In AF for the third time after two previous cardioversions and with a seven day ECG monitor also diagnosing tachy bradycardia with 3 second pauses in my heart rate I was told at the end of May that I needed a dual chamber pacemaker as a matter of some urgency. I had asked the cardiology secretary and also the nurse and doctor at the pre assessment if I would get an MRI compatible one as I have recently had two MRI scans and probably need a third one. They said that that was up to the doctor doing the procedure.
I arrived at the hospital at 8am on Friday rather apprehensive about the procedure although viewing ones on YouTube it seemed a very straightforward procedure. The letter had said no food after midnight but that you could drink unlimited black tea, coffee, water or very diluted fruit squash. I had two mugs of green tea around 6.45 but that seemed according to the nurse to have been a no, no and I was not allowed any more water to drink and was getting rather thirsty by the time in went into the Cath Lab around 10.45.
I had been told that I was the only patient having one on Friday but another man had been added to the list as an urgent case as he had been found to have a heart rate in the 20’s. He went in first and I was relieved when he was wheeled back in after the procedure that he was sitting up looking well and smiling and that his heart rate was already beating away at a regular 70 bpm.
When I went in the four staff introduced themselves. The doctor doing the procedure was a different consultant from the one I had expected. I asked if I was getting an MRI compatible one. He said that he did not know but would check and went over to a table where the equipment was set out and returned with the good news that it would be.
I was given an oxygen mask and a sedative was injected via my cannula and a green curtain/screen was hung over my head leaving me in a twilight world. He explained what he was about to do and was soon injecting the local anaesthetic into my left shoulder area. He had surprised me by saying that I probably would be able to go home in the evening subject to a satisfactory chest X-Ray and that the admission letter is just to prepare you in case you need to stay over. I didn’t feel anything as he cut into the skin or during the procedure apart from a slight tugging. I did not actually feel sedated and was carrying a conversation on with him and asking questions although the nurse later said that I had dropped for a while at off at one point. I could hear/feel him attaching the leads to the pacemaker and soon he was stitching me up and checking it.
Back to the ward to compare notes with the earlier patient. Looking at the monitor I was attached to I was surprised to see that my heart rate was hovering at around 100 as although I had been back in AF for three months it had averaged 72 and had only been in the 130’s briefly over a couple of days in late March on my BP home readings over that time.
After some very welcome water followed a sandwich and I cup of tea I initially felt fine but as the afternoon wore on I felt a pain my ribs on the lower left side. The nurse though it was probably because of pressure that had been applied to my chest during the procedure. To me it was beginning to feel like when I have had in the past broken ribs or when I had fluid on my lung after my heart valve replacement. I was taken down for my chest X-Ray that showed that there was some air in my chest wall cavity. When the doctor came round he said that I would need to stay overnight and that hopefully the air would have gone by morning when I would have another X-ray and meantime to wear an oxygen mask. Patient No 1 was OK and happily set of home after a technician had set up his pacemaker and given him his pacemaker card to carry with him at all times. He then came to set up and explain mine and give me an appointment for the pacemaker clinic in eight weeks. I looked at my card to find that I had been fitted with a single chamber model by Boston Scientific an Essentio MRI SR Pacemaker basic rate 60 Mode VVIR. He of course did not know why I not been given a dual chamber model. He said since being fitted I had 13 pauses in my heart rate that had caused the pacemaker to kick in.
I had chosen chicken casserole for dinner but it was not quite as I expected and was rather exotic. My head started to sweat and I felt flushed and suspected that it might have MSG in it. I began to feel light headed and dizzy and called nurse. She had me lay flat on my bed and checked my BP that had dropped considerably. She thought that I might be dehydrated and had me drink some water and injected something into my cannula followed by a saline solution. My BP gradually start to recover but she kept me laying down for some time. When I felt better I sat up and had my dessert.
Overnight it chest pain felt worse and I passed that information on to the nurse. The consultant who had been supposed to fit my pacemaker came round with his team on ward rounds. After discussing my pneumothorax problem I asked why I not been fitted with the expected dual chamber pacemaker. That was a conversation killer as he had had obviously not know about it. The rest of his group stood open mouthed with nothing to say. He could only say that it must have been a decision made by someone after the pre assessment. I pointed out that my heart rate was now around 30% higher that it had been in recent weeks. He asked if my AF was usually a problem to me. I said that the only times in the past that I had been aware of it was when initially noticing the heart rate increase when suddenly going in to AF. The only other time I’m aware of it is when laying on my left side. He felt it may not need treating providing that I was protected by a blood thinner either Warfarin that I said that I had stopped due to joint pains or his preferred one Rivaroxaban that I have always said is contra indicated for patients with artificial heart valves and confirmed to me by the makers. He gave the usual cardiologists answer that it just has not been trialled on valve replacement patients as they are small group and that if it caused a brain bleed it would be less devastating than a stroke caused by a clot! In the end I agreed to try it. A nurse I had earlier been speaking to later said that I had surprised her by agreeing so easily.
Another X-Ray was done around lunch time. My bed was opposite the window to the nurses station. I could see a doctor, the sister and two nurses with very concerned looks on their faces looking at a monitor. I thought that must be my results and the doctor came through to see me still with the concerned look on her face. I said that I knew it was my results they were discussing. She said that the pneumothorax had worsened and that she needed insert a tube to let the air out. She said that it happens to one of their 30/40 patients a month but a nurse said that it has been happening more often recently.
I was not too concerned as I had fluid drained from a lung after my aortic valve replacement that had taken three days to drain. She went away to get the equipment and then laid out this impressive collection. Anyway after several shots of lidocaine and some morphine she inserted a long needle and a tube between my ribs. The tube went into a container with sterile solution and soon bubbles from the air were going through the solution. When they stopped she asked me to cough to force more out and turn from one side to the other force more air out. She went off to other things after telling me to keep active to keep the air flowing. When I stood up the tube filled with blood so I called for a nurse who was not sure if that should be happening. The doctor came back and was not too concerned about it but my chest pain was increasing making it difficult to move or breathe deeply. I was given more morphine and more oxygen through my mask and told to breathe as strongly as possible to expand my lung. The doctor decided that little was now coming out and if she removed the drain the pain would stop.
Back for another X-Ray that showed that most of the air had been extracted and very little liquid was now in the area. The doctor confidently expected that all would be well by morning.
During the afternoon I noticed Fridays first patient going into the main ward with his wife and hoped that he had not developed my problem. His wife came in to tell me that during the morning he had developed a chest pain that was going up into his throat and that he was sweating and had a headache. They did an ECG and checked him over and told him that he had a virus. Hospital acquired??
I had the X-Ray around 8.30 on Sunday morning and this time the doctor came back with a smile saying that it was clear and that I could go home. The consultant and his team came around again. My heart rate was still hovering at 100bpm and I asked him about another cardioversion or ablation to rid me of this AF beast. I have over the past few weeks had a numbness or lack of feeling in my left foot and lower leg that is now also starting to affect the right foot and have been having tests to find a cause for it. The consultant said that he would like that to be diagnosed fully before taking that route and would leave it for six months before seeing me to discuss it and by that time would know if the single chamber pacemaker was doing its job. I had also told him that I had inquired at a private hospital about having a left atrial appendage closure fitted (Watchman device) he said that they fit an alternative device the Amplatzer Device that we could discuss in the future to avoid the need for blood thinners.
I was still unhappy to be left with untreated AF and later spoke to the doctor who had performed the chest drainage. She suggested Diltiazem MR as an alternative to Bisoprolol and gave me some plus a prescription. It turned out to be a calcium antagonist and probably as bad for side effects as Bisoprolol and is contra indicated for me in some ways.
Write ups on pacemaker procedures seem to vary greatly for the recovery period. My dressing was removed the next day and I can wash normally from day five. Some say that the arm must not be raised over shoulder height my one says head height but I’m playing that one safe. No way do I want to need to have the wire detach itself. However until reading it here I had not realised that bending down to pick things up can also dislodge it.
I do not need any painkillers for the shoulder but I’m aware of it and it is a bit stiff. My concern is what movements I make when asleep or when first waking up and stretching without thinking. The wound looks quite neat with little swelling and I’m not sure if it is a bruising round it or if it is the antiseptic they splashed all over. I have to take 500mg of penicillin four times a day for five days. The first nurse gave me two capsules but the second only gave me one. When I questioned it the first one had obviously got it wrong. As they keep the drugs locked in your cupboard you are dependent on them giving them at the correct time. It did not always happen and I only had three on Saturday and other times the doses were either early or late.
After taking the Diltiazem on Sunday my heart rate dropped to 61. I wondered if it dropped below that and the pacemaker had kicked in. In the evening it crept up to 78 and was similar this morning. Today it has been around 66.