CONTACTS
SUBJECTS
Ablation Pulmonary Vein Isolation Resolve Paroxymal Atrial Fibrillat
3603 -
3603 - ..
3604 - Summary/Objective
3605 -
360501 - Follow up ref SDS G5 0000. ref SDS G4 0000.
360502 -
360503 -
360504 -
360505 -
360506 -
360507 -
360508 -
360509 -
360511 - ..
3606 -
3607 -
3608 - Background
3609 -
360901 - On 191206 1425 letter to VAMCSF Cardiology Doctor Simpson, ref SDS B4
360902 - NE9N, notify possible afib symptoms. ref SDS B4 N874
360904 - ..
360905 - On 191207 0927 Doctor Simpson to order ECG [...electrocariogram...]
360906 - Zio test for AFib, after he returns to work following several weeks
360907 - out of the office. ref SDS B5 NE9N
360909 - ..
360910 - On 191213 0849 call from Tina - scheduled install Zio equipment for
360911 - heart monitoring test; meeting room 2A16 on 191216 1230. ref SDS B6
360912 - NE9N
360914 - ..
360915 - On 191216 1220 Exmeralda in Cardiology at VAMCSF installed Zio XT
360916 - heart monitor on left chest; she added 2 plastic tapes to secure the
360917 - unit against fall off in shower and perspiration during hiking.
360918 - ref SDS C0 AO7H
360920 - ..
360921 - On 191214 1138 letter to Doctor Simpson in Cardiology at VAMCSF,
360922 - ref SDS B8 NE9N, reports 8 weeks ago increased hiking route with steep
360923 - hills from 11 to 15 miles per day. ref SDS B8 MX58 About a week ago
360924 - increased hiking to 20+ miles per day in order to improve weight
360925 - control and to raise lipids toward HDL 80. ref SDS B8 MX61 Weight
360926 - increased after pausing hiking due to orthopedic pain left knee and
360927 - both feet, which was solved after receiving oxycodone and gabapentin,
360928 - and applying elastic bandage to left knee. ref SDS B8 MX64 Today,
360929 - before hiking felt chest swaying indicating afib. ref SDS B8 MY30
360930 - Research indicates walking can aid recovery from afib; during hike
360931 - today, will reduce level of effort back to 15 miles per day, and avoid
360932 - steeper hills. ref SDS B8 368M Ask about medication to treat afib.
360933 - ref SDS B8 MY38 Offer to walk with Doctor Simpson to assist recovery
360934 - from hip surgery. ref SDS B8 MY41
360936 - ..
360937 - On 191214 1138 at 1324 letter from Doctor Simpson in Cardiology at
360938 - VAMCSF says to do hiking that has led to symptoms. ref SDS B9 0K4L
360940 - ..
360941 - On 191228 1416 letter to Doctor Simpson notify Zio log reports chest
360942 - pain hiking with elastic bandage on left knee. ref SDS C2 NE9N 1st
360943 - episode hiking 12 miles through Golden Gate Park on 191220, chest pain
360944 - mild lasted on ly .25 miles. Occurred again next day hiking 20 miles
360945 - up Crystal Ranch Road. ref SDS C2 B652 Occurred next day on 191222, so
360946 - stopped at mile .75 and removed elastic bandage from left leg, pain
360947 - ended for rest of 20 mile hike and on subsequent hikes 20 mile past 6
360948 - days. ref SDS C2 B655 Today on 191228, chest pain occurred hiking up
360949 - mild hills without elastic bandage on left leg, so ended hike at 7
360950 - miles. ref SDS C2 B658 HR 150 - should be 45 - 55. ref SDS C2 B662
360951 - Seems like bypass saphenous graft failed under elevated load wearing
360952 - elastic bandage on left knee. ref SDS C2 B665 Pause hiking until hear
360953 - from the doctor. ref SDS C2 B668
360955 - ..
360956 - On 191228 1416 at 1534 letter from Doctor Simpson notifies he will
360957 - order treadmill stress test. ref SDS C2 RK6L
360959 - ..
360960 - On 191228 1416 at 1537 letter to Doctor Simpson notifies will submit
360961 - Zio XT device with afib data on Monday, 191230. ref SDS C2 WO6F
360963 - ..
360964 - On 191229 1243 received letter from Doctor Simpson notifies need to
360965 - get ECG test at VAMCSF before they can schedule treadmill stress test.
360966 - ref SDS C4 NE9N Further says to get care in the ER if chest pain
360967 - recurs at rest. ref SDS C4 NH77
360969 - ..
360970 - On 191229 1243 at 1256 letter to Doctor Simpson asks where and when to
360971 - get ECG test. ref SDS C4 YH8N Notifies so far chest pain has not
360972 - occurred at rest; has only occurred when hiking. ref SDS C4 YA48
360973 - Notifies of EGD procedure in GI Clinic at VAMC Sacramento on 200107,
360974 - and getting MRI studies on feet and knees at VAMCSF on 200109.
360975 - ref SDS C4 YA51
360977 - ..
360978 - On 191229 1243 at 1420 received letter from Doctor Simpson advising
360979 - ECG is done on 2nd floor building 203, and to arrive about 1000.
360980 - ref SDS C4 LG4J Recommends notifying GI Clinic to delay EGD until
360981 - after resolution of current Cardiology issue. ref SDS C4 6H6G
360983 - ..
360984 - On 191229 1243 at 1538 received letter from Doctor Simpson advising
360985 - ECG was done in this case at the end of Oct, so do not need a new one;
360986 - next step is for VA to schedule stress test. ref SDS C4 E17N
360988 - ..
360989 - On 191229 1243 at 1619 sent letter to Jessica on notifying Doctor Lee
360990 - to delay next EGD scheduled on 200107 0730 for a month until 200204
360991 - 0730. ref SDS C4 4R7J
360993 - ..
360994 - On 191229 1243 at 1700 letter thanks Doctor Simpson for advising ECG
360995 - not needed. ref SDS C4 M48J
360997 - ..
360998 - On 191229 1243 at 1946 letter notifies Doctor Simpson that feet
360999 - elevated on footrest seem swelled. Cellphone reports HR 38. That is
361000 - low for me. Don't feel dizzy or light headed; seems like afib event,
361001 - with chest swaying back and forth. ref SDS C4 MH6N
361003 - ..
361004 - On 191229 1243 at 1946 letter notifies Doctor Simpson Zio device was
361005 - mailed to company a day early on 191229. ref SDS C4 UA47
361007 - ..
361008 - On 191230 0930 received call from Tina in Cardiology at VAMCSF
361009 - scheduled treadmill stress test on 200103, ref SDS C6 NE9N, report
361010 - first at 0700 to ASU on 3rd floor Building 200 for IV, then go to
361011 - Neuclear Medicine on ground floor building 203. ref SDS C6 GE5K
361013 - ..
361014 - On 191230 0930 at 0938 received letter from Doctor Simpson in
361015 - Cardiology explaining symptoms reported last night are okay, since not
361016 - dizzy, until after stress test. ref SDS C6 GF3G
361018 - ..
361019 - On 191230 0930 at 0949 received letter Tina in Cardiology confirming
361020 - schedule for stress test on 200103 0700, and submitting instructions
361021 - to prepare for the test. ref SDS C6 Q76I
361023 - ..
361024 - On 191230 0930 at 1021 letter to Doctor Simpson in Cardiology at
361025 - VAMCSF reporting stress test has been scheduled on 200301 0700.
361026 - ref SDS C6 9W6F Reported mild chest pain at rest for 10 minutes, but
361027 - it resolved while writing the letter. ref SDS C6 JY39
361029 - ..
361030 - On 191230 0930 at 1114 received letter from Lauren, NP and PCP in this
361031 - case; she concurs patient should go to ER if chest pain persists at
361032 - rest, and should have a driver. ref SDS C6 2S4N
361034 - ..
361035 - On 191230 0930 at 1117 received call from Aladin who is Lauren's
361036 - assistent in Medical Practice; he indicated Lauren asked him to call
361037 - and get background on chest pain issue. ref SDS C6 578G Explained
361038 - background is reported in correspondence with Doctor Simpson in
361039 - Cardiology, and this has been copied to Lauren. ref SDS C6 5W6J
361041 - ..
361042 - On 191230 0930 at 1135 responded to Lauren citing call from her
361043 - assistent, Aladin, and reporting background on current issue is
361044 - reported in correspondence with Doctor Simpson in Cardiology, who is
361045 - directing the work, and that Lauren has been copied on all
361046 - correspondence. ref SDS C6 659K
361048 - ..
361049 - On 200108 1130 Doctor Simspon ordered cardiac catheterization
361050 - (Angiogram) to evaluate for failed saphenous bypass graph. ref SDS D3
361051 - UV3M He also cordered Echocardiogram (ECHO) to evaluate cardiac
361052 - remodeling that may be causing atrial fibrillation. ref SDS D3 GG4F
361054 - ..
361055 - On 200113 0841 call from Gina in Cardiology scheduled echocardiogram
361056 - on 200214 1300 to evaluate for cardiac remodeling causing AF due to
361057 - high-intensity hiking. ref SDS D7 NE9N
361059 - ..
361060 - On 200115 0933 called VA Cardiology, ref SDS D9 Q18G; and talked to
361061 - Sue, who has taken the position of Karen for scheduling and
361062 - coordinatoing patient procedures. ref SDS D9 NB9G Sue scheduled
361063 - cardiac catheterization (angiography) on 200128 0730; and, pause
361064 - Apixaban blood thinner 2 days before the procedure. ref SDS D9 4L5N
361066 - ..
361067 - On 200115 0933 at 1747 submitted letter confirming work plan for
361068 - cardiac catheterization on 200128. ref SDS D9 5J7M
361070 - ..
361071 - On 200115 0933 at 1936 submitted another letter correcting date error
361072 - in the letter at 1747. ref SDS D9 4K5G
361074 - ..
361075 - On 200116 0948 received letter from Sue in Cardiology at VAMCSF
361076 - instructions for cardiac catheterization scheduled 200118, ref SDS E0
361077 - G367, pause Apixaban 2 days before 200118, ref SDS E0 G45M; NPO after
361078 - midnight, and until after Cath, ref SDS E0 6S30; bring list of
361079 - medications, ref SDS E0 6S76; bring charger for cellphone, ref SDS E0
361080 - 4B9H; do not drive for 24 hours after cardiac catheterization.
361081 - ref SDS E0 6S98
361083 - ..
361084 - On 200124 0705 cardiac catheterization angiogram performed by Doctor
361085 - Tietjens, ref SDS F1 V544; found all 4 bypass grafts completely clear -
361086 - no plaque buildup of any amount. Saphenous vein grafts in very good
361087 - condition 10 years after CABG x4; best result he has ever seen. He
361088 - said to continue doing whatever you are doing to achieve this
361089 - exceptional result. ref SDS F1 ME8G Doctor asked about hiking and HDL?
361090 - Hiking 3 - 8 miles per day 4 - 6 times a week yielded HDL 30 at time
361091 - of CABG x4 on 091022. About 4 years after surger, increased hiking to
361092 - 11 - 20 miles per day up to 7 days a week, this raised cholesterol to
361093 - HDL 83, that regressed plaque in blood vessels. ref SDS F1 CN7I
361095 - ..
361096 - On 200127 090153 Caroline called scheduled meeting with Doctor
361097 - Pelligrini in Cardiology Arrhythmia Clinic to schedule procedure
361098 - pulmonary vein isolation ablation resolve chest pain peroxysmal atrial
361099 - fibrillation (PAF). ref SDS F3 9C9M
361101 - ..
361102 - On 200320 1741 call from Doctor Pelligrini reporting 2nd Zio heart
361103 - monitor test found PAF episodes increased from 15% found in the 1st
361104 - Zio test last December to 23%. ref SDS G2 9C9M Progression of disease
361105 - requires ablation medical procedure to restore regular sinus heart
361106 - beat, which must be deferred 3 - 4 weeks during current coronavirus
361107 - pandemic. ref SDS G2 YV4L
361108 -
361109 -
361111 - ..
3612 -
3613 -
3614 - Progress
3615 -
361501 - At 0640 arrived in Cardiology on 2nd floor building 203. Waiting for
361502 - medical team to show up for ECHO test, planned in the call with Karen
361503 - in ASU yesterday, on 200429 0700. ref SDS G5 U43I
361505 - ..
361506 - Cardiology patient check-in office was closed. Sign on the door said
361507 - it would open at 0830.
361509 - ..
361510 - Walked across the hall to Cath Lab.
361512 - ..
361513 - Went in and talked to staff.
361515 - ..
361516 - A nurse checked the computer for scheduling ablation procedure today.
361517 - She said nothing is scheduled.
361519 - ..
361520 - On further discussion, she found the procedure scheduled for today.
361522 - ..
361523 - Followed the nurse to the elevator; went up to 3rd floor, and into
361524 - ASU.
361526 - ..
361527 - Nurse Renea took vitals. Blood pressure seems low (like 110 60) and
361528 - HR high (like 70). Dressed in hospital gown for the procedure.
361530 - ..
361531 - Clothing, computer, keyboard, cellphone were inventoried and placed
361532 - in large plastic bag, which was sealed with a strap.
361534 - ..
361535 - Cath Lab nurse walked me to another department to get weight.
361537 - ..
361538 - Weighed in at 184.
361540 - ..
361541 - Walked back to procedure preparation and got on a gurney.
361543 - ..
361544 - Renea set IV in left wrist. She was very good. Didn't feel stick.
361546 - ..
361547 - Anesthesiologist came to discuss sedation procedures. She seemed
361548 - familiar with limitations on versed, and so will use a different drug
361549 - today. The anesthesiologist seemed like the same Doctor Marilyn
361550 - Michela, who did sedation for Doctor Stewart during the lipomo removal
361551 - surgery on 190204 1200. ref SDS 91 4U8K
361553 - ..
361554 - While we were talking Adam arrived. He assists Doctor Pellegrini with
361555 - ablation procedures in the Cath Lab. Adam asked about patient history
361556 - of hiiking and onset of paroxysmal atrial fibrillation that happened
361557 - on 191210, reported in case study on 190101 0730. ref SDS 88 YTWS
361559 - ..
361560 - Adam indicated there is a better chance of success with ablation in
361561 - this case, because it is being performed within months after PAF
361562 - symptoms first occurred, rather than years after onset of disease.
361564 - ..
361565 - While discussing the ablation procedure and patient history, Doctor
361566 - Pellegrini arrived.
361568 - ..
361569 - The doctor seemed to say ablation will burn tissue spots in a ring
361570 - around tissue causing electrical signals in the left atrium...
361571 -
361572 - .
361573 - . .
361574 -
361575 - . E .
361576 -
361577 - . .
361578 - .
361579 -
361581 - ..
361582 - The explanation seemed to indicate this "ring" forms a net that traps
361583 - electrical signals to prevent triggering erratic heart beats, so the
361584 - sinus node can maintain steady rhythm of a beating heart.
361586 - ..
361587 - After the meeting today, research found a video...
361588 -
361589 - Pulmonary Vein Isolation Ablation
361590 -
361591 - https://www.youtube.com/watch?v=-0UOw_Cnzgw
361592 -
361593 - Another youtube explains similarly...
361594 -
361595 - https://www.youtube.com/watch?v=VPaBbu0oKcM
361596 -
361598 - ..
361599 - Another source says...
361600 -
361601 - Pulmonary vein isolation
361602 -
361603 - https://www.mayoclinic.org/tests-procedures/pulmonary-vein-isolation/about/pac-20384996
361604 -
361605 - Pulmonary vein isolation is a procedure used to stop abnormal
361606 - electrical signals in your heart that cause heart rhythm
361607 - problems.
361609 - ..
361610 - Pulmonary vein isolation is a type of cardiac ablation.
361611 - Cardiac ablation works by scarring or destroying tissue in
361612 - your heart that triggers an abnormal heart rhythm. In some
361613 - cases, cardiac ablation prevents abnormal electrical signals
361614 - from traveling through your heart and, thus, stops the heart
361615 - rhythm problem.
361617 - ..
361618 - In pulmonary vein isolation, the procedure creates scar tissue
361619 - in the part of the left upper chamber of your heart where each
361620 - of your four pulmonary veins connects. Your pulmonary veins
361621 - bring oxygen-rich blood from your lungs to your heart.
361622 - Pulmonary vein isolation can reduce the signs and symptoms of
361623 - atrial fibrillation, which affects the upper chambers of the
361624 - heart.
361625 -
361627 - ..
361628 - Another more extensive presentation of cardiac ablation generally and
361629 - focusing on electrical activity in the heart...
361630 -
361631 - Basics of EP Testing and Ablation by Adam Zivin, M.D.
361632 -
361633 - https://www.youtube.com/watch?v=Giq3m7zh5bY
361635 - ..
361636 - Doctor Pellegrini said the CT test yesterday on 200429 0700,
361637 - ref SDS G5 Y64H, shows a possible blood clot in the heart. Ablation
361638 - cannot be performed with this condition. The doctor wants to do the
361639 - TEE procedure, which was cancelled yesterday. It will confirm if
361640 - there is a blood clot. If TEE does not show a blood clot, then the
361641 - doctor will do ablation today.
361643 - ..
361644 - Adam advised TEE is similar to EGD procedure using a gastroscope to
361645 - examine and treat the esophagus and stomach. Lidocane will be given
361646 - to numb the esophagus. Findings from TEE may be sufficient for Doctor
361647 - Lee to cancel EGD scheduled next week on 200505.
361648 -
361649 - Transesophageal echocardiogram (TEE)
361650 -
361651 - https://my.clevelandclinic.org/health/diagnostics/4992-echocardiogram-transesophageal-tee
361653 - ..
361654 - A transesophageal echo (TEE) test... uses a long, thin, tube
361655 - (endoscope) to guide the ultrasound transducer down the
361656 - esophagus
361657 -
361658 - ...the doctor see... the heart without the ribs or lungs
361659 - getting in the way. A TEE is done when your doctor needs a
361660 - closer look at your heart
361662 - ..
361663 - Seemed like 5 or 6 people in the room. There was discussion about
361664 - doing TEE test there in ASU or downstairs in the Cath Lab. Doctor
361665 - Pellegrini decided to do the TEE in the Cath Lab. If the test is
361666 - negative, she can immediately do the ablation procedure, without
361667 - further moving the patient. If there is a blood clot, the patient can
361668 - be moved to Med-Surg for recovery and discharge. In that case, will
361669 - schedule ablation for weeks or months later, after treatment to
361670 - resolve blood clot in heart. This would be a major disappointment.
361672 - ..
361673 - Still on the gurney was pushed out of ASU and into an elevator. The
361674 - entire team walked back to 2nd floor and into Cath Lab.
361676 - ..
361677 - There was discussion whether to move patient from gurney onto Cath Lab
361678 - table to perform TEE, or do TEE with patient still on the gurney? It
361679 - was very crowded in the room at this time. Seemed like 8 or so
361680 - people, plus the procedure table, and the gurney, which came from ASU.
361682 - ..
361683 - Was decided to do TEE on the gurney. If results are negative, patient
361684 - will be moved from the gurney onto the Cath Lab table for performing
361685 - ablation.
361687 - ..
361688 - Doctor Michela used a probe to squirt lidocane into the mouth. Had
361689 - initial difficulty gargling. After several tries, where the doctor
361690 - squirted additional lidocane, she was satisfied gargling was
361691 - sufficient. Seemed like throat felt more numb (thick) than usually
361692 - occurs with EGD procedures.
361694 - ..
361695 - The doctor applied the anesthesia drug.
361697 - ..
361698 - Was asleep for TEE and then ablation procedure.
361699 -
361700 -
361702 - ..
3618 -
3619 -
3620 - 1230
3621 -
362101 - Woke while being pushed on a gurney from Cath Lab into 2nd floor
362102 - Med-Surg for observation overnight.
362104 - ..
362105 - Shared room with another patient who suffered from condition that
362106 - caused severe, extreme and continuous coughing and hacking, and
362107 - delirious shouting out profanities, as if dreaming. This occurred
362108 - througout the day and night, with brief interludes, when the patient
362109 - slept.
362111 - ..
362112 - Machele was the nurse. Did a great job, until shift change, when
362113 - Nadine took over. Nadine was terrific as well. Both very helpful.
362115 - ..
362116 - Adam advised TEE was negative for blood clot. Doctor Pellegrini then
362117 - performed ablation, and has indicated this was very successful
362118 - procedure.
362120 - ..
362121 - Think Doctor Pellegrini came into the room briefly. Confirmed Adam's
362122 - understanding that the procedure met all criteria and without
362123 - complications. Good likelihood AF will not recur, for reasons Adam
362124 - presented earlier in ASU, per above. ref SDS 0 F861
362126 - ..
362127 - Stayed in bed rest of the day feeling very tired and weak. Did not
362128 - try to write up the record.
362130 - ..
362131 - Later research found...
362132 -
362133 - Ten things to expect after AF ablation
362134 -
362135 - https://www.drjohnm.org/2014/12/ten-things-to-expect-after-af-ablation/#:~:text=The%20resting%20heart%20rate%20can,This%20phenomenon%20usually%20resolves.
362136 -
362137 - December 16, 2014 By Dr John
362138 - Filed Under: AF ablation, Atrial fibrillation
362140 - ..
362141 - AF ablation is a big deal:
362143 - ..
362144 - The first thing to say about AF ablation is that it is a big
362145 - procedure. I tell patients to expect AF ablation to be hard on
362146 - them. How could it be easy to undergo hours of general
362147 - anesthesia, insertion of big tubes in the leg veins, 50-75
362148 - burns in the atrium and hours of bed rest?
362150 - ..
362151 - Resting heart rate changes:
362153 - ..
362154 - The resting heart rate can increase in the weeks or months
362155 - after ablation. The increase is usually 10-20 beats per minute
362156 - more than pre-procedure levels. This phenomenon usually
362157 - resolves.
362159 - ..
362160 - Exercise Tolerance:
362162 - ..
362163 - The ability to sustain exercise can be decreased for weeks to
362164 - months after the procedure. It will likely come back. The
362165 - reasons AF ablation transiently decreases exercise tolerance
362166 - are numerous: it is a big procedure, the burns can cause
362167 - stunning of the atria, there is deconditioning that occurs
362168 - before and after the procedure, and many patients remain on AF
362169 - drugs for a month or two after the procedure.
362171 - ..
362172 - Digestive problems:
362174 - ..
362175 - I have seen, in a handful of cases, patients have trouble
362176 - moving food through their GI tract after ablation. Symptoms
362177 - include reflux, feeling bloated, and intolerance of big meals,
362178 - while signs may include distention of the abdomen.
362180 - ..
362181 - Ablation in the left atrium may transiently damage nerves that
362182 - control motility of the GI tract. The good news is that these
362183 - effects resolve with time. I usually treat this problem by
362184 - recommending small meals, and an acid blocker.
362185 -
362187 - ..
362188 - We arrived in the room after lunch was served, but an attendant
362189 - brought a lunch tray. Did not feel like eating anything.
362191 - ..
362192 - Similarly, dinner tray was delivered OA 1700. Could not eat
362193 - anything.
362195 - ..
362196 - In late PM, nurse removed dressing from puncture wounds where ablation
362197 - access occurred on both upper legs. The wound on right leg bled
362198 - continuously. Several nurses tried for about 15 minutes each stopping
362199 - the bleeding holding gause on the wound.
362201 - ..
362202 - Doctor David Aderson was summoned from home to stop the bleeding. He
362203 - was successful using a combination of lidocane and another agent.
362204 - This took half an hour with the doctor holding pressure on the
362205 - bleeding wound. The doctor remembered this case from doing treadmill
362206 - stress test on 200103 0700. ref SDS C9 2J4H
362208 - ..
362209 - Was feeling very ill prior and during this procedure. Thought it
362210 - might be due to not having eaten for 30 hours or so.
362212 - ..
362213 - Doctor Anderson suggested a nurse place a cold compress on my
362214 - forehead. After this was done, felt better. Was able to sleep for an
362215 - hour or so.
362217 - ..
362218 - Talked several times with Kathy.
362220 - ..
362221 - Called and left message for Sally.
362223 - ..
362224 - Got a call from Rob. Talked for about an hour late at night. He
362225 - related again his friend had success after ablation getting back on
362226 - his bike to do long-mileage cycling.
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362235 -
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3623 -