upright”, but not much more.

That means as soon as I try to exercise, my heart can’t beat fast enough to get the oxygenated blood around my body to make that exercise possible.

To give you an idea of what that means, after the ablation, my resting heart rate fell by more than 20 beats per minute. Thanks to my Garmin, I have a pretty good picture of what’s going on - my average resting heart rate is now 39 and it has regularly been as low as 37. And that’s not just when I’m asleep - it’s regularly been in the high 30s while I’ve been going about my daily routine.

Apart from being tired (who isn’t?), this low heart rate hasn’t really affected me. Until I start to exercise. And then things went pear-shaped real quick. To give you an idea, I had to rest for a week after the ablation before I was able to run. When I tried to run, I made it about 60 metres before I was doubled over, gasping for breath.

Four days later at Parkrun it was the same story - 60 metres of very slow jogging, 2 minutes of gasping for breath and 4.94k of walking. Plus coffee of course. Why else does anyone Parkrun?

The following Wednesday I went for a bushwalk, only to discover that when walking up a not particularly steep hill, I had to choose which two of walk, talk and breathe I was going to continue with, because doing all three simultaneously was beyond me.

Now, this would not be such an issue, except that I’m supposed to be running the New York marathon [very exciting!!] in four weeks. And while I’m still trying to figure out what the best preparation for a marathon looks like, I’m pretty sure this is not it.

What is an ablation anyway?

It’s amazing what they can do these days. An ablation involves scarring (ablating) tissue inside the heart (yes, you read that right) by using either heat or cold (I’m not sure which was used on me).

The theory is this takes out of play problematic tissue, usually in the pulmonary vein in the left atrium of the heart, which can short circuit the signal coming from the sinus node.

The process started with a CT scan a couple of days before the procedure proper. This was conducted in a very noisy machine, which was named “Shazza the scanner” for reasons the radiographer couldn’t clarify.

This was mildly unpleasant. I needed a cannula inserted to inject some contrast dye. The radiographer then sprayed something under my tongue, which tasted a bit like Mr Sheen (don’t ask me how I know), to dilate my blood vessels.

These two things caused a weird sensation - a warm feeling all through my body that started at my head and flowed down to my toes. Luckily the radiographer warned me beforehand that this sensation was likely to make me think I’d lost control of my bladder, but she assured me that wouldn’t happen.

She was right on both counts. I’m glad I was forewarned though, because it sure felt like I’d had an embarrassing little accident. Dignity intact, she slid me into the machine, with both arms awkwardly angled above my head.

While I was in the scanner I felt like a test pilot for some kind of early prototype Star Wars pod racer, complete with sound effects. But it was all over pretty quickly and I was left with a residual headache which, as the radiographer told me, faded after about 15 minutes.

So to the ablation proper. This involved inserting a catheter into the femoral vein in my right groin chosen, I’m sure, because it’s a large, deep vein. One that can accommodate a catheter.

The first task for the cardiologist was to perform an electrophysiology study, which effectively means mapping the heart to identify what’s causing my abnormal rhythm. To do this, the catheter was passed up the vein from my groin to the right atrium of my heart, then through the tissue - the interatrial septum - that separates the right and left atria to get to the problem zone.

Once the zone is mapped and the problem area identified, a second catheter is used to scar the tissue. I’m feeling faint just thinking about it. Luckily I was under for the hour or two that all this took, waking up in recovery to hear it had all gone well.

It did mean an overnight stay in hospital though. The problem with using a large, deep vein for the catheter is that if the wound pops, it bleeds A LOT. So once the procedure was over I was left lying flat on my back.

My stay went from one night to two when the nurse encouraged me to stand up seven or eight hours after the procedure and I proceeded to bleed all over the floor, the bed and myself.

It was so difficult to stop, they ended up hooking me up to a clamp contraption. This was a relief as it meant I no longer needed a nurse applying pressure to my groin. Small talk is a challenge in that scenario, I can tell you.

On day three the cardiologist took a look at the wound, which was slowly oozing rather than bleeding by this stage, then gave me a shot of adrenaline to encourage the blood vessels in that area to contract a little and sent me on my way.

Where to from here?

For a week I thought everything was fine - then I tried that first run. I let the cardiologist know how I was travelling and he brought me back in for a chat. Beforehand I had an echocardiogram, which is an ultrasound of the heart. That all came back normal.

The doc then walked me through why I’m not able to exercise at the moment. He said my experience is really unusual, but less so for people who’ve been in persistent AF. He diagnosed patience, because there’s every chance my sinus node will shake off its slumber and get back to working well.

I can already feel progress - in my most recent bushwalk I tackled some much steeper hills and was able to walk, talk AND breathe. So I’m hoping that’s a sign things are on the improve.

As for New York, well I managed all of 15k of running in September, across three runs. I’m sure my fitness has started to erode. I have a reasonable base, so that will help, but I just have to hope I can get back into training in the next two or three weeks.

If that sinus node remains sleepy, it may be I’m on the road to having a pacemaker. But that’s a decision the doc says is three months off, and he’s confident it won’t come to that. Also worth noting you can run quite happily with a pacemaker.

It’s deeply ironic that I was running no problem with no symptoms when I was in AF, and now they’ve treated it and I’m coming out of it, I have developed the key symptom that stops me from exercising.

But I’ve always been a glass-half-full man. A shit sinus rhythm is better than no sinus rhythm at all, right?

Upcoming Events

There are way too many events for me to list everything that’s happening around the country, but here is a selection of upcoming races (with a bias towards South East Queensland).

The Running Calendar website is a great source if you want a comprehensive understanding of what’s available around Australia.