Harald Renner

When I first met Professor Paul in my heart matter, I was surprised by the youthful appearance and the vivid, gentle voice of the cardiologist. I would have thought she was more of a politician than a doctor. He was surrounded by a cultivated ambience that conveyed the impression of solidity and seriousness. I was also impressed by how much time he took for our first conversation. I was allowed to tell him in detail about my tale of woe. He listened to me attentively, interrupted me only occasionally with specific questions and took notes.

My "matter of the heart" had been bothering me for about ten years. At first I still believed in a one-off event with my arrhythmias, then in avoidable triggers of the seizures. I developed avoidance strategies: avoidance of alcohol, coffee and extreme stress, reduction of stress. I learned autogenic training, moved regularly and perseveringly and changed my diet. In the following years, however, the frequency and duration of seizures increased. The end of every seizure was like a relief: suddenly palpitations, discomfort and anxiety disappeared in the chest. Three years ago, the diagnosis of "atrial fibrillation by seizure" was made and a drug therapy was initiated, but nothing could effectively stop the course of the disease. Three months ago my heart went completely out of time, and only rarely did the stumbling phases change into a normal heartbeat. I felt miserable, exhausted and "beside the role". Fortunately I had been retired for four years and no longer had to prove myself in my profession.

Suddenly the chief physician got up from his chair and hurried to the bookcase behind the desk. He quickly found what he was looking for: an atlas of cardiac arrhythmias. He opened the book where the bookmark protruded over the edge.

"Do you know what catheter ablation is?"

"Not much," I admitted.

"Then I will explain with these pictures. Look, this is a picture of the left atrium. You can see the four confluences of the pulmonary vein. It is now known that atrial fibrillation can be triggered by additional electrical impulses from the pulmonary veins. Catheter ablation should therefore electrically isolate the pulmonary veins so that these impulses cannot spread further. It's that simple."

"And how does it work technically?" I asked worriedly.

"In anaesthetised or centrally steamed patients, catheters are inserted through the inguinal veins into the right atrium. The left atrium is reached by a puncture of the atrial septum. There, the critical tissue is heated with high-frequency current and its structure is destroyed."

"How risky is that?"

"Catheter ablation is basically a gentle procedure. Complications are rare, but they do occur. In two percent a stroke or a heart attack is to be expected, in a further two percent a blockage of the pulmonary vein, which would have to be treated surgically, and very rarely the heart muscle can also be injured with pericardial effusion. In positive terms, 96 percent of the time, the procedure has no complications."

"Would you advise me on the operation?"

"I'm afraid I can't make that decision for you. You'll have to meet them yourself. When we talk about the risks of the procedure, we must not overlook the opportunities. If all goes well, you will get a completely normal heartbeat again, without medication with the sometimes severe side effects. You'd actually be cured of your illness. Take your time with your decision and call me when she's fallen."

Three days after this conversation, I decided to undergo the procedure. My heart's desire has not tolerated any further delay.

On January 17, all preliminary examinations and surgical preparations were completed. At 9 o'clock I fell asleep after an intravenous injection. Two to three hours later everything should be over. Around noon I would wake up from the anaesthetic.

When I opened my eyes, the ICU wall clock showed 6:00 p.m. "Are you all right? Can you hear me," the anaesthetist asked. Shamefully blurred I recognized him. I nodded, had a furry feeling in my throat, just wanted to keep sleeping. "Do you understand me?" the doctor asked again. Again I nodded.

"The operation didn't go as it should. Your heart muscle was accidentally perforated in two places. We gave you emergency surgery. Don't worry, everything will be all right." He said something else, but I was asleep again.

It took me a whole week and a lot of persistent questions to get a clear picture of what was happening that day. It is understandable that they were hesitant to tell the whole truth, and not every patient would have been able to cope with it. I felt strong enough for the facts.

Catheter ablation had gone well, and after two hours all disturbing sources were isolated in the left atrium. The electrophysiological control indicated a good surgical success. The team relaxed, my air tube was removed, and I was to be transferred to the guard station. At that moment my circulation collapsed, cardiac arrest, out of the blue, completely unexpected. After two minutes of bloodlessness, brain death begins, as we know.

In this unimaginably short period of time, the surgical team saved my life. Fortunately, the ultrasound device was still ready for operation and the diagnosis "pericardial tamponade" was quickly made. Under ultrasound control, a puncture needle was quickly inserted from the outside through the chest muscle into the pericardium. With the help of this needle, the leaked blood was sucked out so far that the heart could unfold freely again. Through the two holes in the heart wall, new blood constantly ran into the pericardium and had to be continuously aspirated. The highest haste was called for. The leading heart surgeon of the house decided to split my sternum, open my chest and literally take my heart into my hand in an emergency operation. It only took him a few minutes to suture over the two injuries. The bleeding was permanently stopped, my circulation remained stable, my cardiac arrest had not exceeded the critical time mark. I was saved.

I stayed in the intensive care unit for two days, then I was transferred to the cardiosurgical unit for a few days, and after one week I was able to start the rehabilitation treatment, which lasted three weeks.

Professor Paul came halfway to meet me when I entered his office for the second time, on the much longed-for day of dismissal.

"How are you feeling?" he asked after he greeted me with a strong handshake and led me to a comfortable leather chair.

"I'm getting better every day."

"That's what I like to hear." He took a seat opposite me and looked in detail at my medical record: "Well, that looks great," he finally summed up his impression. With an apologetic gesture, he came back to the "grave misfortune" that had obviously bothered him.

"You've been very cooperative and understanding, for which I want to thank you very much. And you were brave too. Exemplary!" He gave me a look of warm admiration.

I nodded to him friendly, but did not answer. He gently touched my arm.

"You know, even in the best specialty clinics, things don't always go according to plan. Even if doctors and assistant personnel go to every conceivable effort and observe all the rules of medical art. Ablation treatment is still new worldwide. It was only a few years ago that it outgrew the field of experimental heart surgery. Of course, the risks are greater than with traditional methods. "You've been well prepared for the risks, haven't you?"

It no longer held me in my armchair, I had to breathe and move, needed distance to flatter the chief physician, who seemed to have mastered the concern about the reputation of his clinic.

"I was certainly prepared for some risks," I replied, "but not for this one. And certainly not that I was told that exactly this incident happened in your house four years ago."

"You know about it?" asked the chief physician in astonishment and leafed aimlessly through my medical file.

"Yes, I heard about it yesterday." After a break I gave in. "The bottom line is, I don't blame your clinic. Anyone who sailed as close to death as I did can only be really grateful if he has survived everything without permanent damage. Your team did a great job, at least after the incident."

"We're all very pleased that you see it this way," he breathed a sigh of relief. "Two doctors had a few sleepless nights because of you." He rose, shook my hand again and wished me all the best for the coming period and of course a quick and lasting recovery. He accompanied me to the door.

How am I today? Well, under the circumstances, as they say. I'm not quite back to my old self yet, I still have pain in my left chest from time to time, but I can walk again two to three kilometres without shortness of breath and heartache. Most important: my heart beats normally. Soon I will be able to stop all my medication.

There's one topic I'll probably be dealing with for a long time. My ward nurse wanted to know whether I had "otherworldly perceptions" at the moment of my cardiac arrest. No, I didn't, at least I can't remember. The nine hours under anesthesia are as erased in my memory. Before the operation and several times after, I found comfort in the Psalm verse: "The Lord commanded his angels to guard me in all my ways, that they carry me on their hands, so that I would not hit my foot on a stone. I wonder if praying helped me. I have no doubt, not for a moment.

Will my life change now? Will I become more conscious, more serious, more deeply involved with the valuable good? Do I remain humble in the face of the miracle that saved me? Do I keep an awesome feeling for the vulnerability and fragility of life? I hope that this will now become my real matter of the heart.

I wrote this true story eleven years ago, completely under the impression of the dramatic events that changed my life. Today I feel so well that I call myself and feel "healthy as a heart" without hesitation. My heart is more powerful than ten years ago, it beats strongly, calmly and in a stable rhythm. I haven't needed specific medication for a long time. Catheter ablation for the treatment of atrial fibrillation has left the stage of experimental cardiosurgery for years and is a standard treatment for a number of cardiac arrhythmias in good specialist clinics. Accordingly, the risk of the intervention was also reduced through progressive practice and experience. I am often asked how I assess the risks of this type of treatment according to my own experience and survival. I cannot give a generally binding answer to this, because any cardiologist who knows the patient will be better able to judge this than I am. There is one point, however, on which I do not hold back: I do not regret my decision at that time for one minute. And I remained grateful and humble in the face of the miracle that saved me.