Procedure- Right PVI Experience

I wanted to write up a little summary of my experience to hopefully help others looking at this procedure. Obviously everyone is different and my experience may not be yours, but if it helps someone, GREAT!

I was taking Propranolol for rate control prior to the procedure. I had to stop it for the procedure and tapered it slowly over a couple of weeks. The taper process was not much fun as I had a return of the ectopics, but it was a reasonable trade off for having it fixed. I found that I had to take it easy while coming off the Propranolol so that my heart rate didn't get too high.

The day before the procedure, I wanted to ensure my rhythm would be present for the doctor, so with my doctors blessing, I did everything that I could to irritate it. I drank caffeinated soda, had some hard ciders after dinner, and tried to stay up as late as possible to be tired. All of these things were previously known to irritate my heart.

The day of the procedure, my heart was cooperating quite well with atrial bigeminy and short runs of Atrial Tachycardia. The ECG confirmed that. The plan was to do as much of the procedure as possible without sedation so they could map my heart while the ectopics were happening. They drew labs, started the IV, and got me on the monitor. They also shave everything in the nether regions. Don't be surprised by that!

Once in the EP lab, I moved over to the table. They put freezing cold stickers in every inch of my front, back, and upper legs. This allows for good monitoring. They also lightly tied my wrists with soft restraints and put oxygen on me. Once ready, the EP numbed my inguinal area where the central line would go. After numbing, he inserted the central line, which gave access for meds, blood draws, etc. He also put in another sheath for the mapping and ablating.

It was tough to do all this awake, but I understood the goal and just really focused on my breathing and staying calm. They spent about 30 minutes mapping the right atrium. Thankfully, my heart stayed in rhythm so they did not have to induce or give any medication. I could feel some of what they were doing. It wasn't super painful, but uncomfortable in my chest at times. They then tests my blood for clotting and administered heparin before the transseptal puncture. For that, they used ultrasound and xray to see he spot they needed to puncture. Once ready, they made the hole and moved over to map the left side of the atrium. This part was more uncomfortable. I felt pain in my neck and chin and my head felt kind of fuzzy and weird. They mapped the left atrium for another 20-30 minutes. They then gave me some Isoproteronol to challenge my heart and it caused my heart rate to increase and I had a bunch of the SVT bursts that they were aiming to fix. The Iso isn't a super comfortable feeling, but I knew what to expect, so it was okay. It just felt like my heart would pound out of my chest.

This is when I was finally sedated. While sedated, they ablated/isolated my right pulmonary vein, paced and used iso to try and induce after ablation, and also used adenosine (which can irritate the atrium to induce arrhythmia). They were unable to induce and I was now in Normal Sinus Rhythm.

Upon waking, I had my usual nausea and was treated promptly. They tested my clotting again after administering an agent to reverse the heparin. Once the level was good, they pulled the sheaths and my recovery time started.

During recovery, I had to lay flat (no raising head, legs, crossing legs, etc) for an hour and a half, and then I could have my head at 30 degrees. The lay flat time is shorter for a vein then an artery. Once my time was up, I was able to get up and walk (three hours total of bed rest). I then went home.

That night, I felt super good, but tired.

Day One Post-Op. I woke up with a horrible headache, ocular vision changes (migraine aura), felt really tired and groggy. My brain didn't seem like it was working right and I had patches of vision loss. I slept off and on and felt pretty rough.

Day Two Post-Op. Didn't do much and had the ocular migraines, headache/vision loss off and on. Some mild chest pain/tightness.

Day Three Post-Op. More active today, but paid for it with a return of the migraine/visual disturbances. Felt pretty short of breath with walking and tachycardia. Heart rate ranging in the 90-100 range all the time, increasing with any activity. Also noticed a persistent cough/tickle and hoarse voice today.

Day Four. Felt pretty good. Still struggling with tachycardia despite the Ivabradine. Didn't feel so much chest pain/tightness. Cough a little bit better, mild headache but no ocular migraine.

Days Five-Seven. A couple of migraines, some tachycardia, but now, at Day Seven, I am down to half a tab of Ivabradine twice a day, and took some decent walks. I feel completely different. No shortness of breath, no leg swelling, no feeling like a heart failure patient. I just walked and felt like a normal person.....Its fantastic. I cannot believe how long I have dealt with this. It feels amazing.
I know I still have quite a bit of recovery time left, but thought this might help others. Thanks for the forum, the knowledge and support. It has meant the world to me.



Edited 5 time(s). Last edit at 11/08/2024 06:38AM by MeganMN.

My EP doesn’t sedate except to relax if requested. I talked to a patient who told me it was extremely unbearable. I was always ECV during ablations ( 8 times once) so I can’t see someone awake for this. I don’t understand why they don’t knock them out like Dr Natalie’s team.

Thanks for the detailed story of your ablation, Megan. I wish you a quick recovery and a quiet heart for life.
Some parts of your story remind me of my 4th ablation procedure, during which I was conscious. I had insisted to, because I have a hard time metabolizing the drugs used for general anaesthesia. Days of headache, mind confusion and episodes of blurred or "tunnel" vision are common unwanted post-procedure effects for me.



Edited 1 time(s). Last edit at 11/05/2024 03:42PM by Pompon.

Quote
susan.d
I don’t understand why they don’t knock them out like Dr Natalie’s team.

Cost. Anesthesia means you need to have an anesthesiologist present during the procedure. Almost all EPs use general anesthesia in the US, but that's not true everywhere. More common to use conscious sedation in Europe.



Edited 1 time(s). Last edit at 11/08/2024 03:19PM by Carey.

I had an anesthesiologist present and was sedated as soon as they mapped, but my rhythm has been extremely difficult to pin down and sedation has always stopped the rhythm and they cannot fox it, so the "no sedation" decision was in my best interest because we needed the rhythm present to map and ablate. After two years, three ablations and two EP studies with unsuccessful induction, I NEEDED this fixed! It wasn't unpleasant or unbearable and I certainly was sedated as soon as they mapped and were going to ablate. It was a team decision that I was a part of!!

If you're likely to need a TEE during the procedure, for example, you'll definitely be put out.

Quote
MeganMN
I wanted to write up a little summary of my experience to hopefully help others looking at this procedure. Obviously everyone is different and my experience may not be yours, but if it helps someone, GREAT!

I was taking Propranolol for rate control prior to the procedure. I had to stop it for the procedure and tapered it slowly over a couple of weeks. The taper process was not much fun as I had a return of the ectopics, but it was a reasonable trade off for having it fixed. I found that I had to take it easy while coming off the Propranolol so that my heart rate didn't get too high.

The day before the procedure, I wanted to ensure my rhythm would be present for the doctor, so with my doctors blessing, I did everything that I could to irritate it. I drank caffeinated soda, had some hard ciders after dinner, and tried to stay up as late as possible to be tired. All of these things were previously known to irritate my heart.

The day of the procedure, my heart was cooperating quite well with atrial bigeminy and short runs of Atrial Tachycardia. The ECG confirmed that. The plan was to do as much of the procedure as possible without sedation so they could map my heart while the ectopics were happening. They drew labs, started the IV, and got me on the monitor. They also shave everything in the nether regions. Don't be surprised by that!

Once in the EP lab, I moved over to the table. They put freezing cold stickers in every inch of my front, back, and upper legs. This allows for good monitoring. They also lightly tied my wrists with soft restraints and put oxygen on me. Once ready, the EP numbed my inguinal area where the central line would go. After numbing, he inserted the central line, which gave access for meds, blood draws, etc. He also put in another sheath for the mapping and ablating.

It was tough to do all this awake, but I understood the goal and just really focused on my breathing and staying calm. They spent about 30 minutes mapping the right atrium. Thankfully, my heart stayed in rhythm so they did not have to induce or give any medication. I could feel some of what they were doing. It wasn't super painful, but uncomfortable in my chest at times. They then tests my blood for clotting and administered heparin before the transseptal puncture. For that, they used ultrasound and xray to see he spot they needed to puncture. Once ready, they made the hole and moved over to map the left side of the atrium. This part was more uncomfortable. I felt pain in my neck and chin and my head felt kind of fuzzy and weird. They mapped the left atrium for another 20-30 minutes. They then gave me some Isoproteronol to challenge my heart and it caused my heart rate to increase and I had a bunch of the SVT bursts that they were aiming to fix. The Iso isn't a super comfortable feeling, but I knew what to expect, so it was okay. It just felt like my heart would pound out of my chest.

This is when I was finally sedated. While sedated, they ablated/isolated my right pulmonary vein, paced and used iso to try and induce after ablation, and also used adenosine (which can irritate the atrium to induce arrhythmia). They were unable to induce and I was now in Normal Sinus Rhythm.

Upon waking, I had my usual nausea and was treated promptly. They tested my clotting again after administering an agent to reverse the heparin. Once the level was good, they pulled the sheaths and my recovery time started.

During recovery, I had to lay flat (no raising head, legs, crossing legs, etc) for an hour and a half, and then I could have my head at 30 degrees. The lay flat time is shorter for a vein then an artery. Once my time was up, I was able to get up and walk (three hours total of bed rest). I then went home.

That night, I felt super good, but tired.

Day One Post-Op. I woke up with a horrible headache, ocular vision changes (migraine aura), felt really tired and groggy. My brain didn't seem like it was working right and I had patches of vision loss. I slept off and on and felt pretty rough.

Day Two Post-Op. Didn't do much and had the ocular migraines, headache/vision loss off and on. Some mild chest pain/tightness.

Day Three Post-Op. More active today, but paid for it with a return of the migraine/visual disturbances. Felt pretty short of breath with walking and tachycardia. Heart rate ranging in the 90-100 range all the time, increasing with any activity. Also noticed a persistent cough/tickle and hoarse voice today.

Day Four. Felt pretty good. Still struggling with tachycardia despite the Ivabradine. Didn't feel so much chest pain/tightness. Cough a little bit better, mild headache but no ocular migraine.

I know I still have quite a bit of recovery time left, but thought this might help others. Thanks for the forum, the knowledge and support. It has meant the world to me.

Megan, I really appreciate the detailed description of your procedure, especially because I am considering an ablation that I think would include an attempt to ablate some very intermittent AT. I was curious about the fact that they isolated your right pulmonary vein. I know PVI is often (almost always?) done for AF, but is this also a common source of AT and other ectopics?

So glad to hear that your procedure was successful, and I hope the migraines have subsided!

Quote
Nancy9
I was curious about the fact that they isolated your right pulmonary vein. I know PVI is often (almost always?) done for AF, but is this also a common source of AT and other ectopics?

Unfortunately, no, AT is usually caused by a small locus of cells in the atria that are firing on their own spontaneously. The locus can be almost anywhere in the atria, so they have to find that source and ablate it. They can't get a good success rate by just betting that it's probably the PVs like they can with afib.

Nancy, according to my EP, it is common to come from the CT in the right atrium, but is also common from the pulmonary veins. Typically, AT can initiate Afib, and he was surprised in my case that I had not had any Afib, and said that I probably would have eventually. They did extensive mapping to the right pulmonary vein and he did a complete PVI to minimize any chances of recurrence. I have always struggled with AT and have had it for 2 years, at a 20-30% average daily burden. I did not have the risk of clots, but the symptoms were very similar to Afib. Although AT can come from anywhere, it is my understanding that there are sites that are more common.

Carey and Megan, thank you both for your replies! I’ve read various places that EPs can sometimes get an idea of the location of the AT by looking at p-wave morphology, but when I asked my EP, she said she wasn’t able to tell from my ECGs. I suspect that my AT may initiate my what is so far very infrequent and brief AF, so I guess I was hoping a “simple” PVI would address both. Will meet with her on Tuesday to talk about a game plan.

Good luck with things! AT can be very difficult to catch and ablate, which is why I have had to go back for repeat ablations. Sedation typically knocks out the AT as well. It would be awesome if they could get them both in one go! I was very discouraged when they couldn't get mine with one procedure, but it ended up turning out okay (so far).

On a side note, I am absolutely thrilled one week out. I have already cut my Ivabradine dose in half and have much less tachycardia. I have been walking and working a little around the farm and for the first time in a long, long time, I do not feel short of breath. Its amazing!!



Edited 1 time(s). Last edit at 11/09/2024 07:23PM by MeganMN.

Quote
MeganMN
Good luck with things! AT can be very difficult to catch and On a aide note, I am absolutely thrilled one week out. I have already cut my Ivabradine dose in half and have much less tachycardia. I have been walking and working a little around the farm and for the first time in a long, long time, I do not feel short of breath. Its amazing!!

That's great to hear! You've really been through the mill with your arrhythmias.

Thank you Megan for such an in-depth description of your procedure! For those of us yet to have an ablation, it really gives a good idea of what to possibly expect. Many fingers crossed you have continued positive recovery!

Thank you all so much! I walked a mile today and talked to my husband, no shortness of breath, no tachycardia! Woohoo! I did have some of the random episodes of dizziness followed by a headache today, but I am wondering now if those are related to the autonomic nervous system insult.