Atrial Fibrillation: Living on Planet Drum

Thah-dump. Thah-dump-dump.



This is my heart, in unseen, muffled, but insistent rebellion. A noisy dysrhythmic protest against-what? Its unfair workload?

The years I abused it? Its anticipated collapse?

I’ve just rolled over, settling into the best posture for my night’s rest. My left arm reaches around Bob’s warm, solid middle, and he mmmm’s in response. It sounds like his smile, and I smile back, into the dark. In sleep, he reaches for my hand against his chest, and I wriggle closer, spooned against his back.

A few seconds later, my chest speaks, and I’m suddenly wide awake again. This is spell number six or eight for the day, but somehow the daytime attacks don’t inspire so much fear. At night, lying next to my new husband, I worry about what all this means for him.

I listen to the flutters interrupted by deep booms, and behind closed eyes I can see the feeling: It’s a large fish, gasping and flopping frantically inside a kettle drum. I feel the slap and slam of agitated heart muscle against the chest wall and wait to find out my future.

Thah-dumpdumpdump-biddybiddy-bump. Thah-dump.

I’ve had these feelings before, and my doctors diagnosed atrial fibrillation, “a-fib” for those in the know. It’s less serious than “v-fib”-ventricular fibrillation-which causes sudden death, but it’s serious enough. A-fib often triggers strokes.

I cannot sleep while I wait for my heart to either normalize or burst up through my windpipe. This aberration of rhythm holds my thoughts like the opening hook of a Michael Crichton thriller: Will the beats soon revert to normal? Or will this be the time when the crazy flutters-biddybiddybiddy-bumpbumpbump-accelerate to the quiver of exhaustion that precedes a flat EKG? Or maybe worse, will the gyrating heart muscle eject a blood clot, swooshing it through the arteries to my brain?

If the pounding and fluttering don’t stop pretty soon (but what’s “pretty soon”?), I’ll have to go to the emergency room. How long is it safe to wait? Can I decide by myself? Yes, I can. I try not to let this be Bob’s problem too.

My heart has always been something of a renegade, racing, slowing, skipping beats. I was born with a mitral valve defect that worsened when I had rheumatic fever in early childhood. I was fully an adult before I understood that not everyone can feel and hear their heartbeats as I do.

In my twenties I invented a crude sort of biofeedback (though I had not yet heard of that technique) that I used to slow my racing heart. When the beats started coming too fast, I’d start singing-just silently, in my head-“Way down upon the Swanee River . . . Far, far away . . .” I started singing fast, in time to the rapid beats. Then, gradually, I slowed my mental singing and the runaway heart rhythm slowed with it.

Twice my heart has given in to infections and hosted rapacious bacterial colonies, sheltering those enemies and feeding them with the tissue of its very walls and gates. And 8 years ago, my fragile heart literally broke-at least the cords that work the mitral valve did: they tore from their moorings and could no longer open and close the valve leaflets.

So the surgeons requisitioned a new mitral valve for me, one fashioned from the generous-sized heart of a pig. I wanted to ask, but never did: What happened to the rest of the pig? Was it cultivated just for its heart valves, or were there byproducts of ham and chitlins as well? And by the way, are Orthodox Jews allowed to have this operation?

My sons bought me a copy of Charlotte’s Web to celebrate my porcine acquisition, and over time, my new valve and I adjusted to each other. But the prosthesis carries no special curative powers. My poor old heart (I can see it as almost a separate, ravaged person), worn and weary far beyond my not-yet-50 calendar years, has had to struggle all along. From decades of illness and unwise exertions-I was a drum majorette, loved fast dancing, bore three children, and smoked and drank to excess-my heart is far larger and hence less hardy than it should be. It is inelastic and spongy. It feels crowded in my chest.

One day just over a year ago, my heart started jumping around in those crazy rhythms and, oddly, it didn’t stop after its usual few minutes of tom-tomming. It didn’t stop all day, and the sound-feelings became deeper, more profound. More rest, I thought; working too hard; get more sleep. I kidded myself that way until, after 3 or 4 days of relentless fatigue, I decided that the manic riffs of “Wipeout” bouncing around my sternum, and alternating with cannons from the 1812 Overture, might warrant a professional’s opinion.

My stoicism brought a tough lesson. I was sternly chided for procrastinating, rapidly admitted to GW University Hospital, infused with cardiac drugs and IVs of blood thinners, and closely watched for symptoms of stroke or internal bleeding. By waiting for days, I had greatly increased the risk of a stroke. After we found that the meds alone could not regulate my heart rhythms (and I held little hope for success with Swanee River), I was treated to a procedure called cardioversion. The docs put me to sleep just briefly while they applied an electric jolt of several hundred joules to my chest.

I think this real-life take on Rescue 911 (“Clear!”) was supposed to scare my heart into behaving properly, but it didn’t work the first couple of times. Hey, this is not a faint-hearted heart! Eventually, though, the shamans of the ampere prevailed, and my rebel heart settled into a fairly normal pace and rhythm.

I left theuniversity hospital with painful burns on my chest, a tube of Thermazene to assuage them, and prescriptions for a heart medicine (propafenone) that could be more deadly than the condition we’re treating, and an anticoagulant (warfarin) that is basically the stuff they use to kill rats by causing internal hemorrhages. Between the drug side effects and the electric shock episode, I also carried home a residue of anxiety and depression that took months to subside.

Then, about 6 months ago, it happened again. As I sat working at my PC: Thah-dump. Thah-dumpdump. Then a few more, then back to normal. I took a few deep stress-management-seminar breaths, ambled into the kitchen for a soothing cup of tea, and decided there was really nothing wrong.

But now it happens more and more often, every day and every night, and I am both scared and curious. I’m frightened about pain and the prospect of disabling illness, but unlike most people, I don’t dread a hospital stay. I am a good patient (I’ve had lots of practice), and my fascination with medical procedures prevails even while I’m at their center.

Thah-dumpbumpbump. Thah-dump-bumbiddybumbiddybiddy . . . .

If my heart takes off on a flight of unremitting tympanic abandon, what will happen next? Recently I heard about a promising new treatment for a-fib that lets the docs go in with a catheter and actually administer little electric burns right inside the heart! Wow, what an advance: Let’s bypass those pesky skin burns and go for some real damage! This procedure is terrifying to ponder; I’m certainly not ready to try it.

Today I have an electronic companion nestled close to my heart. Like a baby in one of those canvas slings that new mothers use these days, my medical techno-toy, a Holter monitor, snuggles between my breasts, and it will carefully record, for 24 hours, the tiniest electrical impulses of my every heartbeat. ” . . . Oh, Lordy, how my heart grows weary . . . .”

Tomorrow my cardiologist will have the Holter EKG printout and, I hope, a better idea of what comes next. She has already told me I’ll need another mitral valve, next time a plastic one, “in the not-too-distant future.” Oh, and by the way, my aortic valve is leaking a little, too.

On the bright side, a spanking new mitral valve prosthesis could reduce the episodes of atrial fibrillation. But we want to put off the surgery as long as possible: My doctor wants to make sure the next valve replacement will be my last, and I’m afraid of trading the frantic bongo beats of Planet Drum for endless silence.

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