I actually had my ablation done on the day you posted your question haha. Everything is still pretty fresh in my mind. I'm a 27 year old male.
I was pretty nervous to be honest. I went into the procedure having read this entire thread, plus watched some YouTube videos about the procedure, and basically read up on everything I could to try to calm my fears. It helped a bit. I was even more fearful because I am a really heavy guy (enough that I was weighed before the procedure to ensure I was not over the weigh limit of the special cath lab table) and I have hypertension. Even though my EP doctor did not say that this specifically increased the risks of an EP study / ablation for me, I think it did increase my anxiety more than the average person. Part of the reason for getting the EP study in the first place is that I have been trying to lose weight and while I have been successful so far, the increased exercise and change in diet caused an uptick in the number of SVT episodes I was experiencing (and I experienced two within 30 days requiring an ambulance).
You will see through this thread and any other reading you do that there are several ways this procedure can be done a little differently, particularly when it comes to if/when you are sedated and how much. I live in Ontario, Canada so this should mostly apply for anyone from the same area, however your procedure should not differ too much.
I was fortunate enough to be booked first thing in the morning, so I did not have to wait for anyone else in line ahead of me. I arrived at 6:30 am and probably was on the table by 8:00 am. Prep was pretty uneventful, matched what I had read here and elsewhere. No sedation prior to the procedure, but they did apply a numbing cream (presumably to make the freezing inside the cath lab less painful).
As I am a big guy (and tall, too) it took some doing to get me in the right position on the table. It is quite narrow due to the amount of equipment that needs to move around it, so they basically told me to take some time to find my centre of gravity so that I was comfortable and didn't feel like I was falling off the edge. Once I was in place they added plastic arm rests to support my arms (otherwise would have been hanging straight down over the edge). The nurses and EP Technologist then got me all hooked up for the procedure. Standard 12 lead ECG, a large pad on my lower back (I think this acts as a ground for the catheters) plus difribrillator pads just in case (you see below that in my case I'm sure glad they take this precaution!). Then they applied an antiseptic solution to both possible entry sites (left and right side of groin).
When the doctor arrived he checked over everything and then the first step was to freeze the entry site, which he opted for all 4 catheters in the right side of my groin (I think this is a pretty standard setup for EP specifically). Thanks to the numbing cream applied earlier there was barely a pinch. Then he went about getting the catheter sheaths in place. I don't know why but at the time I thought they only needed one, through which all 4 catheters would pass. Apparently it's one each. Anyway this was definitely an uncomfortable part of the day. I kept being worried that some part of this process would be painful and really the freezing worked quite well and it wasn't, but I think due to my size he had a real struggle to get the sheaths into the vein. One of them took so much pressure to get into place that when it finally did "pop" into place it made me jump an inch off the table haha. At one point I felt a warm gel run over my right hand and thought maybe that was a secondary antiseptic solution of some kind... I realized I was wrong when I was later able to move my arm again and saw my hand was covered in dried blood. No big deal though, he controlled the bleeding and they are going in through a pretty large vein, no surprise there's going to be some blood.
Once the sheaths were in place, He threaded each catheter up to what I presume was just short of entering the heart, as the x-ray was not in place yet. Didn't feel it at all in the vein but I could hear what he was doing. Next there was a lot of adjusting the table, the x-ray, the monitors, and any other piece of equipment needed nearby. My EP doctor is a short Korean man so I think he needed everything a little closer by than others. I had read that other people undergoing EP studies were able to watch the monitors and see the process, and that it was helpful in distracting them from their anxiety. I was really looking forward to this because I'm a definite technology enthusiast but no such luck. His final choice of x-ray and monitor placement was such that the upper part of the x-ray machine over my chest blocked my view of the monitors. Oh well.
Next was the part that was probably the most unnerving for me. At this point there was still no sedation. He turned on the x-ray and begain threading the catheters into my heart. Others had said that they couldn't feel the catheters in the heart but could feel extra/skipped beats as the catheters "tickled" the walls of the heart. I could both feel the catheters pass into the heart and the skipped beats and everything, but it wasn't too bad. There was then a few minutes that were pretty uneventful and I believe they were just measuring my normal heart rhythm. Following this, the next step is to induce SVT and measure again. This part was extremely uncomfortable for me and I'm not really sure why. I had chest pain, both my hands and lower arms started to tingle and go numb, I was hyperventilating. I told the nurses this and they said it was normal. That made me feel a little less anxious but no more comfortable with the situation haha. My normal SVT did not ever cause these kinds of symptoms.
Anyway, that part lasted maybe 20 minutes, and then the EP doctor told the nurse they could administer Fentanyl. I asked the doctor if that meant he had found the problem area and he said yes. Within 1-2 minutes of receiving the medication I was feeling a lot better. Not drowsy, but all the other stuff I was experiencing went away.
The next probably 2 hours was spent ablating and testing. I don't think I ever really felt the ablation itself. He used RF ablation in the beginning and then as he got closer to the AV node, switched to Cryoablation to avoid damaging the node. There was a lot of communication between the EP doctor and the technician operating the ablation equipment in the control room, how much power to apply, for how long, and so on.
Continued in Part 2