Apr 09, 2011
Part 2 - The Actual Ablation Procedure, Pre-Ablation Notes, and Notes for the Ladies:
A disclaimer - I am not a licensed medical professional. The opinions expressed below are my own opinions and should not be construed as medical advice.
Pre-ablation - A few general notes:
Two weeks before ablation, stopped all exercise per doctor’s orders.
Reduced Atenolol to 2/3 normal dose on the day of the stress test only, per doctor’s orders.
Three days prior to ablation, I was instructed to stop taking Atenolol. Also had to stop eating chocolate until after the ablation. (I can live without Atenolol, but I can’t live without my chocolate.)
No food or water was allowed after midnight before the day of ablation.
The day of the ablation, I was allowed to take my three other medications the morning of the procedure, with just a few sips of water. I was allowed to take my low dose aspirin too.
The usual hospital instructions – do not bring any jewelry or other valuables and wear comfortable loose fitting clothing and shoes.
I did not have to have a urinary catheter during the procedure. (Thank goodness!)
No hibiclens (surgical soap) was required for my shower prior to the ablation procedure.
The hospital asked that I bring a copy of my health directive to the admitting desk on the day of the procedure. HIPAA release too.
Notes for the ladies:
Nail Polish: No, I didn’t have to remove my nail polish before the ablation. Good thing given the cost of pedicures, LOL. Check with your own doctor, though. He or she may have different ideas.
Important – please note: The nurses will give you a “trim” before the procedure. So, if you are squeamish or would be embarrassed to have someone else do this, do what I did and do it yourself the day before the procedure. (They did do a touch-up at the hospital with an electric shaver.)
Bra: I did not wear a bra to the hospital, as I had assumed that my chest area would be too sore to wear it after the procedure. As it turned out, I was fine, had no pain in the chest area, and could have worn it.
Underwear: I had seen somewhere someone had recommended that ladies wear silky jockeys so as not to irritate the groin area where the ablation catheters were inserted, but I can’t remember where I saw it. In any case, by the time I saw it, it was too late. But I thought I would mention it for others who may be interested in purchasing some. Also, I had a problem as the elastic from the legs of my underwear rubbed against the places where the catheters had been inserted and irritated them, causing a tiny bit of bleeding on one side. I took off the band-aids the day after the procedure and replaced them with soft gauze bandaging and paper tape, then folded two soft facecloths and placed them inside both sides of the underwear between my leg and the catheter insertion points. The elastic leg held the facecloths in place and protected the sensitive areas. Problem resolved and it was a very comfortable solution.
Clothing: I wore a soft cotton jogging suit to the hospital. Front zip jacket seems to work best, as do wide pants legs. Also wore clogs and cotton socks. I was allowed to keep my socks on during the procedure, but nothing else except the johnny.
The actual ablation procedure – everything you ever wanted to know (and maybe more):
My husband and I got up at 4:45 am, showered and dressed, and headed to the hospital at 5:45 am, as I needed to arrive at the admitting desk by 6:30 am. Traffic wasn’t too bad and we arrived a few minutes early, parked the car, and headed into the hospital. I was feeling terrible and even though I was walking very slowly from the parking lot to the entrance, my heart was really acting up and I thought I was going to have an SVT attack any minute. The clerk at the admitting desk was very nice and I showed her my identification and insurance card, she asked several questions, had me complete and sign some forms, and collected the co-pay. I gave her my advanced health care and HIPAA directives, then she gave us a receipt and showed us to the waiting area. As we waited, I could see the sunrise through the window and thought to myself how nice it was that it was such a bright sunny new day and the beginning of a new life and heart rebirth.
A few moments later, a hospital staffer came by to escort us to the EP lab. She asked me if I wanted a wheelchair for the short walk to the elevator. I said no and was sorry afterwards as it turned out to be a longer walk than I thought it would be. We arrived at the elevators and took an elevator to the eighth floor EP lab.
We were only in the waiting area for about 5-10 minutes before a nurse came looking for us. I saw a restroom and took the opportunity to use it before we began with the pre-ablation preparations. After I was finished, I was asked to change into a johnny, and miracle of miracles, it was a new one that was roomy and comfortable and actually tied in two places in the back so I didn’t catch a draft or inadvertently flash anyone. I was allowed to keep my shoes and socks, and all my other clothing and my coat went into two plastic bags that were kept with me throughout the day. I was seated in a comfy chair and the nurse proceeded to check my identification, birth date, and what procedure I was having done (safety precautions). She then hooked me up to a pulse monitor, a blood pressure cuff, and an IV. Of course, as soon as she was done, I had to visit the restroom again. But she was great about it, disconnected the BP cuff and the pulse monitor and walked me to the restroom holding the IV tubing and bag. Once I returned, the BP cuff and pulse monitor were reattached, and I was draped with heated blankets, as it was kind of chilly.
My doctor stopped by to meet my husband as they had not had the opportunity to meet previously. They hit it off quite well. The doctor explained the procedure and gave my husband an estimate of how long the procedure would take (2-4 hours) and how long I would be in the recovery room (about 3 hours). The doctor took my husband’s cell number, gave him the number for the EP lab, and promised to call my husband as soon as I was moved to the recovery room. (I had encouraged my husband to go home and work from home, rather than sit in the waiting room, which would make for a very long day. Also, I was hoping he could get some rest as neither one of us had slept well all week.)
By then it was time for the ablation procedure. I believe it must have been somewhere between 7:30 and 8:00 am – not sure as I didn’t have a watch. I kissed my husband and gave him a big hug and then he left and I was accompanied by one of the nurses to the EP Lab.
The EP Lab looks like a big computer room, only with medical equipment and a slightly larger than stretcher-sized table. The nurse took my shoes and asked me to sit on the table so they could apply electrodes and other items. I was painted with a blue liquid disinfectant/germicide from mid-stomach to just above my knees, except for the catheter area and private parts. It was rather cold in the EP Lab, even more so than the room I was previously in, and I was shivering a little bit. Apparently they keep the electrodes refrigerated because they felt very cold as they were applied. When everything was done, I was hooked up to oxygen and one of the nurses helped me to lie down and get settled in and made sure I was comfortable. A foam wedge was placed under my knees. Then the armrests were adjusted and my hands were restrained so I couldn’t accidently pull anything out during the procedure. I was asked to lie flat and as still as possible during the procedure. I was then draped with warm blankets, one from the top of my head down the sides of my neck, and the other across my body, with the exception of the groin area where the catheters would be inserted. I was given a quick “trim” by the nurse and afterwards my private parts were covered as well.
Next, I was introduced to the other doctor who would be assisting my doctor with the procedure. He was very pleasant and I liked him very much too. This doctor would be inserting the catheters, one on each side of my groin, and he would be maneuvering the mapping and ablation wires. My doctor would be doing the EP study and mapping on the computer on the other side of the room and instructing the other doctor where and when to burn. I believe they said there were two wires in one catheter and three in the other.
The anesthesia being used was “conscious sedation” where I would be given sedatives (Versed) and pain medication (Fentanyl). It is necessary to remain conscious and alert for certain portions of the procedure. My preference was to remain conscious for the entire procedure as I was very interested in what they were going to be doing and I was happy they were willing to accommodate my wishes. (You’re probably thinking “This gal is crazy”, right?) I was told if I needed additional sedatives or pain medication I only needed to say the word and the nurses would administer more. They made every effort to ensure my comfort and the nurses were always close by, constantly checking to be sure I was feeling OK.
Next step was the insertion of the catheters. I was given several shots of Novocaine at the catheter sites. Unfortunately for me, I have a high tolerance to pain medication and Novocaine and I need more than the average person in order to achieve the desired effect. I notified them in advance, as I wanted to be completely numbed before they started inserting catheters and wires. Also, I dislike needles with a passion, always have. Once I was numbed, the doctor began inserting the catheters. I only felt pressure as this was being done. He seemed to have a more difficult time with the left side than the right side. Wish I could have observed what he was doing, but I couldn’t see anything that was going on as I wasn’t allowed to raise my head. However, the nurses explained everything that was going on every step of the way. My guess is that the preparation time took about an hour.
Once the catheters were securely in place, they began the mapping procedure to identify the problem areas that needed to be ablated. I felt many different sensations, some uncomfortable, but I wouldn’t call it painful.
After that, they gave me a medication to induce an SVT attack (Isoproterenol). I didn’t think it was going to work at first, but then all of a sudden the SVT triggered. I felt like my heart was going to explode out of my chest and I started to panic which is typical for me during one of these attacks, and was having a little trouble breathing. I think it was more from stress and anxiety than anything else. I was given more sedatives and calmed down and was able to hold on until they obtained the information they needed to perform the ablation. It was probably only a minute, but it seemed like forever. Once they had what they needed, they knocked down the SVT and a few minutes later I felt fine. I later learned that my heart rate was up to 240 beats per minute, even more than my last attack which was in the 200 beat per minute range. For whatever reason, the previous SVT felt worse than the one that was induced in the EP Lab.
Now that they had the info they needed, they proceeded to perform the ablation, my doctor at the computer and the other doctor at the controls of the catheters. I could feel the ablation wire moving around in my heart, but nearly no discomfort or pain. When they burned the problem areas, I felt heat in my heart, but it didn’t hurt at all. I lost track of the number of times they burned, but the nurse said it was either 10 or 11 times. I plan to ask for a transcript of the procedure for my records. Even if I have to pay for it, it will be worthwhile to have. I was given medication and sedation throughout the entire ablation and the procedure was much easier to endure than I had expected. Everyone was great and took excellent care of me. No complaints at all. And my doctor came over several times during the procedure to check on me personally and make sure I was doing OK. Once the doctor had finished ablating, they attempted to induce another SVT event, but were unable to trigger one -- which meant I was now SVT-free for the first time since I was 13 years old!
Once they were finished, my doctor came over to talk with me. I finally learned what type of SVT I have. It is AVRNT, which is one of the more common types, and is on the right side of the heart. He said they were hoping to kill the entire problem area, but as some of it was very close to the node, they had to stop. If they hadn’t stopped, I would have ended up with a pacemaker. He said they were able to damage the problem area severely enough that I would likely never have a problem with it again. About a 5% chance of any future problems. I can live with those odds. 95% success is excellent!
I asked him if he considered this to be a success and he said yes. I think he was even more disappointed than I was that he wasn’t able to kill it all. He is a good man and a great doctor. I have the utmost faith in him and complete trust in his abilities. After he finished talking to me, I thanked him profusely. He then headed over to the phone and personally called my husband, as he promised. I have never had a doctor do this before. He is truly amazing.
After my other doctor removed the catheters, the nurses removed my electrodes, the oxygen, removed my restraints, and other items, I was transferred to a stretcher. Before I left the EP Lab, I expressed my heartfelt thanks to the other doctor and all the nurses for all they had done for me. I was then wheeled to the recovery room. I saw a clock in the hallway on the way to the recovery room. It was 11:35 am.
Once I was settled in the recovery room, one of the nurses asked me if I wanted something to eat. I was parched as I had not had any water since the previous evening and was very hungry too. I was given the choice of a corn muffin and coffee or a boxed lunch containing a turkey sandwich, chips, milk, and diced canned peaches. I opted for the boxed lunch. It wasn’t easy to eat, as I had to lie flat for a couple more hours, but I was hungry and didn’t care if I made a mess with the crumbs. I ate most of the sandwich and the chips and drank some water. I felt fine and had no pain at all.
My husband arrived a few minutes after I had eaten lunch. I think he was surprised to see me looking and feeling as chipper as I did. Since I was still very thirsty, I had two more glasses of water. My doctor stopped by the recovery room to check up on me and make sure I was doing all right. He said I could go home at 3:00 pm. Around 1:30 pm the nurses raised the head of the bed a little bit. Around 2:00 pm they raised it a little bit more. Shortly after that I was allowed to get up and sit in the chair. When I continued to do well, they let me get up and use the restroom. It felt funny to be walking after so many hours of being immobile. Then I was allowed to get dressed. Finally they removed the IV in my arm and I was helped into a wheelchair for the ride down to the lobby. My husband went to retrieve the car, parked outside the hospital entrance, and the nurse helped me into the car. I thanked her again for all she had done for me throughout the day. Then we headed home.
Despite my fears, this is one of the best decisions I ever made and my experience was a very positive one. Most of the credit for that was due to having the right doctors and the most wonderful, caring nurses and other medical staff. Knowing what I know now, I would not hesitate for a moment to have the ablation done. I hope this post has been helpful to anyone considering ablation. Please contact me if you have any questions or concerns.
Next post – Part 3 - my post-ablation experiences. Probably won’t have this ready until Monday or Tuesday. Thanks for your patience! And have a great weekend!