Re: How painful

[Kat__0]

Posted By Kat on June 24, 1999 at 10:55:44
I've been putting off an ablation for over a year now because I just don't like the answers to my questions.(like mild discomfort,yea right)
Is this procedure painful or not???
If there is no discomfort why do they have to use an amnesiac to make you forget the procedure.
Can it be done with freezing and an IV painkiller???
I had Fentynol and Propofol along with a local  before and its a  pretty strong combo.
I just don't want the other drug that makes you forget.
I want to know things were okay.
I keep thinking your body feels awful pain while they do it but they give you the amnesiac so you won't remember.
That is so barbaric.

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on June 24, 1999 at 13:07:37

Dear Kat,
Thank you for your question. Ablations are practically pain free (think going to the dentist).  A relaxing medication similar to valium is sometimes given and can have some amnestic properties but this is not the reason it is given.  Here are some other commonly asked questions concerning radiofrequency ablation.
What is radiofrequency ablation?
A radiofrequency ablation or RFA is a treatment for abnormal heart
rhythms. During RFA, your doctor will use a special machine to direct high
frequency electrical energy to remove areas of the heart muscle that cause
the abnormal rhythms. It can also be used to "disconnect" the electrical
pathway between the upper chambers (atria) and the lower chambers
(ventricles) of the heart. The type of RFA performed depends upon the
type of arrhythmia you have.
What to do before a RFA.
Should I take my medications?
Your doctor may ask you to stop certain medications (such as those that
control your heart rate or aspirin products) one to five days before your
procedure. Ask your doctors which medications you should stop.
Can I eat?
You must have an empty stomach. Do not eat or drink anything after
midnight the night before your procedure. If you must take medications,
drink only small sips of water to help you swallow your pills.
What should I wear?
When you come to the hospital, wear comfortable clothes. It is best not to
wear any jewelry or valuables.

What should I expect during the RFA?
Where does it take place?
Your test will take place in a special room called the EP
(electrophysiology) lab. Before the test begins, a nurse will help you get
ready. The nurse will start an IV (intravenous) line, This is so the doctors
and nurses may give you medications and fluids during the procedure if
necessary.
Will I be awake?
It is common to be nervous. A light sedative will be given to you through
your IV to relax you and make you drowsy. This medication will not put
you to sleep. You will be asked to report any symptoms, answer
questions or follow instructions given to you by your doctor. If you are
uncomfortable or need anything, please let your nurse know.
Will I be monitored?
The nurse will connect you to four monitors:
Defibrillator/Pacemaker:
Attached to one sticky patch placed on the center of your back and
one onto your chest. Allows the doctor and nurse to pace your
heart rate if it is too slow or deliver energy to your heart if the rate is
too fast.
Electrocardiogram or EKG:
Attached to several sticky electrode patches placed onto your
chest, as well as catheters placed inside your heart. Provides a
picture on graph paper of the electrical impulses traveling through
your heart.
Oximeter monitor:
Attached to a small clip on your finger. Checks the oxygen level of
your blood.
Blood pressure monitor:
Connected to a blood pressure cuff on your arm. Checks your
blood pressure intermittently throughout the study.
These monitors allow the doctor to check your heart rhythm and
the body's responses to arrhythmias.

What are catheters?
The catheters used by the electrophysiologist are special wires that can
pace the heart and precisely record its electrical activity.
How does the doctor insert the catheters into my heart?
Your groin area will be shaved and cleansed with an antiseptic solution.
Sterile drapes will be placed to cover you from your neck to your feet. A
light restraint will be placed across your waist and arms to prevent your
hands from coming in contact with the sterile field.
The doctor will numb your groin by injecting a medication. You may feel
an initial burning sensation, then it will become numb.
The doctor will then insert several catheters into the large blood vessel(s)
in your groin. The doctor will use the fluoroscopy machine to guide the
catheters into your heart. It is important that you remain still and resist the
temptation to raise your head to see what the doctor is doing while the
doctor places the catheters are being placed.
Sometimes, it may be necessary to use both an artery and a vein.
What will I feel?
After the catheters are in place, the doctor will look at the monitor to
assess your heart's conduction system. Then, the doctor will use an
external pacemaker to give the heart electrical impulses to increase your
heart rate. You may feel your heart beating faster or stronger when your
heart is paced. If an abnormal heart rhythm occurs, the nurse will ask you
how you are feeling. It is very Important to tell the doctor or nurse the
symptoms you feel.
The doctor will then move the catheters around your heart to see which
area(s) your arrhythmia is coming from. Once the doctor finds the area of
your heart that causes the arrhythmia, energy is applied through the
catheter. You may feel some discomfort or a burning sensation in your
chest. This is normal. During this time you must stay quiet, keep very still,
and avoid taking deep breaths. If you are extremely uncomfortable, tell
your nurse or doctor and more medication may be given.
How long does on RFA last?
About 2 to 6 hours.
Are there any risks to an RFA?
Radiofrequency ablation is generally very safe. However, as with any
invasive procedure, there are risks to having an RFA. Special precautions
are taken to decrease the risks. Your doctor will discuss these risks with
you. Any specific questions should be directed to your doctor.

What should I expect after the RFA?
When will I find out the results?
Results of the procedure will be given to you and your family after the test.
Your doctor will also discuss when you can resume activities.
If you have any other questions, please ask your doctor or nurse.
Will I have to stay in the hospital after RFA?
After RFA you will be admitted to the hospital. You will be taken to your
room and placed on a special monitors called telemetry. Telemetry
consists of a small box connected by wires to your chest with sticky
electrode patches, The box causes your heart rhythm to be displayed on
several monitors on the nursing unit. The nurses will be able to observe
your heart rate and rhythm.
You will be discharged the next day and given follow-up instructions.
Many individuals feel extra heartbeats on and off for a few weeks.
Sometimes you may also feel as if your tachycardia (fast heart rate) is
starting, but then it stops. These sensations are normal and you should not
be alarmed. If however, your tachycardia reoccurs, notify your doctor.
How do I care for the wound site?
After the RFA, the doctor will remove the catheters from your groin. To
prevent bleeding, the doctor will apply pressure to your groin area for
several minutes. Then, you will need to be at bedrest for one to six hours.
Keep your legs as still as possible during this time to prevent bleeding.
No stitches are needed. Your incision will have a small sterile dressing on
it which can be removed the next day. Keep the area clean and dry.
Report any redness, swelling, or drainage at the groin site to your doctor
or nurse.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[Kat__0]

Posted By Kat on June 24, 1999 at 17:36:19
Now thats a complete answer.
Will I feel the cathaters going into the vein?
If I get too nervous will the Doctors respect my wish's to stop the procedure?
I just want a little control over the situation.
Why can't they use a general anesthetic?
Everything your heart does shows on the monitors anyway.
Is it possible to avoid my groin area and go in another way.
I want to walk afterward.

[Shanon__0__0]

Posted By Shannon on June 24, 1999 at 23:37:11
Kat -- I had an EPS/w possible ablation done last Monday.  I had the same worries you've expressed, so I thought I'd share my experience with you.
I did not feel the vein punctures in the groin because they had numbed the area. I don't remember a lot of the procedure because of the drugs, but I know I was awake for most of it.  I had no swelling or even minor pain walking right after the procedure, and only little bruises at the groin and jugular puncture sites.  I was a bit groggy for a day afterward, but I also had open heart surgery fairly recently, so I didn't go into at 100% anyway.  I felt the surgery team was very open with me about what was going to happen, what was happening and so on.  I did have to call my doctor the next day because I couldn't remember what he told me in any detail!  
Feel free to e-mail if you have any other questions.  I can't answer some of your questions, like can they use sites other than groin, but I can tell you it was an easy procedure for me.
Best wishes -- Shannon










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