Mark Scheffer

Mark Scheffer enjoyed his practice as an orthopedic surgeon. He also loved sailing. But one day, after a serious episode of irregular heartbeat, he collapsed on the stern of his 47-ft. boat just off the coast of Maine. Two years prior, he had been diagnosed with atrial fibrillation, but the frequency and intensity of the "episodes" gradually increased. Dr. Scheffer recalls, "Arrhythmia slowly eroded my quality of life — robbing me from enjoying leisure activities and feeling confident in my orthopedic practice."

Dr. Scheffer trained at Mayo Medical School from 1989 to 1994. His wife Susan and he had two of their three children at Rochester Methodist Hospital during his residency. After he completed his training at Mayo, Dr. Scheffer served active duty in the Air Force to pay back a scholarship commitment, serving the first three years in England. During his final year overseas, Dr. Scheffer contracted a severe pulmonary infection and experienced heart palpitations, which subsided after the pneumonia cleared. "But a short time later, while making rounds in the Air Force hospital, I suddenly felt nauseous and light-headed. My heart began to race so fast that I went right to the emergency room," he recalls.

There, Dr. Scheffer was diagnosed with a type of arrhythmia — atrial fibrillation. "I was told to live with it because corrective procedures were too risky for the mild case I had," he says.

A Growing Concern

Over the course of two years, Dr. Scheffer's mild case of arrhythmia became more severe and began stealing the joy from his activities and profession. "I tried to avoid anything that seemed to trigger episodes, which included stress, coffee, wine, sailing and down-hill skiing," says Dr. Scheffer. But despite his diligence, he experienced an episode in which his heart rate exceeded 200 for a sustained period of time. He was admitted to the hospital and put on medication. "The drugs caused my heart to stop and I actually went into heart failure and needed to be revived," he says. "Obviously, this was a real scare. And, while I survived and eventually stabilized, I still had this condition when I was released from the hospital."

Most sailors despise unpredictable winds and the threat of an impending storm. "I had this perpetual dark cloud hanging over my head wondering when and where I would have my next episode," says Dr. Scheffer. "I was in a constant state of anxiety."

Some time later, Dr. Scheffer's best friend from residency training came to the east coast to visit the Scheffer family. "My friend's wife Liz is a cardiologist from Minneapolis and she saw how my life had changed since our last visit," recalls Dr. Scheffer. I wanted to take them sailing and put my troubles aside, but it didn't go very well. "You can't live like this," Liz told Dr. Scheffer. "She didn't tell me anything I already didn't know, but hearing it from a cardiologist gave my situation stunning reality."

Dr. Scheffer also knew that because his episodes were becoming increasingly frequent, there was a growing risk of going into chronic atrial fibrillation. "I became skeptical about doing anything," he recalls.

"If Liz hadn't known Paul Friedman, whom she trained with, I might not have felt comfortable making that first call to Rochester," says Dr. Scheffer. As it turns out, she trained with Paul Friedman, M.D., a cardiologist at Mayo Clinic in Rochester. "Liz said she'd call ahead to let Dr. Friedman know I'd be getting in touch with him to discuss my options," recalls Dr. Scheffer.

Charting the Course

Dr. Scheffer had previously been told his condition wasn't severe enough for treatment and the surgical risks outweighed the benefits. "Dr. Friedman listened to my concerns and understood how this condition was negatively affecting my life," recalls Dr. Scheffer. As a sailor, it's important to chart your course or your ship gets off track and ends up somewhere unintended or lost. "After my initial conversation with Dr. Friedman, I felt like I emerged from a dense fog and suddenly knew where I needed to be and what I needed to do. I made an appointment in Mayo Clinic's cardiology area. I made plans to fly to Rochester."

"Before I performed any tests on Dr. Scheffer, I talked with him in more detail about how arrhythmia was affecting his life," says Dr. Friedman. "Medical tests tell us what's happening inside the body, but only the patient can tell us when and how his condition affects him over the course of his daily life. The only reason to consider this procedure is to improve quality of life."

Although Dr. Scheffer may have felt his strong symptoms were a curse, they proved a blessing in that they prompted him to seek treatment before his condition permanently affected his heart muscle.

"Dr. Scheffer had a well preserved heart muscle with no weakening of the heart's main pump," recalls Dr. Friedman. "His ECG confirmed that he indeed had atrial fibrillation, a chaotic electrical rhythm of the heart's upper chambers, the atria."

Dr. Scheffer had paroxysmal (episodic) atrial fibrillation for two years. "The heart depends on electrical activity to give it the signal to contract," explains Dr. Friedman. "There is also electrically active smooth muscle inside the veins that take blood from the lungs back to the heart, the pulmonary veins. The muscle in the veins may at times electrically discharge at a very rapid rate, and trigger arrhythmias. In some people with atrial fibrillation, pulmonary vein triggers cause the top chambers of the heart to beat too rapidly or quiver." Triggers may also reside in other locations, and short circuits within the heart muscle itself may also be present.

In a procedure called pulmonary vein isolation ablation, specialists cauterize the electrical connections between the veins and the atria to disconnect them electrically from the heart to restore normal rhythm. At times, additional ablation (or cautery) is required to interrupt short circuits within the atria. For Dr. Scheffer, this cautery disconnected the fast electrical activity in his pulmonary veins from the left atrium. The result is a well-defined and controlled scar that electrically isolates the veins. "In some ways it's like putting insulating tape around an electrical wire to prevent short circuits," explains Dr. Friedman.

The ablation procedure is performed using catheters (thin, soft, steerable wires) that are advanced to the heart through veins in the legs under x-ray guidance. Most commonly, electricity delivered at the tip of the catheter performs the ablation, although other energy sources are available. People are typically up and walking within hours of the procedure. Additionally, three-dimensional, computerized work-station based mapping systems may be used to guide catheter navigation within the heart during the procedure, as in Dr. Scheffer's case. Dr. Scheffer actually had several episodes of arrhythmia during the abalation procedure, which confirmed the hyperactivity in several "hot spots" in his heart.

"Three months post procedure, Dr. Scheffer was taken off all medication and his heart was functioning normally," says Dr. Friedman.

Returning Home

"When I came to Mayo, I felt like I was returning home," recalls Dr. Scheffer. As a resident, Dr. Scheffer was often so busy studying, taking call and preparing for a career as an orthopedic surgeon, that he didn't fully understand what Mayo Clinic meant to patients.

"When I went through the Mayo Clinic network for all my tests and preoperative care, I had a whole new appreciation," he says. "As soon as I stepped foot in the registration building, I knew I had come home for help. The institution that had trained me so well was now helping me get well."

After his successful ablation procedure, Dr. Scheffer returned to the East Coast to enjoy life without fibrillation episodes. Just a few months post-op, he skied the Whistler and Blackcomb mountains in British Columbia, Canada, without that crushing feeling of apprehension at the top of each slope.

"I had the best skiing season ever and it's smooth sailing on the boat," he boasts. "My stamina is back and I'm feeling more confident and productive in my orthopedic practice," he says. "Best of all, I don't live in a continual state of apprehension."

"The risks of the cardiac ablation procedure have to be weighed against the benefits to the patient," says Dr. Friedman, who recommends patients go to a medical center that performs atrial fibrillation ablation on a regular basis. "Procedure success depends on an experienced team, with physicians, nurses, and technicians all working together to treat the patient," he notes. Over the past few years, significant advances in the procedure have been made, and the risk of serious complications is small.

As Dr. Mark Scheffer stands on the stern of his sailboat, mesmerized by the beauty of the crystal blue waters of the Atlantic Ocean with a gentle wind on his face, he thinks "life's a breeze."