Successful Catheter Ablation Helps EP Patient David Malik Reach New Heights

Interviewed by Jodie Miller
Interviewed by Jodie Miller
An estimated 2 million Americans suffer from atrial fibrillation. Cleveland attorney David Malik, who had a 30-year history with the disease, finally contacted Andrea Natale, MD, the Director of the Electrophysiology Lab and Co-Section Head of Pacing and Electrophysiology at the Cleveland Clinic Foundation, for help. Dr. Natale is a pioneer of many of the current catheter-based cures for atrial fibrillation. At the suggestion of Dr. Natale, Malik underwent a new procedure at the time called catheter ablation in March of 2000. He is now symptom free and has since become the first recovered atrial fibrillation patient to successfully reach the 19,340 ft. summit of Mt. Kilimanjaro. Now that he has defeated AF, what are his future plans? Climbing Mt. Rainier. The first time there was any hint of the disease was when I was 19 or 20 years old. I was in college at the time, and I didn t feel well I had been exhausted and generally sick so I went to the emergency room. I didn t know what it was. I remember the physician telling me that the ECG showed some rhythm problems, and it looked like atrial fibrillation. That was the first time I ever heard anything about it, but I didn t pay much attention to it. Primarily, it was medication. It seemed as if, over the years, every time there was a new medication, I would be prescribed that medication. The other medications would work for only a period of time. Nothing ever worked on a continuous basis. Some of the medications I can t remember which ones exactly, but there were one or maybe two had been taken off the market, because they had some incidences of sudden death. I was put on one medication after another for most of those 30 years. As time went on, the atrial fibrillation became more severe. In fact, I had a ventricular septal defect that was corrected when I was 28 years old. After that, the atrial fibrillation dramatically worsened. There was no interruption in the medication. It did. In fact, it was only after I was cured that I recognized how devastating the effects of the medication were, and how much better off I was as a result from the cardiac ablation. As the medications no longer worked, I began to have cardioversions. Actually, I was cardioverted many times. One year, in 1999, I think I was cardioverted 12 or 14 times, including five in a two-week period. One cardioversion, in particular, I wasn t knocked out enough, so I literally jumped off the table. I always tried to be active, but I couldn t be active without consequences, and the degree of difficulty and effort would be a lot greater than someone who didn t have atrial fibrillation. During this time, I tried to learn how to be somewhat active with the atrial fibrillation, but it was pretty overwhelming. When I look back now, I really do not know how I did that. I know I didn t have a choice, but things are so much improved now. Actually, I had consistently been treated at the Cleveland Clinic. What happened was and I understood this more after the ablation because I became an advocate even within the institution itself, I had not yet been sent to an electrophysiologist. It came to a point where I d been on medications like amiodarone and comiodone for so long, I was in a category of patients that could have negative effects for long-term use. There was really no alternative for me, until someone suggested this ablation procedure, which they knew was being done at the clinic. I was then referred to Andrea Natale, MD. Actually, the Electrophysiology Department at the Cleveland Clinic had known about my case, but no one had yet made the recommendation for the ablation until a couple of years later. In fact, it wasn t my cardiologist that specifically told me to get the procedure done, it was one of Dr. Natale s nurses, Diana Bash, that told me about it. Their advice evolved from there is no other alternative to this is what s left. Besides, I didn t want an implantable device. It certainly would have not fit my personality! The ablation was done at the end of March 2000. I was told to wait 90 days, however, during that time I didn t feel like anything had changed. I checked in again with my doctors, but they reminded me to give it 90 days. It was kind of eerie, but around the 90th day, I had a day when I had no atrial fibrillation episodes. Then I had another day with no episodes, and another day, and those days turned into weeks, and now those weeks are years. After the ablation, I really didn t know what to do with myself, because I was feeling so good. Mountain climbing sounded interesting, so I started to research it and I found that it might be feasible. I started to work out, and set a goal to continue working out for a year before climbing Mt. Kilimanjaro. However, beginning a workout regimen was difficult. At first, I could only walk on a treadmill at a minimal speed for about 15 minutes. Now I can easily do the treadmill for 45 minutes to an hour, at the highest elevation. Also, I used to put very little weight on the leg press machine, but now I can press 590 lbs. during my leg workouts. In another three months, I ll be up to 800 pounds. Before I could benchpress very little weight, but now I am benchpressing my body weight, which is 180 lbs. In addition, in the past, I wasn t able to take a hike with a backpack; now, I am able to walk for 3 hours with a 65-pound pack. I can t tell you what this procedure has done for me. Words are a feeble expression. In order to prepare, I had gone to Colorado the previous summer. I went four times, and during that time, I climbed what they call Fourteeners. I climbed 6 of those to prepare (Mt. Grays, Mt. Quandry, Mt. Princeton, Mt. Huron, Mt. Democrat, Pirss Peak), and I would continue the climb until they became too icy and slippery in late October. One knew my story, and she was pretty amazed. Our guide, as well as another guy who was a Harvard professor, were pretty surprised by the whole thing. Actually, I was pretty amazed by the whole thing and nervous. However, now I am branching out more. I ve just spent the last week in the Northern Cascades/upper Washington area, taking a very intensive course learning how to rock climb, and climbing 400- and 600-foot walls at a 5.9 degree of difficulty. In a way, climbing is not as stressful physically, as it is stressful mentally, because when you re climbing solid rock literally going straight up the last thing you want on your mind is I m going to have a bout of atrial fibrillation. However, I think that after experiencing chronic atrial fibrillation for this long, it always stays in the corner of your mind. When I first did those climbs, I had a great instructor, so I learned how to put protection in the rocks, to balance myself and hold on tightly, and to learn where to place my feet; my body was just clicking, it was great. I am also learning how to balance my mind as well, and to keep this fear of recurrent atrial fibrillation in the hidden corner of my mind. As each day passes, it gets easier to believe I can achieve things I could only have dreamed of before the procedure. Yes, I have been symptom free. My most immediate plans within the next year are to climb Mt. Rainier. This mountain has a lot of snow, and is a combination of snow, rock, and ice climbing, where you have to use ice picks to get up. It is pretty intense and mentally challenging. In April, I am going to Everest to the level of Base Camp 2, which is around 20,000 feet; at that time I ll see whether or not this climb is a real possibility. That is a more far-reaching goal at this point. Rainier is more similar to Everest than Kilimanjaro, but it is still not anywhere near what Everest is. Everest is a multi-month trip, costs about $75,000 per person to do, and you need a team, not to mention it is over 29,000 feet high. Mt. Rainier is about 14,000 feet, and Mt. Kilimanjaro is approximately 19,000 feet. The dramatic difference with Mt. Everest, though, is the danger, the snow, the uncertainty. Even though today we have great technology, storms and avalanches cannot be accurately predicted. When you are in a rope team, and you are in thin air, it becomes very dangerous. The danger worries me. It will take four days but it will be an intense 4 days. The advice I would have would be to really research the institutions that offer remedies, because they are not always created equal. I would say it is incumbent upon the patient to research the physicians and the equipment. For example, Biosense Webster has tremendous mapping equipment, and they have catheters that are state of the art. When Dr. Natale did my procedure, it took 8 hours. Now, he can do the same procedure in 2 hours. The technology has increased dramatically in a very short period of time. Every patient wants to have a physician that performs a lot of procedures, is aware of what the alternatives are, and whether ablation is appropriate for that patient. I don t think it is right for everyone. So I tell all patients to shop for the right physician, and to make sure their equipment is state of the art. As a patient, I even got on the internet and read articles written by the physicians, and then asked them about it. I am an advocate for people who want to undergo cardiac ablation. It is simply my nature. People contact me through calls, emails, letters, and I tell them about my experience. I am pretty impressed by the people I have talked to, because they don t want to go into this with blinders on. They want to know as much information as they can get, so sharing my experience with them is helpful. I believe it helps them, and that it helps me too. I believe that for whatever reason I can do these kinds of things now, I have a responsibility to show others what technology and good medicine can do. It is my personal challenge, and I get a lot of satisfaction talking to others about it.