From Scary to Stable: Patient Finds Afib Relief... and More
February 26, 2019
Retired church administrator Ron Smith has many things that make his heart quiver: photography, woodworking, his wife of 55 years, and his four kids, 11 grandkids and one great-grandbaby. But what started making him uncomfortable was an ever-increasing number of heart palpitations that made his heart literally quiver.
When that quivering became distracting, Ron checked in with his Adventist Health-Portland primary care physician, who listened to Ron’s heart carefully and ran some tests. It appeared Ron might have atrial fibrillation (AFib), a condition in which the upper chambers of the heart (the atria) beat irregularly. He was referred to cardiologist Dr. Mark Hart at Northwest Regional Heart & Vascular.
During Ron’s first visit, he had an electrocardiogram (also called an ECG or EKG). Dr. Hart could tell Ron had Afib. At best, the feeling can be unnerving; more concerning is the opportunity for blood to pool in the heart and cause a stroke.
This was a diagnosis Dr. Hart knew well. A leader in cardiology, Dr. Hart is medical director of the catheterization lab for Northwest Regional Heart & Vascular. He has also led or contributed to more than 30 clinical trials.
Under Dr. Hart’s guidance, Ron started a phased treatment protocol, beginning with a conservative approach that included a medication to help with AFib as well as a blood thinner to reduce his risk of stroke. The medication helped, but didn’t eliminate his irregular heartbeat.
Ron and his cardiac team decided to move to the next step in his treatment plan. Ron’s heart imaging showed he had no valve disease or clogged blood vessels. “My heart was in great shape,” Ron says. “I think I have genetics in my favor that way. I was glad for that.”
With this in mind, Dr. Hart scheduled Ron for cardioversion—an outpatient procedure during which electrical shocks are delivered to the heart to restore a normal rhythm. “I was admitted to an outpatient room, and they administered anesthesia—a quick knock out for maybe five minutes,” Ron explains. “Then they shocked my heart and knocked it back into a sinus rhythm, which is what we wanted.”
The effect lasted for about two weeks, but then Ron’s heart palpitations returned. Encouraged by the initial success of the cardioversion, Ron and Dr. Hart made several more attempts over the next year.
Ron’s cardiac stress test had revealed Ron had a competing heart problem: a left bundle branch block. This meant there was a blockage in the electrical pathway that carries impulses to the lower chambers (ventricles) of Ron’s heart. “That may have been caused by rheumatic fever I had when I was 14,” Ron says.
With that in mind — and when it became clear cardioversion couldn’t offer Ron a permanent solution — Dr. Hart referred Ron to Dr. Fawaz Alhumaid, a heart rhythm specialist and director of arrhythmia services at Adventist Health-Portland.
The bundle branch block made Ron’s AFib harder to treat. Dr. Alhumaid explained that treatment for one condition tended to make the other worse. “Big treatment for AFib would impact the bundle more — the latter being more dangerous because it could stop my heart,” Ron says.
Dr. Alhumaid suggested Ron try cardiac ablation. He explained how, during the ablation procedure, he would follow the map of Ron’s heart signals to the exact nerve cells that were causing the chaotic signals. Using heat, Dr. Alhumaid would kill the problematic cells while keeping the proper nerve signals healthy.
“I was a little apprehensive about that one,” Ron admits. “But I was encouraged by the fact they do so many of them. The doctor explained very carefully the pros and cons, the risk factors.”
On the day of his ablation surgery, Ron’s concerns were eased again as he was wheeled into the special operating theater at Northwest Regional Heart & Vascular. “Being a little bit of a techy, I was so impressed. There were huge monitors above and beside me so the doctor could see everything he was doing remotely,” Ron recalls. “It was amazing—absolutely amazing. I felt confident just by the way they handled themselves and the obvious investment in equipment and technology.”
His mind at ease, Ron went under anesthesia. The surgery went smoothly, and Ron spent one night at Adventist Health Portland for observation. As Ron headed home the next day, he only had a little discomfort in his groin where his heart team inserted his catheter during surgery.
The cardiac ablation was a success. Ron’s heart rhythm was steady as he came out of surgery, and the effect has lasted for years now.
Dr. Alhumaid hadn’t forgotten Ron’s bundle branch blockage. During a follow-up visit, he asked Ron to watch himself carefully. “He said, ‘If you have any fainting spell, I want you to be in touch,’” Ron says.
Ron remembered Dr. Hart’s concerns. One day he was driving to his regular check-up and, at a stop light, felt his heart just stop for a moment. “I never blacked out, but I came close,” Ron says. Shaken and pale, he finished his drive to Northwest Regional Heart & Vascular.
When Dr. Alhumaid heard about Ron’s episode, he left a standing order at the desk for Ron to have an EKG upon request anytime he felt he had an issue. “That was a comfort to know that,” Ron says.
Ron was also comforted that Dr. Alhumaid was taking his issue serious. “He really got serious about studying and thinking over my situation,” Ron says. “It was obvious he didn’t just think about me when I showed up for an appointment.”
Knowing Ron’s episode could repeat anytime — and wanting to be careful not to trigger his AFib by treating the bundle branch block — Dr. Alhumaid broached the idea of inserting a pacemaker. “He explained he was seeing a gradual increase in my bundle branch problems over time and warned me that, at some point, it would need a pacemaker anyway,” Ron says. “He explained the possibilities and recommended we go ahead with the pacemaker and eliminate the likelihood of my fainting and falling or crashing a car.”
With Dr. Alhumaid’s explanation, Ron agreed and had the pacemaker implanted. It regulates his heart and transmits data that is monitored at Northwest Regional Heart & Vascular. “In a nutshell, basically my day-to-day feeling with health and life and all that is back where it was 10 or 15 years ago,” Ron says. “I have virtually no noticeable odd things happening with my heart.”
Now Ron sees Dr. Hart once a year for a checkup, as long as the pacemaker data continues to look good. Ron appreciates the phased protocol his doctors championed. “They’ve really thought it through,” he says. “They have all these tools and procedures available, but they’re not going to subject you to them if they’re not necessary.”
In addition to the confidence-building technology and expertise Ron encountered at Northwest Regional Heart & Vascular, he values obvious care and compassion the entire staff has for patients. “I’ve been going to Northwest Regional Heart & Vascular for years now, and I have not met anyone who wasn’t cordial, good-natured and helpful,” Ron says. “Even the appointment schedulers are friendly, as well as the nurses on the floor during the night.”
He also appreciates that all his care is coordinated through his Adventist Health primary care provider, Dr. Matthew Satcher. “All my records are available online in MyChart,” Ron says. “I love that.”
Every step of his journey, from bringing his early concerns to his Adventist Health primary care provider to meeting with his cardiac team at Northwest Regional Heart & Vascular, Ron has appreciated the patient-centered care he’s received. “They made it comfortable and easy,” he says. “You can have confidence these doctors really know their stuff.”