It was a perfectly ordinary day at work. Joe, age 51, felt just fine that morning. He was busy working at his desk when he felt his heart suddenly start beating incredibly fast. Then he felt hot and had a hard time catching his breath. He'd never experienced anything like that, so he got up and walked out to get some fresh air. As he walked, he began sweating and feeling nauseous. He noticed that his left hand and arm were numb. Classic signs of a heart attack? He wondered.
A coworker saw what was happening and rushed him to a nearby doctor's office. The doctor's office wasted no time calling 911.
"I was starting to get scared," Joe says. "The ambulance paramedics were looking at my vital signs and telling me to relax, but there was nothing I could do to slow down my heart. Then I saw a paramedic get the defibrillator paddles ready, and I knew I was in real trouble. I told them to tell my wife that I loved her."
The paramedics gave him a nitroglycerine pill to put under his tongue. Within a few minutes, as suddenly as the racing had started, his heart began beating normally again. Tests revealed that Joe had not had a heart attack. What he had experienced was sudden onset of atrial fibrillation, a misfiring of the heart's electrical system that causes the heart to beat erratically and race out of control.
Joe received a referral to Dr. Gurbir Dhaliwal, a cardiologist at Sutter Health who saw patients near Joe's home in Yuba City. Dr. Dhaliwal explained what was happening with Joe's heart during the attacks. He also warned that atrial fibrillation put Joe at risk of a stroke because blood that doesn't move through the heart normally can form clots, which could then travel to the brain. To determine the best course of treatment, Dr. Dhaliwal referred Joe to Dr. Subramaniam Krishnan, a cardiac electrophysiology specialist at Sutter Health who treats conditions related to the heart's electrical system.
As often happens once atrial fibrillation starts, the attack that sent Joe to the hospital was the first of many. Though he was on relatively high doses of medications to prevent the abnormal rhythm attacks, they persisted. The attacks came out of nowhere and lasted anywhere from a few seconds to several hours. When the attacks struck, Joe had to stop whatever he was doing and sit down immediately until the breathlessness and dizziness passed. There was no way Joe could drive from his Yuba City home to work in Rancho Cordova. In fact, driving at all was risky, so he was relieved to learn that Dr. Krishnan came to Yuba City twice a month to see patients.
"We are fortunate to have an expert such as Dr. Krishnan providing arrhythmia clinic services locally," said Dr. Tin Way, chief of cardiology for Sutter North Medical Group. Dr. Way was instrumental in bringing electrophysiology consultation services to patients who live in Yuba City, Marysville and surrounding communities. "Patients now have the option of being evaluated locally and only traveling to Sacramento if they need invasive procedures. It's rare to have such expert arrhythmia care available in a community such as ours. We're very appreciative of his services."
Dr. Krishnan reviewed Joe's test results and examined him before telling Joe that there was every likelihood he would benefit from a procedure called catheter ablation, which does not require open heart surgery. Instead, Dr. Krishnan would puncture the blood vessels in Joe's groin and thread a small device through large blood vessels to the heart. Once the device was in the heart, Dr. Krishnan would stimulate the electrical activity to locate the abnormal areas generating the misfiring impulses. He would then place a tiny device on the abnormal cells to freeze and destroy them. If successful, the procedure would stop the abnormal heart beats and racing heart. As promising as the technique was, Dr. Krishnan cautioned Joe that the procedure sometimes needs to be repeated.
Unfortunately, Joe had to live through several months of atrial fibrillation attacks due to unanticipated insurance issues that slowed down the process. The attacks continued with little relief, sometimes even waking Joe from a sound sleep. Most attacks passed quickly, but one lasted for eight miserable hours. Joe was more than ready for his procedure. He and his wife arrived at Sutter Medical Center, Sacramento at 5:30 a.m. with high hopes.
For his part, Dr. Krishnan was intent on making this first procedure successful. He spent more than three hours verifying which cells were sending out the misfiring signals and ensuring they were destroyed. He felt confident that he had achieved success, but knew that only time would tell.
"Dr. Krishnan was unbelievable," Joe says. "He made sure my wife got back to see me as soon as she could and patiently explained everything to us. By the time I had recovered enough that my wife felt she could drive home to Yuba City, Dr. Krishnan was concerned about her safety. He felt it was too late for her to drive, so he had a bed brought in so that she could sleep in my room."
To everyone's delight, the catheter ablation was an unqualified success. Joe was able to get back to work within a few weeks, and he's been completely free of atrial fibrillation since the procedure.
"You hear advertisements about care that's all about the patient," Joe says. "That was absolutely true in my case. Dr. Krishnan and his nurse, Joel Pascual, were right there for us every step of the way. I can't speak highly enough about the care I received. And it gave me back my life."