It's a rainy Friday night in October, and 27-year-old coach Greg Ernster is pacing the sideline.
A win would give his eight-man football team out of Tabor, Iowa, control of the conference and a taste of revenge — they lost to their rivals the year before. Ernster's heart quickens as his players line up to return the opening kickoff.
When his heart starts pounding again two weeks later, away from the field and game-day nerves, it's different. This time, something is wrong.
Ernster suffers from atrial fibrillation, or a-fib. His heart normally hums about 60 beats per minute. Then, without warning, it races wildly to 150 beats per minute and keeps climbing.
His chest tightens. He's dizzy. It's difficult to breathe.
Doctors don't know why Ernster's young and otherwise healthy heart falls out of rhythm. To fix it, he has a choice: a lifetime of medication or an interventional procedure usually performed on people three times his age.
A-fib, like many heart conditions, is most common in older people: The median age of a-fib patients is 75, according to the American Heart Association. When it occurs in young people, it's typically due to a congenital heart defect, or the result of an infection that leads to a lone episode. Sometimes high blood pressure, or binge drinking can exacerbate an already damaged heart.
Ernster's heart, though, isn't damaged. He is healthy and active. He does not have an infection. Yet three times in two years the 27-year-old has landed in the hospital clutching his chest.
The first time, in March 2012, he woke up with difficulty breathing. He ignored the shortness of breath and drove to Fremont-Mills High School in Tabor, where besides coaching football he also teaches PE. Suddenly, in the middle of a faculty meeting, his chest hurt, he felt light-headed and the room started to spin.
A colleague drove him to the nearest hospital, where the doctor shocked his heart back into rhythm.
Eight months later, it happened again at home. A neighbor drove him to the hospital. He started blacking out in the car. At the hospital, medicine eventually slowed his heart, returning it to its normal rhythm.
Doctors shocked Ernster's heart again last month when he experienced a-fib for the third time.
The frequency of the episodes is alarming, and it's likely to continue at random unless he gets long-term treatment, said Dr. Shane Tsai, one of Ernster's cardiologist at the Nebraska Medical Center. He specializes in the heart's electrical system.
Tsai offered Ernster two options: treat it with medication for the rest of his life, or undergo a procedure called a cardiac ablation.
Daily medication does not cure a-fib but decreases the frequency of the episodes. The potential side effects include sexual dysfunction and trouble sleeping, as well as dizziness and shortness of breath.
There's also a small risk of arrhythmia, which can lead to sudden death.
“You take a young guy like Greg and you ask him to take a drug for the next 50 years that might have that side effect, and you start to be a little more cautious about using those drugs,” Tsai said.
So Ernster chose ablation. He is Tsai's youngest patient to undergo the procedure, which he performed last week at the medical center.
He entered Ernster's heart through blood vessels in his leg. He used a catheter wire that generates heat to burn tissue on the inside of the heart, isolating the veins that misfire.
Ernster's family was spread out on chairs in the waiting room when Tsai finished the procedure, about six hours after they wheeled him behind closed doors.
“I was hoping this was going to be easy,” he tells them. But as Tsai started the procedure, Ernster's heart “flipped” into a-fib, forcing him to work on Ernster's as it raced. After Tsai finished the ablation, Ernster's heart eventually self-corrected to a normal rhythm.
It will be a year before they know if the procedure fixed the problem.
So Ernster is recovering, hoping that next fall will be different. That this time next year, he won't be in the hospital. That he'll be pacing on the field coaching his team to a state title, his heart pounding — the way it's supposed to.