No More Arrhythmia, No More Medications

When he’s not spending time with his parishioners, Pastor David Sarafolean enjoys biking, hunting, fishing and camping.

David Sarafolean felt fine. Married with three kids, he was working long hours as a church pastor, serving on volunteer boards and earning a second master’s degree. Four years ago, when a parishioner suggested he look into a low-cost heart and vascular screening offered at MidMichigan Medical Center–Midland, he gently put her off.

“Fortunately, she politely brought it up more than once,” said the 52-year-old Midland resident, “so I finally relented and went for the tests.”

Sarafolean thought everything would be routine, but the electrocardiogram showed he was in atrial fibrillation, or AFib. The electrical impulses driving his heartbeat had become so erratic that he was advised to go straight from the clinic to the Emergency Department.

“I knew it was important, but I had work to do. My wife was away on a women’s retreat and I had children waiting at home,” Sarafolean said. “I promised the doctor I would follow up with a specialist as soon as I could.”

He did follow up, and Cardiologist Robert Genovese, M.D., performed an outpatient procedure called cardioversion to shock his heart into its normal rhythm.

Dr. Genovese also referred Sarafolean to Electrophysiologist Nilofar Islam, M.D., who specializes in heart rhythm disorders. As they talked about the future, when Sarafolean’s heart might need more help, Dr. Islam described cardiac catheter ablation, a minimally invasive treatment to restore normal heart rhythm, often without the need for medication.

Sarafolean’s cardioversion helped for about eight months before the erratic heartbeats returned. “At that point, Dr. Islam and I knew we had to go forward with ablation,” he said.

During cardiac catheter ablation, a narrow tube is inserted into a blood vessel and up into the heart. With a sensor on the tube’s tip, Dr. Islam maps the heart’s electrical pathways in 3-D. She then causes the heart to send impulses that reveal tiny areas of damaged tissue. Deactivating (ablating) the tissue leaves only properly firing pathways, and a normal heartbeat.

“My first ablation was in December 2009 and I did well until fall 2011,” Sarafolean said. “Then one day I felt jittery, like I’d had too much caffeine, and the next morning I woke up in AFib. Dr. Islam got me in right away for a second ablation procedure, this time in the new EP lab at MidMichigan, which was very cool.” The lab had opened a few months earlier, offering every diagnostic and therapeutic electrophysiology (EP) procedure.

As Sarafolean recovered, Dr. Islam wanted to check for any other factors that might affect his condition. She was concerned because in the top part of his heart, his left atrium had expanded to a very large 58 millimeters in diameter. When a sleep study revealed sleep hypopnea, Sarafolean began using a continuous positive air pressure (CPAP) machine, with good results.

As his medication was gradually reduced following surgery, Sarafolean found that his stamina increased. “This fall, I enjoyed being outdoors, hunting, fishing and camping,” he said. “I have shed a few pounds. I am biking 3 or 4 days a week and have more energy. I feel sure that being active helped my heart respond well to treatment.”

When Sarafolean had a follow-up echocardiogram, even Dr. Islam was astonished how well his heart had recovered. “My left atrium is now 37 millimeters, well within normal,” he said. “Another problem, blood backing up into my atrium, has also gone away.”

“I have nothing but praise for Dr. Islam and her team for the treatment and care I received,” Sarafolean said. “Dr. Islam explained everything perfectly. Everyone in her office answered every question and were very thorough at following through on all sorts of things. If I had any concern, I called them and always got a call back.”

An interesting part of the story, he notes, is that over the course of four years, he used a variety of MidMichigan programs and services which all worked together seamlessly to support his health – a low-cost health screening, cardiovascular services, the Sleep Disorders Lab and MidMichigan Home Health for his CPAP equipment.

“My situation was serious. Who knows how long it would have been before it was detected or before I had a stroke? But now I’m off meds and don’t have any symptoms. My irregular heartbeat has been taken care of.”

MidMichigan Health offers a full array of heart and vascular services, including open heart surgery, vascular surgery, electrophysiology for heart rhythm problems and advanced interventional procedures. Those who would like more information on MidMichigan’s comprehensive program may visit www.midmichigan.org/heart.