History of 5 Pulmonary Vein Ablations in 5 years Yet Causality Denied 2017-12-06T20:16:17+00:00

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  • Dr. Moiseky Kman
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    #7539 |

    I am a well-read medical professional with 32 years of clinical practice, albeit not in pulmonary medicine, but I do know when something is not right when even the minutest of tasks precipitate shortness of breath, dizziness, extreme fatigue and positional lightheadedness on the verge of blacking out. Today marks the 2 year and six month anniversary of the start of my painfully frustrating, humiliating, and life changing experiences in an attempt to get to the bottom of what is causing my functional decline. I needed to stop working, retire my license to practice, and severely limit my activities to strategic levels of minimal functioning to carry out activities of daily life.
    It was 2 years ago that I had a right heart catheterization which showed equivacable findings. Repeated echos do indeed display pulmonary vein narrowing. Recent CT angiography revealed ‘mild to moderate’ reduction in pulmonary vein diameter in my left atrium. According to the literature, this correlates with a reduction to 25-50% of the original size. Other findings on CT consist of left pulmonary artery enlargement, increased right ventricle wall thickness, left basilar atelectasis, and significant left pulmonary artery thickening and reduced vascularization of the lung tissue itself. Current thinking is that there is discordance with what is seen radiologically and what is seen clinically. This means that ‘what the patient feels is worse than it looks.’
    My cardiologist disputed peer reviewed journal articles reflecting the current thinking on radio frequency ablation as a treatment for paroxysmal atrial fibrillation and its association with iatrogenic ‘pulmonary venous hypertension.’ The incidence of PVH has been cited as ranging from 3-26% of cases. But, that incidence is only with 1x ablation and not the 5x ablations which I had. The pulmonologist who I saw, touted as a PAH expert, reviewed the CT angio in my presence, looking solely at the pulmonary arteries, not the pulmonary veins, or even the radiologist report indicating the pulmonary vein pathology. In response to my worsening symptoms, he recommended having my CPAP air volume to be increased, and he told me to “See a left sided heart doctor because I’m a right sided heart doctor only.” This was a PAH pulmonary specialist telling me this. So I played along and asked for a ‘left sided heart doctor.’ Needless to say that ended the visit.
    From my perspective, I just want to feel better, I don’t want to get any worse which is in fact happening. And, I certainly do not want/or expect to be treated the way I have experienced by ones entrusted with my care. Its extremely unsettling when your presenting signs, symptoms, and spot-on clinical history point to a problem which is causing a lot of suffering not only for me but for my family too.
    2.6 years and counting, disabled, out of work, and only a minimally effective bronchodilator to show for it. PVH is a relatively new clinical consideration in the realm of PAH and needs to be recognized as such by the medical community because of the great number of patients treated by radio frequency ablation for atrial fibrillation.

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