Upcoming ablation

[tired of my heart!]

I am a 26 year old female with Lone a fib.  My heart is structurally normal.  My blood pressure is normal.  I am not overweight.  My episodes of atrial fibrillation are usually 45 mins long with a pulse of 160-190.  I am always dizzy during the episodes and I feel like passing out.  The episodes of my a fib are sometimes every few days to every several months.  It seems that they are more frequent around stressful times (like they are now).  I am having an ablation in Sept.  at Barnes Hospital in St. Louis.  I have a lot of questions and worries, but I will ask my most nagging ones.

1. What do patients usually remember with conscious sedation?  Do you think it is a good choice for me?

2.  I am desperately wanting to have another baby.  I had a miscarriage last oct. due to a partial molar pregnancy.  After a treatment of methotrexate I was told to wait a year to be sure I am healthy (which will be Dec 07).  My question is: After my ablation, when would a person like me be considered safe to become pregnant?  Should I assume that I will need more than one ablation?  

Thank you SO MUCH for your time!

[StephPT]

it IS a long procedure.  Unfortunately, due to the nature of MY arrhythmia, i had to be awake for two of my procedures, which translated into about 10 hours each.  they were the LONGEST days of my life, as you are strapped to the table and can't move.  I would have taken conscious sedation any day of the week!!

As for what the doctor said about radiation exposure, they track that during the procedure (the amount of time that the fluoro is actually turned on), and mine was WAY under the limit, even with the length of my procedure.  It is, however, a risk, and something to consider.  I don't think i would want to go through a pregnancy WITH A-fib, but it's your arrhythmia, not mine.

Good luck with your decisions!

steph

[Michael J. McWilliams, M.D.]

any radiation exposure is not good for the body or potentially eggs or sperm.  The risk is low, but it is never zero.  Again, it all depends on how bad  your symptoms are.

[tired of my heart!]

Why would it be better to have children before the ablation?  My dr. told me that it would be dangerous to get pregnant before we had my arrhythmia fixed and the drugs he wanted me on (flecainide)  were not considered a good option.  

If I wait until we know the ablation was successful and I can be off of any medications, are their any other risks associated with the ablation that would affect my future pregnancies?

Thank you!  You did help me very much!  I REALLY appreciate your time!

[tired of my heart!]

Thanks for the info on the conscious sedation!  I would love to fall asleep and wake up when I am done!  It sounds like a long procedure and I have heard you are groggy, but you semi know what is going on...eeek!  Your experience made me feel better about this!

I am not on any medications except 325mg of Aspirin a day.  Hopefully that will work in my favor!

Thanks

[Michael J. McWilliams, M.D.]

1. What do patients usually remember with conscious sedation?  Do you think it is a good choice for me?

I do conscious sedation as well.  I have never had a patient complain after the procedure.  If you are anxious, you can alert the team and they can give you some more medication.


2.  I am desperately wanting to have another baby.  I had a miscarriage last oct. due to a partial molar pregnancy.  After a treatment of methotrexate I was told to wait a year to be sure I am healthy (which will be Dec 07).  My question is: After my ablation, when would a person like me be considered safe to become pregnant?  Should I assume that I will need more than one ablation?

There is a 25% chance you will need a second ablation.  Issue of when to get pregnant has never been studied.  The best choice is to have your kids before you have the ablation.  If the symptoms are too significant, I would wait a few months after the procedure.

It is very important that you have an ep study before you ablation.  In people your age it is not uncommon to find another cause that initiates the atrial fib, like an accessory pathway.  I have seen several cases now where once the accessory pathway was ablated, the afib was gone.

good luck with your ablation.  I hope this helps.  

[StephPT]

I can't comment on the pregnancy question (although it would certainly depend on the cardiac medication you are taking or need to take after the procedure).  I will be interested to hear the doctor's response.  You may need to be on coumadin, too after the procedure.

As for the conscious sedation, you won't remember anything of the procedure, as it has an amnesic effect.  You may also have some trouble remembering things that happen immediately after you wake up, as there is some carryover.

I have had 4 ablations (thank goodness the last was successful) for a swallowing-induced tachycardia that was treated very similarly to A-fib, as it originated around the pulmonary veins in the left atrium, and i have had 2 TEE's with conscious sedation.  it's good stuff!