Atrial Fibrillation - A personal discovery with a shocking treatment

Atrial Fibrillation Association, Tuesday 14 January 2014, UK:

Across the UK incidents of the serious heart condition, atrial fibrillation, have increased by just over 20% in the last five years. By the age of 40 each person has a 25% chance of developing the serious heart condition, atrial fibrillation. Having this condition increases a person’s risk of an AF-related stroke by up to 500%. However, too often AF is not detected and for many it isn’t until a person suffers a catastrophic stroke that AF is diagnosed.

Good then that my strangely high heart rate was picked up during a lactate threshold test and the causative AF was confirmed by my GP shortly afterwards and not alternatively at a postmortem ...

However, here I find myself on Valentines Day ...

Friday 14th February 1.30pm

... On the second floor of the Bassetlaw Hospital in Worksop, lying in bed 1, in the Coronary Care Unit, 4 months after my 50th birthday. With over 15 ultra-marathons under my belt in the last few years along with numerous shorter outings out in the hills of Northern England in all weathers, I never expected to find myself here.

The cause of AF is not fully understood and can happen at any stage, apart from increasing in frequency with aging however I hope my AF has developed for no explainable reason - and that I have what is known as "Lone AF".

One good outcome from this experience was a full heart MOT involving an echo cardiogram where I listened to my own heart beat and valves working, chest x-rays and several comprehensive blood tests, all allowing me to collect a clean bill of general health and - as I was informed - become a prime candidate for an Electrical Cardioversion with every chance of success and the reversion to the sinus rhythm of a normal heart beat.

Whats one of those I asked? This was the response I got:

Cardioversion is the conversion of the heart rhythm from Atrial Fibrillation (or Atrial Flutter) to the normal rhythm, known as sinus rhythm, electrical cardioversion is also known as Direct Current Cardioversion (DCCV). Electrical Cardioversion !! This may sound terrifying, but it is very simple in principle and is a highly effective treatment in carefully chosen patients. The idea is to use an electric shock to activate the whole heart at once. This prevents the perpetuation of Atrial Fibrillation. After the shock the normal heart
beat (sinus rhythm) will be able to emerge.The cardioversion itself involves linking the patient to an ECG monitor which is connected to the cardioverter/defibrillator then the general anaesthetic is given. You are then thankfully asleep and so totally unconcerned about the procedure.

Risks Involved:
• Slow heart rhythm (bradycardia) – usually very transient and at most needing treatment with an intravenous medicine (Atropine) or a short period of pacing (electrical stimulation of the heart to initiate heart beats) for a short time.
• Fast heart rhythm (such as ventricular tachycardia) which may need a follow-up shock before the patient regains consciousness.
• Stroke, which is very unusual if the patient has been fully anti-coagulated before the procedure.
• Skin burns or irritation from the electrodes (patches) - this is unusual with modern patch electrodes but can happen more frequently with older metal paddle electrodes.
• Early reversion of the normal rhythm back to Atrial Fibrillation – this may require a further shock (when still under anaesthetic).
• General anaesthetic risks – rare in normal sized people with no other medical problems.

Electrode patches or plates are positioned on the back and front of the chest, or on the upper right and lower left of the chest. The cardioverter/defibrillator is charged and set to deliver a shock simultaneously with the next heart beat. Often the first shock is successful but sometimes several shocks at increasing energy levels or with different electrode patch positions is needed to convert the rhythm. The normal rhythm is restored in about 90% of patients, but a small proportion immediately return to Atrial Fibrillation. Over
the next few days, 10% - 20% lapse back into the arrhythmia but this can be reduced when necessary by asking the patient to take an anti-arrhythmic drug. After the procedure the patient is awake
within a minute or so and, although groggy for a while, quickly regains full control and will be ready to go home after a few hours.

Simple Innit?

And so it proved, as I was indeed fully sedated and so unaware of the business end of proceedings:

Jolt 1 @ 100J of energy failed ...

However strike 2 @ 200J struck the home run ...

and I was back to a normal sinus rhythm.

All the while, I was linked to various monitors which provided comfort that my blood pressure was OK

and the big screen confirmed this and the return of the sinus rhythm ...

Admitted in the hospital @ 1.45pm and then being driven home through the pouring rain, after getting the discharge @ 6.30pm that day, my thoughts included:

Would this return to a sinus rhythm last a good while? - time will tell
Would my general health improve? - by definition yes
Would my running improve? - logically yes


Sunday 16th February 11.30am


Delighted to report that following a 15 mile long steady lope around the lanes of North Nottinghamshire all remained well with no sign of AF ... A steady heart rate of 124 along the lanes, rising to 133 on the steady inclines then back down. Sitting in the chair, late Sunday afternoon saw it back at a steady 51 and so fingers crossed that my visit to the Coronary Care Unit was a success.

How long I remain clear of the AF is uncertain but it remains the shadow behind me, the gentle reminder that it's worth keeping focused on all health matters: I'm living, running and walking proof that all aint necessarily what it seems. But, my registrar seemed OK to sign my Certificate for a French marathon later in the spring ... for a small Fee of course.

Hope to see everyone back out on the trails in March? Falcon Flyer, Wuthering Hike anyone?