Cardioversion Scheduled

I had sent my EP an email Friday and called this morning concerning my persistent affib since last Tuesday and the possibility of having a cardioversion. He called me back about 15 minutes later and we discussed the cardioversion as well as possible options following. He mentioned staying on Flecanide with the possibility of switching me to Tikosyn which does not thrill me in the least. He also seemed disappointed that the ablation wasn't holding as he felt that everything in the lab looked very promising.

Hindsite and research and discussions with others since my ablation in January tells me he should have performed an RF ablation as he did back in 2009 opposed to doing the cryo this time around. But that's water under the bridge and I cant go back there Nor can I afford to dwell on the might haves or should haves as life is too short. However, moving forward I will be making better choices and slay the demon that haunts me.

The cardioversion is set for this Friday @ 8am. So I am sure my day there will start sometime around 6am. Of course this will involve another TEE witch I really despise but my guess is that the cardioversion will make the TEE seem like childs play.

rocketritch - It goes without saying that I certainly can appreciate your disappointment. My afib history includes at least nine or ten cardioversions..(.toward the end, I 'sort of' stopped counting), but my point is that my experience was not at all horrific and I certainly hope yours is not either...nor should it be.

Prior to starting the TEE, I was always sedated first and then came the ECV procedure. Sedation is fairly light so when I woke up, I was still in the lab on the table but it was all over, no pain - no discomfort; just slightly groggy... but alert enough to understand and remember what the EP was telling me. Then, I was wheeled back to the recovery room and held for about 2 hours before being released with instructions. Food was available if I wanted to eat something.

Best wishes to you for a very positive experience and that you remain in NSR. I'll be watching for your report.
Jackie

Quote
rocketritch
The cardioversion is set for this Friday @ 8am. So I am sure my day there will start sometime around 6am. Of course this will involve another TEE witch I really despise but my guess is that the cardioversion will make the TEE seem like childs play.

Both procedures should be a complete breeze. If you've had a TEE in the past without anesthesia, demand it this time. It's absurd to do that procedure on conscious patients. Ditto with cardioversion. What should happen is they knock you out and then very shortly thereafter you wake up and feel perfectly fine.

I've done 3-4 TEEs and somewhere in the neighborhood of 15-20 cardioversions. Every one of them was trivially simple, quick, and utterly free of any sort of discomfort.

My issues with the TEE stem from my first experience. I wasnt sedated beyond the spray they shoot down your throat and that wasn't much. The Doctor pretty much sprayed my throat and shoved it in, almost in a single motion. Then he yanked it out and left. The nurse that was going to give me sedation still had the needle in her hand. She and the tech fell alll over themselves apologizing. In the end the three of us ended up having a pretty good laugh.

My second TEE wasnt bad at all. I tried joking with the nurse and doctor about my previous experience but neither of them were having it. The tech got a kick out of it though.

They are definately supposed to give you Sedation. That way you don't gag on the Instruments shoved down your throat. In any regard you would be put under anyway for the ECV. It's all done at once, it's takes alot longer to do a TEE, than just an ECV, so you will be out for 10-15 minutes. The biggest risk from this procedure may just be from the Anethesia.
Don't eat for like 4-6 hours before-hand. They will probably instruct you to hold food and water from Midnight onward.

This post interested because of the TEE (TOE in the U.K. - different spelling). I've had 4 CV's but a TOE was never done - or mentioned.

Both TEEs and CVs are done under conscious sedation by some physicians. Terrible practice, IMO, but it is done.

Is a TEE any worse than an upper GI endoscopy/gastroscopy? Is the tube around the same diameter? I’ve had 5 endoscopes down my gullet over the last 25 years with nothing but throat spray as I always want to drive myself straight home afterwards. A bit of gagging/wretching and a lot of eye-watering but not that bad otherwise!

It's a similar diameter and they don't go as far down, but I really can't imagine any reason to gargle that wretched crap and get gagged by a tube when they can just knock you out for a few minutes instead. With propofol, you'll be clear headed 20 minutes later.

Quote
mwcf
Is a TEE any worse than an upper GI endoscopy/gastroscopy? Is the tube around the same diameter? I’ve had 5 endoscopes down my gullet over the last 25 years with nothing but throat spray as I always want to drive myself straight home afterwards. A bit of gagging/wretching and a lot of eye-watering but not that bad otherwise!

Never had a GI endoscopy/gastroscopy so cant give you comparison.

Quote
mwcf
It's a similar diameter and they don't go as far down, but I really can't imagine any reason to gargle that wretched crap and get gagged by a tube when they can just knock you out for a few minutes instead. With propofol, you'll be clear headed 20 minutes later.

I agree with you, unfortuantely that has not been my experience. Maybe Friday . My best defence though is having a sense of humor. I asked my doctor back in January if the device had gotten any smaller since my ablation back in 2009 because he was aware of what happened. His reply was, "I hope that yoru throat got bigger." Everyone in the room busted out laughing.

Quote
rocketritch
I agree with you, unfortuantely that has not been my experience. Maybe Friday .

Embrace the power of patient refusal. If you calmly and politely say the words, "I refuse _____" then they have no choice but abide by your decision and find another solution, and the only other solution is anesthesia, which they should be doing in the first place. All they're trying to do is cut corners and get you out faster -- at your expense.

The other reason to have Anesthesia, is so you don't move around during the Procedure. It's rare, but sometimes they poke a hole in the Esophagus.

Completely agree with Carey and Anti-Fib here, and Ive had 14 total TEEs including 3D Color Doppler TEEs as my last 5 or 6 such procedures done by TEE Grand Maestro Dr David Rubinson at Scripps Green Hospital in La Jolla CA.

NO way I would agree to a ‘gaga-thon’ with a wide-awake TEE ... just tell your Cardio ... “After you Doc, you go first!” ... I’m sure he or she would instantly change their tune and protocol after writhing around on the table for 30 minutes without sedation as the Cardio is manipulating the not very tiny crystal head at the business end of a TEE endoscopy tube!

It is just nuts and is utterly being cheap-skates at the patients comfort expense, and you could make a good argument for greater risk of an inadvertant perforation .... actually any esophageal perforation is, by definition, inadvertant! ... but just refuse out right and tell the TEE Cardio “no dice” on the awful numbing throat spray alone as your only local Gag defense.

Then ask them to get either a nurse anesthetist or a full Anesthesiologist in the room for the procedure to admin IV propofol-only, literally one of the safest anesthesia drugs there is, and very short acting leaving you essentially clear as a bell and fully ambulatory at 30-45 minutes after the procedure (not to mention the 15 seconds of genuine ‘Bliss’ as the propofol is administered) and next thing you know you’re awake and feeling relaxed but clear and calm and the whole business is over.

Shannon

All done and back in rhythm. Thanks for all the thoughts and support.

The doctor wants to start me on a Ticosyn so I stopped the Flecanide today. I will be going back to he hospital on Tuesday to start the new drug.

BTW the TEE was a total disaster again.

Quote
rocketritch
BTW the TEE was a total disaster again.

What happened? A TEE shouldn't be a disaster a single time, much less multiple times. It should be a trivially easy procedure that takes only minutes, followed by maybe an hour of boredom waiting for the anesthesia to wear off.

Quote
Carey

BTW the TEE was a total disaster again.

What happened? A TEE shouldn't be a disaster a single time, much less multiple times. It should be a trivially easy procedure that takes only minutes, followed by maybe an hour of boredom waiting for the anesthesia to wear off.

I wish I knew. The anesthesiologist said that as soon as the doctor got the TEE towards the back of my throat and asked me to start swallowing he would administer the propofol and I would feel nothing. As I layed there gaging and choking I could feel effects but not the euphoria I was hoping for. That is until I heard a nurse frantically question if he was giving me enough as I was obviously struggling. Then breif euphoria, then nothing until I woke up from the cardioversion.

They did not spray my throat this time. They use some sort of numbing gel that disolved and worked its way down my throat.

Geez, find another doctor to do the procedure if you need one again. What you just described was an utterly incompetent TEE.

What the Hell? Is this?

Why stick the Instrument in first, let you start to gag, and then give the Propofol?
I had at least 12 of them done, they always got everything ready, and then administered Propofol before sticking the thing down my throat.

Unless the Dr. had a "Wait and See" strategy to see if you could tolerate the the Thing stuck down your Throat. That way you would have been exposed to much less Propofol, as you only need to be under for a minute to get the ECV, vs maybe 10 minutes for the combined TEE/ECV.. This seems very unlikely. The other thing is that every time I have gotten Propofol (about 40 times) it has always been a gradual process, taking 30 seconds or longer maybe even a minute to completely knock me out. They give some, and then wait to see if I am all the way under, and then give more, not ever wanting to give more than necessary.



Edited 2 time(s). Last edit at 04/07/2018 10:22PM by The Anti-Fib.

Quote
The Anti-Fib
What the Hell? Is this?

My sentiment exactly. I was begining to think it was me before reading everyone elses expereinces. Now I'm pretty sure its not me it's them.

The cardioversion lost it's hold yesterday afternoon. I was hoping it would last until today as I am supposed to start on Ticosyn today. I'm currently sitting in a comfortable chair at the hospital waiting to be admitted.

Sorry, but hopefully the Tikosyn will take care of that for you.

Quote
Carey
Sorry, but hopefully the Tikosyn will take care of that for you.

Thanks Carey. I got admitted late last night so I just started the Ticosyn this morning. If I don't convert on my own another cardioversion will take place. My doctor and I are going to have a long talk about this before it happens. I refuse to have another bad TEE experience.

Besides that I am planning on having three boring days in the hospital. Unfortunately this means I will not be attending the Brit Floyd concert this Friday evening with my family.

Took my first dose of Ticoxyn @0900 and converted back to NSR @1210. I seem to be tolerating it so far as the the EKG is normal. We will see what the next few days and weeks bring.

I'm not a medication type person so my hope is that the meds are just a stepping stone towards the next phase of my journey.

That's great news! I hope it is just a stepping stone and the early signs are it's going to work for you.

Thanks again Carrey.

They started me on 500 micrograms 2x yesterday. Today they reduced to 250 micrograms 2x due to QT duration. I spoke to my EP yesterday and still have some questions. I did ask his NP a couple today. Both my ablations included PVI and CTI ablation. The first in 2009 being RF with 5 years duration of no problems leading to another 4 years of mageble PIP events, and the one this past January Cryo. Based on our conversation, and I will verify this tomorrow with the EP what he did in January was touch up work on the PVI from 2009 and also the CTI.

This tells me that he did not explore any further than that especially this last time as he had his hand tied using cryo. I am also marginally unclear as to the viability of using cryo for CTI and its limitations. I do know that cryoo has its limitations beyond the PVI isolation. I'm quite sure that Shannon explained this to me during our conversation but I can't remember as we covered a pretty extensive amount of information in a relatively short period of time.