EP study and ablation for atrial tach

[LynnSB]

After years of trying to find out what caused my brief but scary and lifestyle-if-not-life-threatening arrhythmias,an event recorder revealed atrial tach.I am amazed that a 2 lead recorder could reveal so much info but my doc says I have"very frequent PACS,atrial runs, non-sustained for along atrial tach, and inappropriate sinus tach, rare PVCs." In consult with an EP doc,he says the focus of the atrial tach appears to NOT be reentry but ectopic and coming from the pulmonary vein and is, they believe , amenable to an ablation.
I'm very excited about having the EP study/ablation and they think there is a "good chance" of a cure for my problem which would eliminate these horrible feelings ( the a-tach and atrial runs make me feel momentarily scared and sometimes weak).
Questions: 1.isn't a pulmonary vein focus a more difficult location for a successful ablation?
2.In general,what's the recovery time like for an ablation?
3. I live alone and just wonder what i have to avoid or watch out for afterwards.. how soon i can go back to work, etc. I know i need to talk to my docs about this and will when i see them but for now, any info in general would be greatly appreciated.

thanks so much!

Lynn

[Cleveland Clinic]

Lynn,

I hope your ep study works out, thanks for the post.

The difficulty does depend on the ability to locate the focus and subsequently ablate it. Pulmonary vein isolation is a little different the ablation of a site of ectopic activity and from ablation of a accessory pathway. The important thing will be to locate the focus during the mapping procedure.  While it is possible to get an overall idea where the focus is from the outside, the mapping procedure during the EP study will really tell how difficult the procedure is.

It sound like your doing the right thing by visiting a center with a high volume and expertise. The success rate will be higher and complication rate lower.

There is alot of debate over the role of atrial premature beats in the genesis of fibrillation.  I cant give you a definite answer with confidence.

Your recovery should be quick. They will probably watch you in the hospital for a day or two and then you will be able to get home and back to work with a few physical restrictions.

good luck!

[arthur]

I had paroxysmal AFib, a demented form of atrial tachycardia, which was due to pulmonary vein foci.  It was successfully rf ablated.  The procedure can take some time (anywhere from a couple of hours to 9 hours in my case), depending upon how many foci are found, where they are, and which one(s) are the bad guys.  It's conducted with a mild sedative, so you might just sleep through it.  I was back home the next day (care is generally taken to assure the site(s) of the catheterization clot up well and no complications show up).  Talk with your EP about the complication rate in his lab...complications include pulmonary edema (swelling of the vein) and stroke (due to loose clots)...in my case, the EP had a zero percent complication rate because he was careful to only ablate the offending focus and no other.  Lots of places today like to toast all the foci they find, and this may be because the technology keeps the complication rate down (typically 0-2%).  

Outside of occassional PACs (due to several foci left alone), for the past three years since the ablation I have had no recurrence of the AFib.  This is despite being extremely physically active, which used to be a sure way to trigger the AFib.

Do your research and ask a lot of questions.  I tend to agree with you, that atrial tachycardia stemming from a PV focus, should be easy to ablate.

-Arthur

[LynnSB]

I forgot to mention that my doctor said that because I have such extremely frequent ectopic activity, coupled with the runs of a-tach, that he thinks this raises my risk of a-fib as I get older and that that's another good reason to go ahead and do the ep/ablation.

[LynnSB]

thanks SO MUCH for responding. That's very encouraging! I'm going to a major, major heart center very skilled in EP and my cardiologist who is very well known ( not an EP) will be there, too, which makes me feel good.. he's chairman of the dept. of medicine and great cardiologist so I think I'll be well looked over!

[ValerieL]

I have been trying for several weeks to get through, your questions are very similar to mine. I have SVT, with runs over 242 bpm, and that is too high. I am 38 years old and my doctor said he doesn't want me to keep doing this. I have had this for 26 years. I would be thrilled to have it taken care of! I am going to Stanford Hospital to have it done by a well known EP doctor. So, I know I am good hands. BUT, unlike you I am terrified! Should I be? I cannot find out anywhere about the % of complications and what the percentage of peopleis who have complications. I saw the response about a 0% complication rate, is that really so? I would think there could be complications if a wrong site was ablated but honestly I just can't find the info. I just wonder, should I be worried? I am absolutely terrified, and would love to go into this without this worry.  I posted to the post below about the person who had 6 ablations and now has major problems. My sister had 3, and she is fine except for some afib which they say was not caused by the ablation. She was one of the test studies when they first started using the RF ablation.  I also wondered about recovery and such, thanks so much for posting this question!

Valerie

[Anne 35]

Hello Valerie,

I am a 35 year old female with pvc's, psvt, afib and aflutter, and heart rates recorded at 256bpm.  I blacked out a couple of times,but do not know the heart rate, because I was not wearing a monitor during.

I had an ablation three weeks ago tomorrow.  It was a breeze. I do not remember the complication%,because I think they vary depending on the type and the number of arrythmias you have.  I will however tell you what to expect.  

First shave your bikinni area very good on both sides, this will save you from having the nurse do it.

What to expect during:  Very good drugs.  My procedure lasted about 5 hours for my family, doctors, and nurses.  For me it lasted about 5 minutes.  I was feeling no pain.  I did however wake up breifly, during the procedure.  I can remember my heart racing like no tomorrow, and hearing the doctor, and nurses talking.  Everything was black, but I was awake.  In my head I was saying over and over again I am awake, I can feel my heart racing.  I could feel a sensation in my chest, but not pain.  Finally I got my eyes open, saw light, and heard a nurse say I see eyes. At the time I thought something was wrong, but found out later that I woke up when the doctor did a burn.  At no time did I feel pain.  Just the racing heart startled me, and confused me for a few seconds, and then the next thing I remember was seein my family.

I will finish on another post in a moment.  My laptop battery is about to go.

[Anne 35]

I like you, did not know what to expect. This is so routine to the doctors, that I think they forget sharing some details with us would ease our minds.  During the office visits, it seems like they get beeped for an emergancy just when we have two more really good questions to ask.  I did not even know where they would cutting me.  

They went in through my kneck, and my groin on both sides (I had one little whole on my right side, and two little wholes on my left side)  I am not sure if there are always this many points of enteries. I had been under the impression there was usually only one point of entry.  So this may have something needed in my case, or perhaps just how my doc does it.

Let them give you a cath for your bladder, because it can run longer than they expect, as in my case.  The nurse told me it was optional, but that she would if it were her.  And I am glad I did.

What to expect afterwards:
I was in the hospital for two days, some people go home after one.  My whole body was sore from laying for so long.  The sooner you make yourself get up and walk the better you will feel.
  
The two days after I got home, were sort of foggy, and I slept alot, and seemed like my short term memory was a little hazzy.  Maybe from the drugs, or just the ordeal.
  
You should not drive, or lift anything heavy for a few days.  I did not drive for about 7 days, because it took that long for my kneck to loosen enough to turn my head to watch for traffic.

My kneck wound hurt the most, but looked the best.  You could not even see the scar after a week.  You can see the punctures in my groin areas If you look really hard. No stitches are needed.    

I felt some bumps and mild palpitaions in my heart, along with some strange chest pain for five days after my surgery.  My heart palpitaions were mild but alarming, I thought it was coming back.  However, I found out it is normal to have some pvc's, and twinges after any surgery. The chest pain, my doctor explained was my heart hurting from the burns they did.  The small punctures you see on your body do not tell the whole story of what is done inside. Now three weeks later I am feeling better than I have in a long time, and have not had any palpitations that caused any major symptoms like I did before. I can already breath better.  

I hope this helps.  And if you have ever had a baby, this is a walk in the park compared to that.  If you have any specific questions let me know.  

Good Luck

[Anne 35]

Excuse my typo's, I really do know how to spell neck.  It is just late and I am just tired. Did not proof read.  And my favorite excuse that I cannot use much longer I just had a heart procedure for goodness sake!!!!

[ValerieL]

THANK YOU SO MUCH! Anne, thank you for sharing all of the details. I do feel better about what to expect now. Exactly what I was thinking about trying to get answers from the doctor, they are always so busy and to them it is routine. My sister had two points of entry with hers, her neck and one in the groin. She had wolff parkinson white, svt and afib. She also woke up with her heart racing and they asked her if that was what she had been feeling, she said yes, and they upped her meds and off to sleep she was again. She also experienced pain with the first one in her heart, they told her it was not from the procedure, she was a test study, so maybe they didn't realize at that time that it was from that. I also remember her having PVC's afterwards. That is great you are feeling better now. I didn't even notice the typos! I really appreciate all of your help. Thanks so much!!!!!!!

Valerie

[Anne 35]

Glad it helped a little.  Have they set a date for your ablation yet?  If so, when?

Also, post after you have it and let me know how it went.

Good Luck


Anne

[LynnSB]

I'd really appreciate it any other people who have had ablations would also follow-up and post what it was like for THEM.

I've heard that some people GO HOME THE SAME DAY (?). and others stay in the hospital one or two days.

I will be alone afterwards so that sort of scares me..

[Momto3]

Hi...I had an ablation for pvcs on August 1st.  I am multifocal, but the doctors only ablated one of the predominant "culprits". I put off the procedure for a couple of years because I am a big chicken! In July, I decided that I did not want to take the RX (antiarrythmic) and did not want to be skipping my life away : )

As far as the procedure goes, I was in a "twilight" state and don't remember much of anything (versed, fentynyl, propofol). An anesthesiologist with me during the entire procedure. I felt the IV, but that was no surprise..haha..After dealing with THOUSANDS of pvc's per day, it feels wonderful to feel only an occassional flutter. The doctors say that it generally takes 2-6 weeks to know the success of the procedure, but so far, so good! I still get pvcs, but I knew that because I have other foci. They are not NEARLY as frequent. Now, I can take a beta blocker IF I get uncomfortable, but no more mandatory medicine...YEAH!!!

Check out www.heartceneronline.com for details from people who have experienced the pulmonary vein ablation.  My ablation was not a PV ablation, but it went something like this:
1) Arrive at hospital around 7:15 a.m.
2) Changed into gown, got IV started
3) 8:15 Got the "first" dose of versed to relax...It worked!
4) 8:20(?) Wheeled into EP lab (COLD!)and someone put big sticky patches(like EKG, but bigger)on me. I was prepped around this time, but don't remember any of it, including the bladder cath.
6) Sometime during the procedure, I vaguely remember doing some simple arm exercises (the doctor had explained ahead of time that she might ask me to do that (sometimes stimulates arrythmia)
7) First recollection of waking around 3:15 (I think this is when they took out the bladder cath, but no pain
8) Wheeled to my room, and pretty much really awake around 4:00
10) Rested with a 10# sandbag on my cath sites (3 in groin) to avoid need for stitches.
11) Out of bed (sandbag off) at 10:00 p.m.
12) Home at 1:00 p.m. next day.......Rested on Sat/Sun...back to work Monday.....
Hope this helps!  I would do it again if it were necessary....I asked a ton of questions and was particularly interested in the anesthesia since as I said....bawk, bawk, bawk.....Good luck!

[Momto3]

Hi...I had an ablation for pvcs in August. I put it off until July when I decided that I did not want to take the RX (antiarrythmic) and did not want to be skipping my life away : )

As far as the procedure goes, I was in a "twilight" state and don't remember much of anything (versed, fentynyl, propofol). An anesthesiologist with me during the entire procedure. I felt the IV, but that was no surprise..haha..After dealing with THOUSANDS of pvc's per day, it feels wonderful to feel only an occassional flutter. I guess it takes 2-6 wks. to know the success of the procedure, but so far, so good! I still get pvcs, but I knew that because I have other foci. They are not NEARLY as frequent.

Check out www.heartceneronline.com for info from people who have experienced the pulmonary vein ablation. Mine was not a PV ablation, but it went something like this:

1) 7:15 a.m. Arrive at hospital (Friday)
2) Changed into gown; IV started
3) 8:15 "First" dose of versed to relax...It worked!
4) 8:20(?) Off to the EP lab (COLD!)where someone put big sticky patches(like EKG, but bigger)on me. I was prepped, but don't remember any of it, including the bladder cath.
5) Sometime during the procedure, I vaguely remember doing some simple arm exercises (the doctor had explained ahead of time that she might ask me to do that to stimulate arrythmia)
7) 3:15 p.m. First recollection of waking (I think this is when they took out the bladder cath, but no pain)
8) 4:00 p.m. Wheeled to my room; pretty much awake now
10) Rested with a 10# sandbag on my cath sites (3 in groin) to avoid need for stitches.
11)10:00 p.m. Out of bed (sandbag off)
12)1:00 p.m. Left for home...Took it easy for rest of the weekend; back to work Monday
Hope this helps! I asked a lot of questions and especially about the anesthesia since I was pretty scared. Good luck!

[Momto3]

Sorry for the double post...my oops : )

[ValerieL]

Thanks so much, Lynn for posting and anne and momto3 for answering questions and sharing your stories, this has helped me more than anything! The doctors that I am dealing with are not going to see me until I have my EP studies, my own cardio does not have all the answers. I went to heartcenteronline.com and I read some things that have me a little confused. First, let me tell you my sisters experience with ablation 3 times. Also, I have been trying desperately to post questions for the doctor, but I have had no luck. I am sorry I invaded your post, these were just answers I was hoping to get too, and I thank you for your post.

My sister was a test study about 10 years ago for RF ablation at Stanford Hospital. She had WPW, SVT and now has Afib. The wpw caused a life threatening rate and rhythm for her. Over 300 BPM and irregular. They had to electro convert her. They successfully ablated her the first time for those things except the afib. She went in and they gave her what she said were the best sedatives. She remembers waking briefly to feel her heart racing then off to sleep she went. She woke up in recovery and ended up staying the night because she was very dizzy from the medication. She had to come back 90 days later, because she was a test study so they could go back in and look again. Both times they went thru her fermoral artery. It was successful. She did have chest pain with the ablation, but they said it was not from the procedure, I guess they didn't realize. Afterwards, she was fine. The last time she went in was to try and correct the afib, but they could not reach the area for a clear ablation, so it didn't work. That time they went through a vein, not an artery. They also never kept her overnight except the first time for dizziness.

Here are my questions. Does anyone know?

Are they routinely done through a vein now and not an artery? My cardiologist told me they now go up through a vein? Is this the case for most or is this what you are talking about Lynn? I am just confused about pulmonary vein ablation.

Do they do the EP studies at the same time as ablation, or do they have you come back to do it again. Heartcenteronline said that they do two procedures. I don't want to have that done twice, I was hoping ablation would happen at the same time. Heartcentral also said they use the femoral artery still.

How long does it usually take? HCO said 6 hours is standard, but that seems like a long time for everyone. I understand if there are a lot of things going on, it can take time, but my sisters did not take that long, it was a few hours.

Thanks so much!

Valerie

[Anne 35]

Good evening Valerie,

Just clarify, the chest pain that I felt was for several days after my ablation.  I felt no pain while I was under the drugs, or during the procedure.  It was not a major or crushing pain.  Just a dull ache that did not move.  Almost like a minor scrap, that only hurts enough to let you know its there.  My doctor said not everyone feels chest pain afterwards, but some do.  He also said I woke up when he burned me, but I only remember my heart racing not pain.  

They scheduled my EP study and my ablation at the same time.  My doctor told me ahead of time that he would induce my arrythmias and ablate them while he was in there at the same time.  He said he would stop the procedure if they were coming from an area to risky to ablate.  I had worn a monitor for two months so they had a pretty good idea of my problem.  I think I have heard of people having the study and the ablation done at separate time.  I do not know if they had not shown anything on a holter moniter, and they did not schedule an ablation because they were not sure if their problems could be fixed by the procedure.  Or if when they got in there it was to risky.  Maybe different doctors do it different,  if I were you I would call the nures and see what you are schedule for.  

Also, I was told my procedure would take anywhere from 45 min. to 2hrs, not including the prep time.  Mine took longer, however, I think they really do not know until they get in there.

Through an artery or vein, I do not know.  

Please try not to worry about the procedure.  For you it will be over in a flash.  

When are you having it?

Anne

[ValerieL]

Thanks Anne!! Your reassurance really helps me. I am not sure when they will do it. They are calling me sometime this week. My doctor said it is usually within a few weeks that they set up the appt. I am nervous about the procedure, but I feel better now that I know more about it. It looks as if complications are pretty rare too. I will let you know when I am scheduled to have it done. It will be wonderful not to have this problem anymore. I never realized that I am somewhat guarded in things I do so that I am careful not to cause an event. It has been 26 years of having this, and I will be so glad to have it gone!

Thanks so much!

Valerie

[LynnSB]

I just learned my EP study/ablation is scheduled for Monday.I'm so scared.. but excited!!  Good luck with yours!

Lynn

[ValerieL]

Wow! That was so fast!! It is good to get it out of the way, less time to worry about it! I am sure you will be fine and you will probably be so happy when it is done! I am wishing you the very best. Please post back when you are done and tell us how you are doing. My thoughts will be with you!!!!!!

Valerie

[Anne 35]

Good luck with your procedure.  I hope you will think about having someone stay with you that first night you are home.  Especially if you come home after one day.  I hate the thought of you being alone after that.  

Good luck again, and it will be over before you know it.  You will be amazed at how much more energy you will have, and how much easier it is to breathe.  

Anne

[LynnSB]

Thanks, Anne. Well, I really don't have anyone to stay with me. I'm sending my son to his dad's for the night and my mom is in her 80s and my friends have their own lives.I will keep numbers of neighbors handy in case of any emergency.

what's so bad about afterwards?  I really want to grasp what this may be like... do you just feel sore or groggy or does your heart act up a lot or what?

thanks!

SB

[arthur]

Sore (at the groin) and groggy (in my case, because there's nothing quite like a sleepover in the cardiac ward...loud monitors, lots of lights, and of course, nurses checking in on you).  I was very very glad to get out of there the next day, as I was looking forward to getting some rest (at home).

If there are foci remaining that were not isolated (or burned), then it's also likely that you will experience an increased production of arrhythmias for days/weeks due to the trauma of the procedure...although the trauma is slight, the nervous system surounding the area treated will be turned up for a while and this results in increased PACs/PVCs if there are other foci about.  In my case, the increased production lasted for months (I had and still do have some unablated foci).

I spent a few days straight (3-4) at home before going back to work...mainly because I wanted the groin catheter entry points to heal thoroughly.

I'm sure that your procedure will go smoothly.  Enjoy the adventure and the new world awaiting you.  -Arthur

[LynnSB]

thanks, Arthur! I actually wish they'd let me stay at the hospital over night, but with insurance and such .. it is not to be ( barring some unforeseen complication, I guess).. so I will just plan on taking it easy around here for a few days.

Thanks again for taking the time to write and offer encouragement.

L

[Anne 35]

I agree with Arthur, sore and groggy sums it up.  It would be possible to be alone afterwards, it just would be easier to have someone there to  fetch things for you.(soup, water the remote, etc...)  I felt a few bumps and twinges in my heart (I assume PVC's), but nothing that caused any symptoms like my atrial flutter and afib did. Just a bump every now and then.  

Like I said, it will not be horrible afterwards, I just wish you had someone with you.  I'm sorry.  

Let us know how you do.

Anne