CW: Pedaling to an AF victory…without a 3D-mapping system

Everyone likes winning. Bike racers like it. So do doctors.
When doctors win, lives get better.  That’s the ends. The means, the journey, the race itself, vary from the simple to the complex, from the boring to the eventful, from the free to the obscenely expensive.
For instance, lives are enhanced when a complex catheter-based procedure succeeds. When those red dots form barriers that organize the squiggles. And then, with persistence and neural-pathways honed over years—like a surgeon who knows how deep to cut—applying a few more burns stops the arrhythmia. The heart pauses and restarts, now with a beautiful regularity.  Ah…this feels so good, still.  Winning doesn’t tire.  
But does victory always require such technological fury?
Can victory be had with something much simpler?

It is dumping rain; a miserably cold rain exacerbated by the early-afternoon darkness of November. The windshield-wipers couldn’t keep up.  In a warm car, I was rushing home to get on the trainer before dinner.   Through the haze there is a blinkie up ahead. “No way,” I thought, “someone is riding home in this crap…Are they serious?”

A decision awaits.  

Drive by?  Or ask?

Bloggers ask.

I cracked the window just enough to ask, “pretty rough out…hey?”

From behind the rain-soaked wrappings a cold and familiar face proudly proclaims, “Hey doc, what’s up? You race CX, so I know you ride in this stuff too…I am seeing you next week.”

Wow, I thought. “Good for you, be careful.”

Days later, in the office, he tells me that I changed his life. Looking down at the chart to see whether he had an ablation, which he had not, I looked up at him.  Before I could ask how, he offered…

“Months ago you told me…no one who rides a bike should be as fat as you are…You were right.”

A thinner more confident young man was before me. 

“How’s your AF?” I asked, as this was the reason for the office visit.

“It is gone.”

“But we stopped your medicine; it should be worse,”

“I am different now.”

Like bike racers, AF-doctors know a win is a win.
Somehow a spark was struck, a fire lit. This, without a stent or nary a single GPS-guided red-dot to the heart.  In this case, the ‘program’ rode away—through the pouring down rain and November cold—for the victory.  Good choices bested pills and averted–at least for the near term–a complex procedure.  
Obviously, not all that ails the heart can be cured by simple lifestyle choices.
A lot could, though.
If only we doctors could light that spark as easy as we can squish a blockage, burn an aberrant pathway, or install a device.
It was really cold out.  He was riding.  That’s a triumph. 

JMM

3 comments

  1. That's an incredibly heart-warming story.

    Prevention is truly better than cure, and lifestyle measures impact on the disease much earlier in the process than drugs/ surgery.

    I don't take on patients for AF ablation if they have a BMI>40. What's the point?

  2. I am a firm believer that even though that many studies point to extreme exercise as a cause for AF. My personal experience tells me that vigorous exercise and being fit can also counteract, or at least inhibit it as well. During my bout with AF, before my ablation, my AF would go from being somewhat problematic to completely dormant for as long as a year or more.
    This correlated with my fitness fluctuations during the on and off season along with years I really made an effort to maintain a higher fitness level throughout the winter months. I also know that July and August could be problematic months for me as well if I was not diligent about hydration and electrolyte replacement.
    That being said I also believe that it is a temporary fix to a permanent problem as after a while no matter how fit I became the AF just became worse.

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