3 unsuccessful ablations! Whats next???

[ccu nurse]

I have posted here several times in the last year about my condition. I am a 25 yearold female who is an ICU nurse. I just had my 3rd ablation for inappropriate sinus tach and junctional tach done about 4 weeks ago and had several complications. About 12 hours into the procedure they had done extensive amount of mapping and said that my sinus node had fully recovered from previous ablations and that there was alot of scar tissue that was hard to penatrate, they made about 8 burns when suddenly my pulse ox dropped to 60's and they couldn't ventilate me and my ph was 7.1. My lungs filled with fluid and I experienced what I guess was a flash pulmonary edema and they also thought they may have caused a pneumo so they aborted the rest of the procedure. They said they would have burned much longer if not for the complications, but he also said that my areas of activation seemed to lie more endocardial than epicardial and that if I needed another procedure it would have to be using either a diaprhamatic puncture approach or a open thoracotomy approach and they said both were very risky(is this true).I had the procedure done by a very wellknown electrophysiologist so I am sure he did his best, but what now? I came home and had about one good week without tachycardia but then it returned to rates as high as 200. I have tried about all meds possible but I was wondering if you have any suggestions on any combinations of meds that might be helpful or if you know about any new procedures or ablation cathetars that may be available soon?? I would appreciate any advice you could give.

[CCF-M.D.-CRC]

Dear ccu,

Inappropriate sinus tachycardia (IST) ablation is a difficult ablation under the best of circumstances and it sounds like the conditions during your last ablation made things harder.  It's unclear why you would get flash pulmonary edema and this probably should be looked into.  Was a pneumothorax found?  Was there a pulmonary embolus?  

I think your options now are similar to what they were previously: medications or yet another ablation attempt.  I support a last resort would be ablation of the AV node and insertion of a pacemaker but I would not pursue this until all other options had been exhausted.  

There are a few centers (including the Cleveland Clinic) that perform epicardial ablation without open heart surgery.  There is some risk but it is in general a safe procedure. There are also 'cooled tip catheters' which generate deeper burns.  Cryo (freezing) ablation is not approved for IST in the US yet but is being used in Canada.  We are involved in protocol use now and it should be on the open market here in the next year or two.  

If you would like to be seen at the Cleveland Clinic for a second (third?, fourth?) opinion I would recommend Dr. Andrea Natale.  He is one of the leading electrophysiologists in the country and in very experienced in IST ablation as well as epicardial ablation.

[heartbuddy]

I would like to comment to the 3 unsuccessful ablations.  Good luck!  Be sure to have only the very best working on you now.  I too have had multiple ablations.(only 2 though)  Two days after the first one I was in Atrial Tach, Fib, and Flutter.  They went back in on the 4th day and ablated in the R. superior pulmonary vein.  After that my rythum was normal.  Problem was I was very sick.  Terrible headaches all day, every day and reoccurring respitory problems.  After several months I switched docs and pulmonary vein stenosis was the diagnosis.  I would like to hear what kind of symptoms anyone else has or had with pulmonary vein stenosis.  It is very hard to get any info on the subject.  My future outcome is pretty uncertain and would like to hear any comments from any other sources.  Thank you.

[Irene]

I think I may have responded to one of your previous messages.  This is just to say that I have had an AV node ablation (I already had a pacemaker) and my life has improved greatly. Despite the fact that I only have one lung, and my heart is displaced and rotated, the procedure took less than two hours.  The price of all this is that of course I am now dependent on the pacemaker, but I certainly feel that I made the right decision.  Good luck.

[high stress]

Dear ccu,
I have read your previous postings.
I had (note past tense)chronic atrial fib.,diagnosed in 1984.
I went through the regimen of meds.,and even had electroshock therapy.
I had not been taking any medicine,have generally abused my body in every conceivable way-illegal drug use excepted-until 8/14/01.
At 3 am I awoke to chest pressure and difficulty breathing.The condition worsened and @2 pm,I went to the ER.I had a "resting pulse"of 180 and bp of 170/110.I was admitted,overnight,and then released.After several followups with my cardio.,I underwent an ablation procedure,and had a rate adaptive pacemaker inserted.
The surgery was a success.For the first time,i have a normal rhythm.My overall health has improved 100%.I am able to do anything I want,and my energy level is out of this world.
Before the procedure I was 38 feeling 68,and now I feel alive again.I'm still taking my meds.,per Dr's orders,but other than that inconvenience,my life is great.
I am on a low carb/high protein diet(30 carbs per day),have lost 25 lbs.in 6 weeks and have joined a health club.These changes will extend my length and quality of life.
I urge you to consider a rate adaptive pacemaker.It changed my life.
Take care and God Bless.