I can't say I fully understand your post, so my input may be off the mark.
I suffer from permanent AFib and my EP and Cardiologist (both in the same association, but not a private hospital) say the risk/benefit of an ablation says the risk is too high, so no ablation. I am not trying to scare you, my benefit factor is part of the problem. For reasons you may understand reading my profile, the probability of an ablation working on me isn't good, so any risk may be too much. Said another way, I am able to maintain a reasonable heart rate, with some irregularity, with the help of beta blockers, and calcium channel blockers. I take warfarin to lower my associated risk of clot formation/stroke. That is I am on "rate control and anticoagulant" and I tolerate these medications well. So, no ablation.
I would be willing to take the risk (low, I don't have number, ask your doctors) associated with an ablation if the doctors believe they have better than a 75% chance of success. If you read my profile (I think it is in there) you'll see I underwent a mini maze procedure when I had a heart valve repaired and that didn't stop the AFib. My AFib is rock solid.
So, if you are able to live a reasonable life style using medications, discuss with you doctor just going forward that way. Again, if the estimate is 75% or higher that an ablation will cure the problem, I'd say go for it.
I had mine done at 59 after nearly a lifetime of SVT which towards the end was occuring 3-5 times per month. For me, the few drugs that I tried were totally ineffective in lowering the number of episoides I was experiencing. My doctor was becoming concerned with the number of events, and the high rate I would experience while having one. So I had my EP study and was successfully cured.
The thing to remember is when you're in the cath lab, you have everyone there that you'd want in case of an emergency.
No doubt you'll have an opportunity to speak with the electrophysiologist prior to the procedure. Speak to him about your concerns, and perhaps that will set your mind at ease. SVT is a curse, and it was a relief to get rid of it after 54 years.
Thank-you for your reply, Jerry. I took Flecainide for 6 days and had to stop it. No SVT, but I lost 17 pounds in 1 week and had 2 ER visits with squeezing chest pain. I took 100 mg of Flecainide 2x daily with 25 mg of Atenolol (which I've taken every day since 1988 when I nearly passed out from a terrible SVT event over 165 BPM, extreme tunnel vision). I also took 2 mg of Ativan. Here is what Flecainide did. I take it, get dizzy about 30 minutes, am okay for about 7 hours, then SQUEEZING chest pain and SOB for the next 5 hours before the next dose. Vivid, horrible nightmares. I then tried Sotalol 60mg 2x daily which I only dosed 3 times. Dry-heave vomiting, anxiety, when I ate I'd go up to 150 bpm. Now I'm just taking Atenolol 75 MG a day and 4 mg Ativan to relax. Can't work and can't exercise.
If they start the ablation for SVT and see I have A-fib, then what? An A-fib ablation right there with only 28% rate or an SVT ablation first and then A-fib later? Kaiser doctors just shrug. This SVT is debilitating, I haven't worked for over 2 months, but if it gets worse after the ablation then life isn't worth living, can't go anywhere or do anything! Thank-you to you both, appreciate any advice/suggestions.
I had an episode of afib after having svt for many, many years. My doctor felt like there was a very good chance that the afib was triggered by the svt. He recommended an ablation for the svt in hopes that would eliminate all of the svt episodes I was having, along with stopping future afib episodes. Before having the ablation, I asked him if he could check for afib while doing the svt ablation and just take care of that at the same time. He said no, that the triggers were in two different areas and that he would only be looking for/working on the sites that trigger the svt. He said the svt ablations were much less risky and statistically much more successful. That's not to say that he would never do an ablation for afib, cause he does them all the time, but that was not something that would be done at the same time as an svt ablation.
I went ahead and had the svt ablation and it was a success. As scared as I was going into it, it really wasn't bad at all and I would do it again in an instant to be rid of the svt.
It sounds from your post like maybe your doctor isn't very easy to talk to. Is there a chance you could go to another doctor?? He should be giving you more information than just a shrug when you ask him questions.
Thank-you for that reply, Annie. I am most definitely thinking of seeing another EP doctor at Kaiser. This fellow didn't believe I had A-fib on 2 5-hour occasions before, didn't believe my "Oregon Scientific" heart monitor watch was accurate, (It is, I check it with ER monitors and it is right on) and he didn't believe I had a 265 BPM episode in 1988 when I was just on Verapamil and still stayed conscious, even though I told him I could barely see through my tunnel vision. And yet, this doctor's reviews are almost all positive! Maybe those are just the ones he posts?
It is hopeful to me that since most people have successful SVT ablations that mine will be. Most sites I've been on say they are 98% successful, while Afib ablations are only 28% successful.
My A-fib episodes happen like this: 2 violent PVCs in a row with no beat inbetween, then SVT, then A-fib for about 5 hours which usually corrects with a bowel movement. That is how I've escaped the 200+ SVT episodes in the past 29 years (since 1983!) by holding my breath and bearing down. But on 1-30-12 I had an SVT episode that I couldn't valsalva out of.
My afib episode also occurred as I converted out of an svt episode. It lasted for 12 hours and finally stopped with IV medicine given to me in the hospital. My ep said that sometimes svt can cause afib, with your heart converting out of svt and into afib. That's when I knew it was time to get the svt taken care of asap! Sounds like you are at that point too, especially if you couldn't get your svt to stop in January. Good luck!
Thank-you, Annie. The strange thing about my 2 five-hour A-fib episodes is I am not nearly as afraid of them as I am of SVT, even though SVT is a more regular rhythm. A-fib just feels like a butterfly is floating in my chest. The doctors say it is much more dangerous than SVT because of the likelihood of blood clots and stroke. I have not had to take the rat poison called Coumadin yet, thank-God. I know a 98-year-old woman who has A-fib and flat out refuses to take Coumadin and calls it "rat poison"....She's lived a great life, I am only 54. I had to put in for retirement 3 years before I wanted to and I'm hoping my doctor leaves me off work for a few more months until I get the right doctor and have the procedure done, there is a 6-week wait a Kaiser, but I've had SVT and Afib for 30 years so why rush now? Because it is way more frequent! My body is turning to jello because exercise really sets off the SVT.. My employer has already said if I call an ambulance for myself again, they'll retire me on an "occupational disability" which is a garbage pension compared to the pension for 55+ which I'll be in early July. Just a nightmare.
I too have PSVT and have had 3 ablations. We also have Kaiser coverage. Interesting difference is in our area Kaiser is not equipped to do ablations and so they sent me to the medical university here in town. There was no problem with Kaiser covering it.
As for what they might find, I went in for PSVT which they found but they also found some atrial flutter, a close cousin of a-fib. They dealt with it just fine.
I haven't read all the comments here but I do hope you get another cardio to listen to your input. A-fib can be managed with medication if ablation is not an option or is not successful. I'm not sure why they would require you to retire on disability. I have friends with a-fib that are still working. One is in his 70's, still working part time. As for tachy bursts, I've had them all my life, given birth to 3 kids and raised them (talk about stress) and worked with wildlife for 21 years now. Does my heart kick up into tachy? Yeah but I wait it out if I have to.
Don't give up just yet. It can be better than what you have going now.
Thank-you for that comment, ireneo. I am curious about the "EP Study" Kaiser is really pushing me to get. That will really tell the story, I guess. This particular Kaiser is the only Kaiser in 100 square miles that does ablations, only 5 EP doctors so they have a 6-week wait.
It really helps me to talk with you good people because I have never met in person anyone who has had an ablation except my former cardiologist who strongly recommended I do not have it done. Why? Because he has had FIVE done with no improvement to his heart. On the first his heart was "pierced" by the catheters and he had to have open heart surgery to stop the bleeding. The 4 subsequent ablations were worthless and he has more problems now than ever before but still works. He refused to tell me where his catastrophe occurred but I bet it was a top-notch facility. Now you see why I am petrified? My job deals with public safety to some extent and if they declare it a success and I go back to work and have a worse event and lose consciousness, innocent people could die or be injured and there would be lawsuits all around, probably mostly on Kaiser and my employer, maybe on me. That is why I have to take a garbage 23-year pension and just get out.
The only person on television I have ever heard talking about a successful ablation was Howie Mandel of "Deal or No Deal" fame. He went into A-fib in a Canadian airport and passed out. He stayed in A-fib and his family gave permission for emergency ablation (guess they do that in Canada) and they went in and did a successful A-fib ablation and he is fine.
The medications are horrific. Flecaidine (Tambocor) and Sotalol are impossible for me to take. I've heard such bad stories about Coumadin. I am just taking 75mg of Atenolol per day and 3-4 mg of Ativan per day.
I wonder if they will do the EP study and not do the ablation. I've heard of that being done which seems a bit of a waste. If you have records of your arrhythmia and know exactly what is going on (you do) and the medication is not controlling the outbreaks of a-fib, then I don't know what's left.
As with any procedure, there will be a risk involved but the odds are in your favor. I've had 3 ablations with no complications at all. My second time in took 7 hours not counting the recovery. Still no problems. Am I completely cured of all my arrhythmias? No, but it is so improved that I'm grateful I went through it. If I have a bad heart day and my rhythm keeps popping in and out of normal, I can take a Diltiazem to calm it down. But that's a much milder drug than what you have.
I wish I had some solid information to help with your decision but my heart is not the same as yours. It's unlikely they'll mess up and poke a hole in you. And they may not fix the a-fib completely but it might be worth doing the procedure to find out if it works. You know where you stand now. An ablation might turn things around and make life easier for you. The unknown is frustrating.
The unknown is terrifying AND frustrating. Funny thing----the Kaiser doctor who started me on Flecainide then Sotalol in February after I proved I had SVT with the cardiopal event call-in monitor, told me in 2008 that "You're probably just having runs of PVCs" and when I asked him about ablations he somberly shook his head "no" saying "only as a last resort".....Now that same Kaiser doctor, with egg on his face, is saying to "just get an ablation and get rid of the arrythmia altogether." Then he sent me to another cardiologist when I couldn't tolerate those drugs, for another opinion. Kaiser doctors don't go against what other Kaiser doctors say.. So I've seen 3 different Kaiser doctors and gotten 3 different opinions because I never tell the second or third one what the other ones say.
This ablationist that is going to do my ablation says he's been doing them since 1993 and has done "thousands" and nobody has ever died "during" an ablation. Then he holds up his index finger, folds it over, and says "and only 1/2 of 1 percent of people get heart block and need a pacemaker." What degree of heart block? There is 3 degrees. When this guy walked into the room his belly was almost dragging on the floor, he kind of carries it like a basketball. At least 500 pounds. He contradicted everything I said, that I've never had A-fib unless he saw the actual EKG strips, my "Oregon Scientific" heart monitor watch wasn't accurate, I couldn't stay conscious during a 265 BPM episode which I did though I had extreme tunnel vision. If I ask for another ablationist I'm gonna be in trouble, maybe dead.
Yikes. You are in a tough spot. It's hard to trust or respect a doctor that treats you like a child or one that doesn't set a good example. I went through that with my first pregnancy. My Kaiser OB was a very large man who harped on me about not gaining too much weight (I was skinny at the time and he would only "allow" me to gain 25 lbs). All I could think was, "Hey, I'm gaining weight because I'm pregnant. What's your excuse?" I'm glad he did not deliver my child and I changed OB/Gyn right after that.
The main thing if you can overlook his bad attitude is the fact that he does have plenty of experience. That is important. And there's a good chance when they go in to trigger the arrhythmia to find the errant signals, he may just trigger a bit of a-fib as well. That's how they found my a-flutter. It never showed up on the monitors.
My EP cardio was very careful, not too aggressive in attacking my heart because I didn't want to end up with a pacemaker and he didn't want to put me in that position. We understood each other. :-)
You still have time to think it over. And there are other meds out there you can try if you aren't ready for an ablation. I had to change meds once because the first med did not agree with me and I ended up in ER. Don't rush into this, think, get information until you feel this is what has to be done. Take care.
Joe, with respect, I think you're getting yourself over-stressed about this. You've had two Afib episodes. is thatr right? One was 30 years ago, and the other 11 years ago. THat's a LONG time ago! It sounds like you're experiencing more frequent episodes of SVT. Is that right? It's my belief that your Afib didn't "cause" your SVT. I believe both were casused by some change in your heart's eletrical system. These things can and do happen;muscle tissue changes shightly and along with it your heart's electrical sysytem changes as well. Again, I don't think one caused the other, rather both are a result of a change in your heart's wiring.
Now that doesn't change what you're experiencing! When I was experiencing SVT episodes of 3-5 times per month, I was very fortunate that my cardiolgist stopped after trying 2 medications, Metoprolol and Sotalol, and said.. "Tom drug therapy is just as dangerous and perhaps more so than the electrophysiology procedure, and I think we ought to look at that." So that's when we began to look at that possibility. In my case, things worked out pretty well, but I don't know if the affected muscle tissue will bridge over again someday. For now. I live SVT free for the first time in 55 years.
If a surgical procedure is your path, you need to understand that the chances of anything happening to you are extremely remote.... extremely. In the unlikely event that something does happen, as I said above, everyone you'd want to be there in case of an emergency is right there in that room.
I've met more decent and kind people like yourselves, tom and ireneo, in the past week than I have met in the past 30 years. It really helps to hear your responses and reply back to you. Doctors often see patients as just pieces of meat on an assembly line, I mean, they try to be kind but they just can't get too involved, that is just the nature of their profession. I've had some of my cardiologists since 1982 on the verge of a nervous breakdown. Like the first A-Fib cardiologist in 1982 once told me: "I am NOT giving you cardiac medicine for one A-fib event, I am not going to see a 24 year old man in otherwise perfect health take cardiac meds for 1 A-fib event!" That attitude cost me my job and 4 years later I did start on Verapamil.
To date, the only person who has had an ablation that I have spoken to "in person" was my cardiologist of recent years, and he had nothing good to say. Only that the catheters "pierced his heart", he nearly bled out, and the 4 subsequent ablations did no good. That is from a cardiologist! Yet I think this ablation is my only hope to be able to travel in retirement, go places, see long-lost relatives in Europe. Right now I'm afraid to venture too far away from an English-speaking doctor in an American hospital. I mean, what is life if I have to live in constant fear with every PVC and SVT episode that my heart is about to stop? I'm sick of it so yes, I am going for the ablation.
I was terrified of having an ablation and put it off for years, suffering with the very frequent svt episodes, taking medicine every day (which was becoming less and less effective), and wondering all the time when the next event was going to occur. When I had an afib episode triggered by the svt I knew it was time to get it taken care of. I can't tell you how happy I am that I did it. Yes it is very scary to think of someone going in and messing with your heart, but this is what these doctors do every day and they are very good at it. Also, how long ago did your cardiologist have it done? It is a procedure that has gotten more and more common over the last 20 years or so. Perhaps he had it done in the early days and that's why he doesn't have anything good to say about it? You also want to go to an electrophysiologist who has done a lot of these procedures. I can't say I wasn't terrified the day I went into the hospital to have it done, but I am soooo glad I did it and would tell any friend who was questioning whether to have it done or not to go do it! Having the ablation truly beats a lifetime of medicine that probably isn't working well anyway!!
First, I don't think that atrial fibrillation can cause SVT (unless the atrial fibrillation itself is so rapid that your ventricular rate is in the SVT range, but even then, the diagnosis is atrial fibrillation, not SVT).
Atrial fibrillation is the "end stage" of supraventricular arrhythmias, sort of an "atrial cardiac arrest". The atria are beating at a rate of 400-600 bpm, where a supraventricular tachycardia often has an atrial rate of 150-250 bpm. You can say that atrial fibrillation is an extremely rapid SVT, but all impulses are luckily not conducted.
That said, there is some concerning points in your post. Your cardiac arrest, is a cause found? That, along with your atrial fibrillation and SVT, makes me a little suspicious that you POSSIBLY can have a bypass tract between your atria and ventricles, which both can cause SVT runs, make atrial fibrillation more likely, and most important, make atrial fibrillation dangerous for you, because a bypass tract man conduct the fibrillation dangerously fast.
So the question is; is "hidden WPW syndrome" completely ruled out?
Adrenaline provoked arrhythmias are usually not a problem during an EP study. If you go into a dangerous rhythm they will shock you back instantly. Also, if they are able to induce ventricular fibrillation during the EP study just by giving you adrenaline, you may need an ICD and this could be a good idea to clear up?
If the dentist was able to stop the cardiac arrest just by doing CPR, you may possibly not have had ventricular fibrillation? You may have had another ventricular arrhythmia (a reaction towards lidocaine?) or rapid atrial fibrillation or a pause in your heart rhythm, but this is just speculations.
Sorry for a very techical answer. I'm not a doctor, I'm just thinking loud..
sorry for some typos. "may conduct", not "man conduct"
Thank-you for that interesting reply. I just had an episode at 9:40 p.m. PST on 4-19-2011 of 210 BPM that lasted only 4 minutes, didn't even valsalva out just corrected on it's own, now I'm around 100 BPM but can't dose before 12 midnight with atenolol/ativan. I've been to ER 7 times including the January event where valsalva failed for the first time and really freaked me out. I'm getting episodes of shortness-of-breath that last a few minutes and subside, not sure if this fast heart rate is related. I exercised yesterday for only the 4th time since the January event and sure enough I have the SOB and SVT event today, that is how it's been behaving. Not during exercise, but the day AFTER! Weird! And treacherous, because the ER visits aren't proving anything. The EKG, chest X-ray and 2 blood draws are all NORMAL! ER doctors are getting to know me by name and hate me and my co-pay is $50 a visit.
In 1973 when my heart stopped for about 20 seconds, the only thing I recall is severe chest pains (I was 16 years old and very athletic) and severe tunnel vision after the dentist shot me full of epinephrine about halfway through the procedure. There was no 9-1-1 in 1973 so the last thing I recall is that he told his secretary to "call an ambulance" and right when she picked up the phone my heart started again and he tells her: "No wait, he's got a pulse again, forget it, he's okay." He finished up pulling all 4 wisdom teeth and after tells me: "I thought I lost you there for awhile, some people have bad reactions to epinephrine in larger amounts." Yeah, I guess so. I was in the hereafter briefly.
With all the EKGs and stress tests I've had over the years, I think WPW syndrome would have showed up. Kaiser has done everything to cover it's butt. EKGs, stress tests, sonar tests, you name it. I finally PROVED that I have these SVT events with the cardiopal event monitor, otherwise they insisted it was just "runs of PVCs"....
My Kaiser docs have never said anything about a bypass tract problem between the atrium and ventricles, that is interesting, guess I'll soon find out in the EP study if I live that long, 6-week wait they're so backed up. They've only told me that if I have 4 PVCs in a row with no beat inbetween I'll never know what hit me, the best death imaginable, the quickest. I've had 2 in a row. I've heard of people in V-Fib and V-tac over 280 BPM that were fully conscious and responsive with paramedics right there and then have an SCA. Thank-you again!
Well, if you have a run of 4 PVCs you will not die. What is dangerous is long, rapid runs of PVCs, like the 280 bpm you refer to. Where 4 PVCs in a row is by some doctors considered ventricular tachycardia, 4 PVCs will not make the heart stop. Why this is considered serious in people with abnormal hearts is the fact that the arrhythmia can develop into longer runs that are poorly tolerated.
Regarding 1973, if you was awake during the arrhythmia, and you only had a near-fainting event, it's less likely to be cardiac arrest, which causes fainting within 6 seconds or so, and very rarely corrects on its own. Rapid runs of SVT or VT can make the pulse very weak or non-palpable, which is just a sign that the systolic BP is below 80 mmHg, but not necessarily a sign that the heart doesn't beat. SVT can cause fainting.
What is important to find out, is what rhythm you have during the SVT runs, if it's not already done. There are a lot of them;
- Atrial tachycardia (the rhythm occur at an "extra" pacemaker in the atria, just like another sinus node). Does usually not respond to Valsalva.
- AV Nodal Reentry Tachycardia (AVNRT): The most common SVT. Responds to Valsalva as the AV node is involved. An extra pathway in the right atrium that short-circuits the rhythm. Is NOT triggered by PVCs, but PACs.
- AV Reentry Tachycardia (AVRT). Caused by a bypass tract between atrias and ventricles (WPW). Can be triggered by both PACs and PVCs. Responds to Valsalva. The rhythm can be narrow-complexed (typical WPW) or wide-complexed (atypical or hidden WPW). The rhythm can be very rapid and in the setting of atrial fibrillation, this phenomenon can be dangerous.
In addition, there are some uncommon arrhythmias that origin from the AV node or the sinus node, but they usually present with slower rates (usually 130-150 bpm).
A cardiologist can easily see the rhythm if he see the EKG during an event. I would definitely ask the doctor which arrhythmia you have. As you are bothered by atrial fibrillation and SVT, it's not certain that your skipped beats are PVCs, they may also be PACs.
Hi to everyone! I had my SVT ablation on 7-10-2012. It didn't even last 2 hours, she found the pathway and ablated it. Weird experience. I received 350cc of Fentinol and 7cc of Versed. What an amazing high, they could have cut my heart out and I wouldn't have known. The doctor stayed behind glass windows about 20 feet away, the RN inserted the catheter into my femorol artery. I felt no burning pain when she ablated the area. What really hurt was when she had to "test" the area to make sure the proper area was ablated. I forgot to ask what that stuff was, adrenaline? I thought my heart was about to explode. Huge pain, even with all those drugs. Only 4 hours in recovery and Kaiser booted me.
There are a few lingering problems I am concerned with, maybe you folks can help me? I had some chest pain and shortness of breath the next day and my BPM seemed to stay between 97 and 125. 9 days later I am down in the 50's and 60's again. But Kaiser advice phoned me to check and when I told them of minor symptoms they insisted I had to go to ER where nothing was found. Then 2 days after ablation I had a dizzy spell while driving and had to pull over. It was coupled with SOB and chest pain, like a knot or pulled muscle on the left side, radiating thru to the right side. Gone in 15 minutes or so. Tingling on left side of my head.
Then 7 days after ablation, I have this weird episode where again I feel this knot on the left side of chest, sob pretty bad, but my Atenolol 75 mg day 2x for dosages and Ativan 4 mg/day for 2x dosages, get me through it w/o an ER trip. Then that night It happens again at 1:30 a.m. and I go to ER and, after 3 hours they boot me with no problems, they tested for stroke, EKG, chest X-ray. No SVT, I would have felt it. I get home, go to sleep and awaken with nasty pain between my shoulder blades radiating thru to my chest, I go back to sleep and when I awake later it is gone!
I have not exercised beyond walking yet. Should I? When I eat even a small meal (I am 6ft2in and 305) I start throwing PVCs and get that "flip-floppy" beat that used to always send me into terrifying SVT episodes. But so far, not one SVT event. Only 9 days. No A-fib yet, either. So, the doctor did her job, I just have to figure out what this "new wrinkle" is. Thank-you to you all for any advice! Joe
After my ablation I felt all sorts of weirdness for the first month and pvcs/pacs to this day but it has all settled down to the point I barely feel anything anymore. It takes a good 3 months for you to be on a good road to recovery and for some it is more. I would say it was a good 6 months for me but I had had quite a few episodes the months leading up to my ablation so it is likely my heart was a bit more stressed. But basically try not to worry too much especially since you had your chest pain evaluated and you do not appear to be having a cardiac event. It is possible what you are sensing is a response to pvcs. I know I do sometimes get some pain with my pvcs but again it should ease up with time. If however it continues to persist I might say see if you can get a monitor to catch whatever it is. It really is the only way to know for sure what is really causing your chest pain. Finally for me I will say it took a good 3 months for me to be able to exercise to full capacity. It wasn't that I couldn't do it but it seemed if I did too much I made the ectopics worse so use your best judgment about exercise. But mostly rest up. It sounds like your ablation was a success. Take care.
Thank-you for that, Michelle. I just got home from the ER where I was for 11 hours last night. The left side radiating chest pain is intense. But these doctors say it is definitely not cardiac related. I am stumped. I expected way more PVCs than I am having. But they are only occurring after I eat. These ER people are getting tired of me and it is hurting me financially. But on a scale of 1-10 of pain, this pain is a good 8 1/2. Oh well. Thank-you again!
Gosh you know, if you are in that much pain I would definitely call your doctor. ERs are really for life threatening issues so they just check to make sure you aren't dieing but it doesn't mean there isn't something else going on. I would be concerned that maybe some fluid was building up and I am really not sure if the ER checks for stuff like that so why not give your doctor a call and see what he has to say. He may run a few tests that the ER wouldn't. At least you will know you have covered all your bases. I do hope the pain eases up for you soon. Hang in there and just give your cardiologist a call. Take care and keep us posted on how you are.
hi there, i had ablation done for avnrt and a fib last may. Now i am in diastolic heart failure confirmed recently by right and left heart catherizatiion done a couple months ago. i started having congestive heart failure symptoms 1 month after ablation and the drs would not take me seriously. i am 45 yo with 2 young children. think long ang hard about the choice to have the ablation procedure, my quality of life and my kids lives has changed 100%. not worth the risk as i am living proof of permanent heart damage from the so called simple procedure of cath ablation. thanks for your time.