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Post-Ablation Experience Review - Part 2/2

Here's where we get to the part where I was glad they take the precaution of applying the debrillator pads at the start of the procedure.  At 3 different points during the ablation process I went into A-fib.  I don't think I've ever had atrial fibrillation before so this was new to me.  Same sensation as SVT but different heart rhythm.  The doctor later explained that my heart was getting easily irritated and that was causing the A-fib, and he said this may become a more common occurence later in life.  Anyway, on each occasion, the nurse gave me something in the IV to knock me out for a few minutes and then they shocked me and continued with the procedure.  I never felt anything and to be honest, the first 2 times when I woke up I didn't remember falling asleep and wondered if I had imagined the whole "we need to shock you" thing, but the 3rd time I made a conscious effort to pay attention.  They didn't tell me to but I did the whole "count backwards from 10" thing when they injected the drug, and felt myself passing out.  Anyway I guess being on the Fentanyl really helped with regard to the whole de-fibrillation thing.  I was certainly less worried about it than I would have thought I would be.

Towards the end of the procedure there was a lot of switching cryoablation catheters.  My EP doctor later explained that I have an oddly shaped ridge in my heart, near the AV node, and he was having difficulty getting the right angle to ablate the area carefully.

Throughout the procedure there were testing periods where an arrythmic drug is administered and the heart is essentially "driven" with the catheters at increasing heart rates (think of starting with a volume knob at 1 and slowly turning it to 10, then dropping it back to 1 quickly).   This is done to see if the ablation has been effective and SVT does not occur.  It's pretty unnerving to be laying there at rest on the table, and feel your heart race increasing to 150+ bpm and then drop back down to 80 or so, over and over.  It doesn't hurt, but it feels weird.

Finally after 3.5 hours we were done and I was in agony because my back has been flat on this hard, flat table for quite some time, unable to move.  I don't lay on my back usually because my back isn't that straight, and I was definitely ready to get out of that position by then.  The catheters were removed but the sheaths left in place, and I was transferred to a gurney and wheeled back out into the general cath lab prep area.  At this point the nurse (same who did the first prep) explained to me that she would be removing the sheaths. All 4, at once.  It took only half a second and certainly didn't hurt, but following removal, pressure needs to be applied at the site for about 10 minutes.  So there I am with a nurse's hand pressed down on my groin for 10+ minutes.  Luckily she was ready with some small talk to break the tension haha.  It was at this point that I discovered the dried blood all over my right hand from the beginning of the procedure.  After the 10 minutes had passed, she checked that the bleeding had stopped, and then applied a dressing.  Then she left to go begin prep on another patient.

Well, not 30 seconds after she had left me, I felt a warm sensation on my leg and as I reached down to check I felt a very wet bandage.  Then I checked my hand... covered in blood for the second time that day haha.  Called her back over and we did another 3 minutes of pressure on the area, once again the bleeding stopped, then she re-dressed it and put a "sandbag" on it to keep pressure (I later found out it was two bags of IV saline taped together).  This time it held up.

A short while later my EP physician came over to talk to me.  He discussed how things went.  He said that I had AVNRT and that he was quite sure he had managed to ablate the problem area.  He went on to say that unfortunately there was a complication during the procedure because the problem area in my heart was so close to the AV node (and probably also because it was so difficult to reach in its inaccessible location).  Despite his precautionary use of cryoablation in this area, some damage occurred to the healthy tissue near the AV node. As a result I now have First Degree AV Nodal Block.  What this means is that there is a small blockage of the signal from the SA to AV node causing a slight delay the signal getting from SA to AV, but not enough of a problem to need any kind of intervention, such as a pacemaker.  First degree is the least problematic variety and generally there are no symptoms, the only place it can really be noticed is on an ECG printout.  This specific risk was brought up by my EP doctor during the consultation and at the time he mentioned it was a 1 in 500 risk.  Overall, I'd rather have a heart that's 1% less efficient than having to deal with SVT several times a year with possibly multiple trips in an ambulance.  It was a risk worth taking.

He went on to say that he would be keeping me overnight in the Cardiac Short Stay Unit to be observed, both because of the AV nodal block and also because of the A-fib episodes.  I was disappointed not to be going home but it was no big deal.  I had a really fantastic nurse in the CSSU who was constantly checking on me and got me anything I could possibly need.  I was kept on heart monitor and the dressing on my groin was checked every hour until lights out.  Following that, I really didn't need any attention at all, but I didn't sleep too well either.  At 6'4", the bed was not really sized for me to sleep comfortably.  I maybe got 2 hours in.  I spent a lot of time on the internet on my laptop.  On a connection frustratingly too slow for Netflix, even in the middle of the night when 95% of people were probably asleep lol.  I went home in the morning after a brief visit from the EP physician.

Since the procedure, I have not had any SVT but I have had some skipped beats, extra beats, and generally just a few seconds at a time of odd feeling in my chest if I do certain things such as bend over.  I'm having a 48 hour holter monitor test next week and then a follow-up with the EP physician a month later.  I attribute the odd heart beats to my heart still healing.  It's the only muscle in the body that doesn't get a chance to heal at rest following an operation, and it's understandable that the heart would feel a little off for a few weeks afterward.  Some other posts I've read here and elsewhere seem to echo this experience.

So, there is my experience with ablation.  If you're worried about your ablation procedure, my advice is to educate yourself as much as you can.  There are several good videos available on YouTube, and lots of posts such as this where people discuss their experience.  I went into the procedure cautiously worried, and to be honest most of that worrying was due to my weight, and I still came out pretty darned good.  Considering that I went in worrying I wasn't going to come out alive, I was definitely more worried than I needed to be.  The procedure has moments of discomfort, no question, but there is no real pain involved.  It's certainly worth a few hours of discomfort for a lifetime of relief from SVT.
9 Responses
Avatar universal
Note this 2 part reply was to user patch2015 but I felt it would be useful to anyone else in the community who is having catheter ablation.  So the first two paragraphs reference original post http://www.medhelp.org/posts/Heart-Rhythm/Catheter-Ablation-for-SVT---any-success-stories-as-Im-so-scared/show/1725427
1423357 tn?1511089042
Excellent report!  If you haven't done so already, you should copy and past Part 1 and Part 2 into a journal under your profile area.  These are extremely helpful for anyone researching electrophysiology procedures for SVT.  Over time Part 1 and Part 2 will become separated from one another.  A journal entry will tie them together.
12492606 tn?1459877633
I am not sure how representative Ryan's procedure is.  Looks like there were issues for the EP to switch between cryo balloon and RF so many times and for the procedure to last more than a couple of hours for SVT.  Usually, an EP either go with RF or cryo (with RF for touch-ups if needed) and not swap around in the middle.  I am glad for Ryan that it turned out OK despite the 1st degree heart block.  

My buddy's son procedure was relegated to the end of the day as more complicated procedures was put earlier on the schedule.  He finished in 2 hrs.  3 spots were mapped and ablated using RF.  He is doing well and back to his normal active life after a month.
Avatar universal
Well yeah, that's sort of the point.  My procedure did not go according to plan, there were complications.  I wanted to demonstrate that despite the fact that things did not go as planned, it still was not as bad as I thought it would be if it went normally.

FYI I never mentioned switching between RF and Cryo a bunch of times.  It was RF up to a point, and then as he got near the AV node he switched to Cryo.  The only thing that was changed multiple times after that was the catheter itself.  I believe they had differently shaped/angled tips on the end to allow for better access to the difficult-to-reach area.
12492606 tn?1459877633
Got it.  Thanks for clarifying.  I happened to be over at my friend's house last night.  The friend's son was the one that was ablated.  He is feeling much better a month post procedure.  Says he still feels a strange beat or two once in a while but then it goes away quickly.  Doctor told him to expect that until scar forms fully.  I thought the procedure was done manually as I know the center's chief EP uses the magnetic/robotic system a lot for the more complex procedures like AF and VT and doesn't leave enough time for simpler right sided procedures.  Not so, his procedure was done with the magnets too although he had to wait till the end of the shift (he was last patient) as more complex procedures took priority.  Anyway, the mapping and ablation were done with the system and one catheter.  The system located 3 spots as I wrote before.  Focal, right accessory pathway and CTI.  Procedure went without a hitch.   He is happy and parents are relieved.
1423357 tn?1511089042
"I believe they had differently shaped/angled tips on the end to allow for better access to the difficult-to-reach area."

Ah yes, those special tips for the "hard to reach areas"!
Regardless, congratulations!
1807132 tn?1318747197
I would definitely post this in your journal so you can direct people to it if you like.  Hopefully any issues with afib will resolve once your heart has time to recover from the avnrt.  Glad to hear you are feeling well.  I had ectopic beats pretty persistent for a year post ablation and another year for me to have days when I don't have any.  Some of us just have them the rest of our lives and others they clear up completely.  Thanks for sharing your story.
Avatar universal
Thank you for your excellent report which I saw now after going through my unsuccessful EP/ablation.  I posted a result and asked the question, "What now?" I found the procedure unpleasant and the groin catheters painful.  I developed a hematoma which was quite painful, especially when they pressed down to disperse it.  They never could reproduce my SVT, even with isoproterenol, but they managed to cause Afib for which I was cardioconverted.
Although I have a follow up appt. with the electrophysiologist next month I was left with an , "oh well..."  Now what??
Avatar universal
I'm sorry to hear that you didn't have a successful outcome.  I know going into this we all have the notion that it might not be successful on the first try.  I honestly think if I had gotten the ablation a year or more ago, they might not have been able to reproduce the SVT.  The whole reason I was referred to EP was that I had two attacks in the span of a month, and I had lots of irregular heartbeats leading up to those, and this was on Verapamil SR, which previously had controlled the situation.  So it was probably one of those things in life that had to get worse before it could get better.  Going into the procedure after being off the Verapamil for a week, there was a good chance I could have induced the SVT myself simply by bending over too quickly or something.

The groin catheter bit was indeed unpleasant.  I think although I did not feel pain where they were inserted, I could definitely feel him fishing them around to get into the femoral vein properly.  I have a small hematoma, the size of a large grape, developed in the hours following the procedure. It has since solidified and I understand it will take a month or two to disappear completely.

I'm now two weeks out, I'm presently on 48 hour holter monitor as requested by EP.  I don't know if this is something that everyone gets afterward or if it's because of the Heart Block issue.  Anyway I'm thankful for how small these monitors are these days.  I remember back around 2000 my mom was on a 48 hour holter and it was this massive box attached to her waist which recorded to audio cassette, and the battery was not enough to last the full 48 hours, it had to be changed partway through (and the cassette too!).  The biggest complaint I could have about it now is that all the tape and electrodes are itchy as hell! lol.  The device itself is smaller than a deck of cards and very light.

Unfortunately I'm not out of the woods on my health yet even with this resolved (hopefully, so far so good).  I still have a lot of weight to lose, and also have had a bunch of neurological symptoms over the past year for which nobody has been able to give me answers (family doctor, ER, a few specialists).  After searching for answers for months, I had a new idea yesterday and sure enough I found something that matches up exactly with the symptoms (I don't just have some of them, I have all of them), and after seeing my doctor today, he agrees it's quite likely.  I need to get an MRI and what they'll be looking for is a non-cancerous brain tumor (acoustic neuroma).  So one health journey ends and another begins. I guess it's just going to be that kind of year.
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