My ablation experience AVNRT / no Sedation full story [Long post]

Hi,

This is not a question but rather I just wanted to post back my experience with my ablation that I had yesterday in full to give an insight to any others who might be going through the same. I opted to go without sedation so I can remember every step of they way. My hope is it will clear up some of the mystery for others looking to do the same.

So first up, the background; I'm 30/male, my SVT's started (noticably) just over a year ago when I got my first full on attack (220+ bpm for over an hour). A couple of trips to urgent care but forunately in each event I was able to get it to abate prior to the dreaded adenosine shot.

After a recent attack it was suggested I went in for the ablation. Let me just say the scariest part of this whole thing was the time between saying Yes to the op and actually being wheeled into the operating room. Pondering over the thought of possibly dying frequently for several weeks did nothing to help e.t.c.

Prior to the op I did some reading up on the sedation and found out about the 'Councious Sedation' methods, by this point I was even more scared of the sedation than I was of the op itself. Particularly as I had a past (somewhat distant now) with mind altering drugs and something like Versed (Midazolam) sounded exactly like the kind of drug I wanted to avoid like the plague. So after a last minute panicked call to the doctors office the day before I opted to go without sedation. I prepped up letter / notice officially refusing consent to the use of Versed and revoking any other consent given on any other forms and brought it with me to the hospital. As soon as I checked in and started filling out the consent forms I had them stamp the notice as received give me a copy and place it into my file to make sure there was no confusion. (Given all the scary stories I found I wanted to make sure there was no possible confusion over this)

Anyway, so they prepped me up for the op. (My one tip here is for anyone with hair on their front or back shave the night before and also be careful not to nick yourself. They stick pads everywhere! Less hair = less pain.) Once I was all set the doctor came through to see my prior to starting, signed one last form and then we were off.

In my case the nurses were all very friendly, they wheeled me into the room telling me about what was going to happen then they got me onto the operating table. The did strap my wrists down in case I flailed my arms, the straps were not tight even though it seemed a little scary. The main instuction they gave me was to stay still as much as possible for the whole op, in particular when they were ablating.

The actual op started with them getting ready to go in to the groin. This was by far the most uncomfortable bit of the whole op. Injecting the local anesthetic into your groin is not pleasant. About 6 or 7 seconds of burning hot needle sensation. I was somewhat prepared for this so I knew I just had to grit and bear it. Then when they put the piece in that they slide the catheters through (sorry I dont know the technical name for this) there is a another 1 or 2 seconds of a wierd uncomfortable feeling again short though as they slide this in. It did make me kind of squirm though so they dropped a small dose of Fentanyl in my IV drip.

Putting the catheters in was amazingly quick. I could see what they were doing on the monitors and the XRay one lets you see the catheters going up through your vein and into the heart, in fact it's what the doc used to see where he was going. This part is almost entirely sensationless, no pain only the very odd pin ***** tingling sensation but nothing to worry about, plus it happens so quickly that next thing you know he's in the heart already. This bit was literally a minute at most.

Next up the shuffling of the catheters and the mapping / pacing. This part is quite wierd, to me it felt like the different parts of you heart would get little jolts (in fact I believe that is exactly what was happning). Its not really painful but just somewhat odd. This continued for a while and they started to pace up certain areas (increasing the frequency) until they found the part causing the SVT. If you've had the full on SVT attack then this is nothing in comparison. They kept going until they had drilled right down onto the problem piece and were able to force it to go into a sustainable SVT. By this point I could tell, my breathing started to get a bit tight and I could tell it was racing, the Fentanyl was doing a good job of down playing most of the symptoms though. The doctor also seemed quite pleased as this meant they had nailed down the cause. Then they try pacing it down, using the same pacing techniques they actually bring you back out of SVT. This part for me was the most worrysome per se since my understanding was that if they cant pace you out of it they have to shock you out of it. In either case the pacing worked and they stopped the SVT as easily as they started it. I wasnt really keeping track of time but to me this seemed to be no more than 30-40 minutes but it may have been a little longer.

Next up they put the ablating catheter in, much as the first bunch this happened so quickly it was in my heart before I realized and again totally painless. Interestingly enough as the ablating ones kind of prodded gently against the part I am guessing they were about to ablate I could feel it. Not sore at all but noticable all the same.

They warned me before starting the ablating part to hold extra still. They switched on the RF and I got a very hot sensation in my heart, maybe a little too hot! I called out that it was not so pleasant so they stopped the RF and topped me off again with more Fentanyl, waiting a minute or two for that to work its way through before starting again. Second time in I barely felt anything. They did some blasting with the RF and it triggered the SVT again, no problem, they paced it back to normal and started again with the RF.

After a few rounds of RF blasting they switched back to the pacing to see if they could make the problem re-occur. In my case it did so they did some more RF blasting.

Second time round they started pacing and it didnt come back, this time however they really cranked it up. They were using an adrenaline like substance with a short half life in the drip to get the heart racing whilst pacing it too. This sounds a bit scary but it really wasnt too bad, I'd fell my heart suddenly speed up as they paced it and then as soon as they stopped pacing I felt the heart go back to normal almost straight away.

At this point the doc told me they had solved the problem and they launched into the finishing stages. Catheters out, again very quick and then finally the removal of the piece in my groin. For this bit they pull it out and immediately apply preasure for about 10 minutes to the site. Then they unstrapped me (yay!) and lifted me onto the bed to wheel me out to post op.

I had to lie pretty much flat for 6 hours after that but the nurses all took great care of me. I stayed over and the next day (today) I went home.

So, to surmise, the only painful bits were the going into the groin (roughly 10 seconds max of discomfort / localised pain) and the very first zap of the RF catheter (which was soon fixed throught he power of Fentanyl).

In terms of anxiousness, once they actually started the op I was actually far less stresssed than I had been the weeks leading up to it.

The Fentanyl works wonders, the nurse helped me out every time I felt discomfort. I got a slight rush of light headedness each time they put it in the drip but it left me clear headed and able to think straight and most importantly without pain.

Most importantly the dreaded Versed / Midazolam never came near me!

[tom_h]

Great post.  With more of these up, folks considering ablation will see the successful ones, and not just the problem ablations that naturally are posted here.

Regarding sedation:  I had general anesthesia for mine.  Although I was given a choice whether on not to use it, I know how I am in situations like that, and I didn't want to jepordize the procedure in any way.  I wanted the EP to do what he needed to do, and not have to worry about how I was feeling.  In my 60 years, I've been sedated many times; for things like toncils, to hernias, broken bones, and colonoscopys.  I can tell you that the sedation they use today is nothing like what it was ....say 30 years ago.  Back then, you could feel your consciousness being pulled away, I didn't find it a pleasant experience.  The dugs they use today though give you a sleepy feeling, a feeling that you've had just a bit too much libation, and all you want to do is sleep.  It's a very natural feeling, similar to going to sleep, but the time period spent in that twilight state is more compressed.  There's no counting backwards, no mask over the face, it's actually very comfortable.

So in summation, I'd say that unless you have some particular reason to not be sedated, don't fear it.  Although as an engineer, I would have been interested in seeing the equipment they use in the procedure, I felt it best for all parties that I'd be "knocked out" for this one.  It didn't increase the time in the hospital; I was in the lab at  9 and back in the car going home by 6.  In in all, I've had extremely worse hospital experiences.  

[garethbp]

Overall, I won't go as far as to say I enjoyed the operation, but for me it was indeed fascinating and I'm actually ever so glad I wasnt wacked out on amnesia drugs.

My advice to anyone considering this is the following...

The run up to the op was by far the most worrysome time I had
The second most worrying time was the first time they triggered the SVT during the op before they paced it down.

Maybe consider / discuss with your doc doing it with just pain killers. Fentanyl is strong stuff and the op is actually not painful for the largest part.

I hope this helps some others going into this to get an insight. Apologies for the massive posting.

G

[tom_h]

Great post.  With more of these up, folks considering ablation will see the successful ones, and not just the problem ablations that naturally are posted here.

Regarding sedation:  I had general anesthesia for mine.  Although I was given a choice whether on not to use it, I know how I am in situations like that, and I didn't want to jepordize the procedure in any way.  I wanted the EP to do what he needed to do, and not have to worry about how I was feeling.  In my 60 years, I've been sedated many times; for things like toncils, to hernias, broken bones, and colonoscopys.  I can tell you that the sedation they use today is nothing like what it was ....say 30 years ago.  Back then, you could feel your consciousness being pulled away, I didn't find it a pleasant experience.  The dugs they use today though give you a sleepy feeling, a feeling that you've had just a bit too much libation, and all you want to do is sleep.  It's a very natural feeling, similar to going to sleep, but the time period spent in that twilight state is more compressed.  There's no counting backwards, no mask over the face, it's actually very comfortable.

So in summation, I'd say that unless you have some particular reason to not be sedated, don't fear it.  Although as an engineer, I would have been interested in seeing the equipment they use in the procedure, I felt it best for all parties that I'd be "knocked out" for this one.  It didn't increase the time in the hospital; I was in the lab at  9 and back in the car going home by 6.  In in all, I've had extremely worse hospital experiences.  

[Jannie411]

Congratulations on your successful ablation -- I'm very happy for you that it went so well!  

[garethbp]

Actually I wasn't against general anesthesia, my vote was either to be fully under or fully awake. It was just the 50/50 twilight sleep that seemed daunting to me. The doc told me that general was an option but it ran the risks of masking the SVT which is why they preferred the conscious sedation (twilight sleep).

If you have had experiences with the twilight sleep and it works for you then all the better you really have nothing to worry about with this op.

[LavenderJade]

So nobody tried to bully you into accepting Versed ? Medical people are really forceful (and sometimes deceptive) about giving this drug to virtually everyone they can, because it makes their jobs a lot easier. Speaking from personal experience, not everyone wants the creepy amnesia this drug causes, sometimes for hours after the procedure is over. I sure hope that in the future I am fortunate enough to get an honest medical team that allows me some say in my own treatment, or at least the right to decline treatment  if they won't abide by my wishes to not be given any Versed.

[jkfrench]

Yes, I agree with you.  I was fortunate to find a doctor to give me a colonoscopy with sedation (versed).  I wouldn't recomend it, but I made it through the procedure.  I figure if I ever need an ablation, I can get through that without versed as well.  It is good to know there are doctors that are willing to let us make the choice.
Congrats on your successful ablation garethbp and may you have a wonderful svt free life moving forward.
Jodie

[garethbp]

Here's the body of the notice I gave to them signed and dated...

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I, , hereby refuse consent to the use of any amnestic drugs, including but not limited to the brand named product Versed or any other Midazolam or Benzodiazepine based product, for the purposes of Sedation/Analgesia as defined by the American Society of Anesthesiologists.

I also hereby revoke / rescind any previous consent to the use of any amnestic drugs for the above purpose; be that verbal, written, implied or otherwise.

This Notice does not cover conditions of General Anesthesia as defined by the American Society of Anesthesiologists.

This Notice shall take effect immediately and act over and above any other consent given for medical care until such time as this notification is specifically annulled / rescinded in writing either by myself, , or my legally authorized representative.


------------------------------------

I got them to stamp it (with date) and give me a photocopy of the stamped received copy. Then I got the notice put into my medical notes.

My understanding is that you are allowed under the Patient Bill of Rights to specifically refuse consent to products like Midazolam.

In my particular case the hospital were very open and willing to help anyway so I found little need to push my case. The notice was my backup in case they had not been so helpful.

For anyone in northern CA tho, I was at Stanford Hospital and they were very open about their intention to use it and willing to accept my reasons for declining it.

[Beccaintexas]

I just wanted to post about my catheter ablation experience.  I had AVNRT for 32 years before they were able to finally diagnose what my problem was.  I am sure that alot of that was due to the advances in medicine.  After my last trip to the ER where they had to stop my attack with adenosine, I finally decide that I would consider a surgical approach.  My sister had been trying to get me to do that for years as she was the head of the cardiac cath labs in the hospital where she worked.  It was not that I was stubborn, but rather that I was afreaid the procedure was still too new and that if medication controlled my problem, then I should just continue with it.  During the 32 years before my ablation, I had finrequent attacks for the first few years but they became more frequent as time went on.  I also had alot more of a problem with it when I was pregnant. I think I had every heart test known to man many times over always with no definitive answers. I had taken beta blockers, calcium channel blockers and even digitalis (which actually made the problem worse).  When I finally visited an electrophysiologist, he was pretty disturbed when he found out my hobby was as a SCUBA diving instructor. My doctor did not give me a choice about being sedated or not.  He said I would be sedated.  After hearing the horror stories my sister told me about the patient moving during ablation and the electrical pathway being totally interrupted (which required the patient to have to get a pacemaker), I did not have any problem agreeing to the sedation although, I would have like to have seen the procedure.  I found it very interesting.  Anyway, I guess because I was sedated, they did not use any local anesthetic to numb my groin area and when they pulled the sheaths of of my groin, that was how they woke me up.  I have to say that between that and the catheter, it was painful!  They gave me morphine so the pain was short lived (thank goodness!).  All I care about is the fact that after 32 years of problems, the proceedure was a success!  I still have problems with skipped beats and extra beats but it is more of an annoyance than it is a problem.  I was strongly recommend this procedure for anyone who is not able to control their AVNRT with drugs!

[Darlingorla]

Thanks for your post and sharing your experience - and you too garethbp if you are still around ...

[merileegal]

I had AVNRT for over 20 years. Your story sound so much like mine. I got so I refused to take med and converted mine with vagal maneuvers for years until that became more difficult. The key to a successful ablation is to have a very experienced ep with a good reputation. My ep told me that there have been huge improvements in the last 10 years for AVNRT. He said 10 years ago when they did ablations, they burned the fast pathway and that there was a 20% risk of having to have a pacemaker. Now they burn the slow pathway and there is like...1% risk of needing a pacemaker. It is actually less than that but they have to show that it is not 100% successful. My ep said it was an easy fix, which it was, and wondered why I hadn't been sent to him before.

In the research I've done for AVNRT some reports say that you run less of a chance of complications by having an ablation rather than being on meds. I believe that. I was also on digoxin for a while, up to 4 pills (don't remember the dosage) until I became sick. I think it was toxic in my system. Another one I went on made me so tired and cranky it ruined my qualit of life. Vagal manuevers worked when I figured those out so that is the way I handled mine until I was finally told about the ablation. So glad I had it done. Like you I still have the other flip floppy feeling or skipped beat feeling but I can live with those. I still am careful about nutrition, stress and all of the those things that were triggers for SVT.They are still triggers for my PACs.

[nadia200]

Hello, I am 20 years of age and have had a fast hertbeat and very fast heart beats since I was about 9 - not sure whether i was born with it or not.
After being told since I was about 14 that I amj a crazy daisy and I am making it all up I returned to see a cardiologist last year who referered me to an electrophysiologist who found I had AVNRT and sinus tachycardia. Imust agree with the previous post the wait for the op is definitly the scariest. I woulod say I am quite a girly girl and for weeks leading up to the op I had horrible nightmares, constantly anxious and thoughts that I would to die. The experience stated above is very much the same as mine. But I did have all the drugs I possibly could - Apparently they said I was amazingly still awake and crying even though tehy gave me enough pain killers, sedation and ant anxiety drugs to knock out a rhino but my fear and curiosity overcame it all. Bearing in mind I am 8 and a half stone.
The tears were definitley more tears of relief than in pain. I can remember it all I just couldnt get my words out straight which was confusing. I would definitly recommend havihng as many drugs as possible just to keep you calm if you are as scared as what I was.
For about a monthy after I had frequent pacs and pvc's which i never had before. And unfortunately now it seems the ablation hasnt worked as I had an episode of my hear tacing at 220 bpm the other day and I am becoming very breathless at minimal exercise such as walking up the stairs etc. I didnt have that before either. I also get cramps and short sharp pains in my heart and sometimes when it happens just before I am about to go to sleep it stops me from sleeping as I am anxious. I am feeling tired constantly... and the ablation happened in August. My cardiologist hooked me up to an ecg for 7 days and I find out the results next week, But for now I no i just have to stay as calm and relaxed as possible and hold tight