Hi everybody.
This post to share my experience about my last (to date) ablation procedure. I think it may be interesting, as it was performed under conscious sedation, Nov 27.
4 weeks before the date, I did start taking dabigatran.
Stress test and echocardiography performed by my cardiologist 3 weeks before the procedure: everything was fine.
Bisoprolol and PIP flecainide stopped one week before the procedure.
Nov 27 :
3 hours driving my car to the hospital, but not too tired at the arrival.
Lots of questions by the nurses, and not always easy to answer because they’re Dutch speaking in this hospital, and I'm not (apart some politenesses). Using my French and a little English, I manage to answer the best I can.
Blood test and some other controls; then, at 3PM, I’m in the operating room.
It's a very quiet atmosphere in there (some music playing in the background), and just two nurses and the EP (Dr K) around me. The nurses are experienced, and I would be proud speaking Dutch only half as well as they speak French! Large electrodes are positioned on my back before I lay down on the table. Then, lots of smaller ones are sticked on my chest for heart monitoring.
Two drips must be placed. The first one in my left arm, the second one more deeply in my left wrist, to reach an artery (around the place where one usually check the pulse).
While the nurses make the preparations for the procedure, afib suddenly starts! I’m clearly feeling it and the monitoring machine starts beeping accordingly. It’s my usual “unsustained” afib: out of rhythm most of the time, avg 115-140 BPM, but with some normal beats (clear P-waves) here and there, and, from time to time, one minute or two in NSR.
I ask if I’ve been injected a drug to induce afib, but the EP says “no, not yet”. He adds it’s rare seeing someone going spontaneously in and out of afib just like I do; but that it’s fine for the procedure, since the ectopic points triggering afib will be more easily visible.
Dr K generously “paints” my right groin (and everything all around) with disinfectant and makes injections for local anesthesia. Little cuts are made, and three catheter sheaths are placed in the femoral vein. I don't feel any pain. I’m just feeling the EP’s hands touching me, their movements and the catheter tubes pushed into the vein. Strong painkillling drugs have been injected, of course, and I’m quiet. I’m a little “floating”, but fully conscious of my body, from head to toes.
Dr K says he’s doing the transseptal puncture, but I’m barely feeling something.
There’s an appliance (resembling those used for radiography) above my chest, so I can’t see a lot in front of me towards my feet, but on my front left, I can look at a couple of screens. There’s an impressive one where my atrium is pictured in 3D, in bright colours, numbers appearing here and there while the picture rotates and changes.
Dr K says that PVs are still electrically disconnected. He then makes some burns in the rear wall of the LA. He asks me to tell if I’m not OK, but there’s no real pain to feel. The drugs are strong! Nevertheless, it’s strange feeling my heart changing rhythm, going in afib then back to SR.
At a moment, I feel some strong bumps in my chest. Dr K says he’s checking the exact position of my phrenic nerve. It’s the nerve controlling the movements of the diaphragm. It’s crucial keeping it safe from the burns.
Dr K says he’s going to make some other burns in the RA, near the superior vena cava. He says it'll make some pain towards my right shoulder. I feel it, but it’s easily bearable.
My heart is now beating in NSR. I can’t see the numbers on the screen, but I guess it’s somewhere between 80-90 bpm.
A drug named isuprel is used to stress my heart. I’m feeling it racing for some long minutes. Then, we must wait to see if other ectopics show up. Everything is normal. Another dose of isuprel is used, another race, but no afib. Not even a single ectopic while we’re waiting.
Suddenly, I feel some strange beats, out of my regular rhythm, like strong ectopics. Dr K says: “don’t worry, I'm doing this”. He’s trying to induce arrhythmia with some impulses, but I don't know how he does it.
He then tells me not to be afraid, since I’m going to have a shot of adenosine; which guarantees some awful seconds to live. I confirm it’s a really scaring sensation, but, happily, it’s short.
As nothing seems able to disturb my NSR, the catheters are pulled out. Then I’ve to slide laterally on my bed, keeping my leg straight, the big pads are removed from my back and I’m rolled out of the room by another team of nurses.
Three hours have passed since I entered the operating room.
I’ve to wait about 15 minutes in another room; then everything is removed from my right groin and compression is manually applied on the insertion site. Then, a compression bandage is placed, and, after another 15-minute wait, I’m rolled to my room. It’s not a “regular” room. It’s an “intensive care” room, close to the nurses’s office. I’m continuously monitored, drugs are instilled in my arm and nurses come see me very often.
I’m offered a light meal around 7:30 PM, then begins some of the most awful nights in my life. I must lay down on my back the whole night (I can’t sleep this way), keeping my right leg fully straight. It does not take me long to have a completely sore back! Regularly, the nurse comes to check the screens, appliances and IVs.
Dr K comes see me around 9 AM. I’m OK (except for my sore back!), in NSR with some PVCs from time to time. I say it’s the first time I’m still in NSR more than 8h after an ablation (now 15h), so it’s probably a good sign.
He replies: “Maybe… But with you, I don’t make previsions…”
In the afternoon, I leave the hospital (my wife driving the car). I've been prescribed omeprazole (1 month) and Pradaxa (3 months). I'll take some bisoprolol (2,5 mg in the evening) and flecainide (2x 50mg).
During the following days, no afib but some ectopics. On the fifth day, at 3 AM, afib is back for 55 minutes.
On the 7th day, afib starts at 0:25. As it doesn't stops spontaneously, at 6:00 I take 100mg flecainide. Bad idea. Around 10:00, my heart starts racing in a-flutter (+/- 125 bpm). It'll last the whole day (despite taking a little more bisoprolol), only slightly slowing down in the evening. It's near midnight (I'm in bed, trying to sleep) when my heart goes back to NSR.
No more flecainide for me!
Since then, I'm back to my usual pattern: short “unsustained” afib episodes (less than 2h), every 8-10 days. In between, I may have ectopics apparently linked to digestive issues – but not always. Supplementing with Mg helps reducing ectopics; adding C, D3 and K2 vitamins + some silicium (equisetum arvense) seems to be a good idea (better magnesium assimilation). I've reduced my calcium consumption too.
My CHADS score is 0, so I've stopped my OAC.
We're all different. Both my cardiologist and my EP (it's the third I see) say I'm a rare case...