Help - What to expect before and during the ablation

My ablation date is coming up at the end of next week and I am unsure of what I need to do beforehand. Will they be giving a blood test beforehand? Do they typically keep you overnight? I'm assuming whoever brings you in has to then go find a place to stay overnight too...yes? (we live about 1 1/2 hours away with traffic and parking etc...) Do they knock you completely out (I hope). How soon can I expect to be back on my feet and going about my business? How much pain is typical afterwards? If you have some Afib, tachy, PVC's, flutter, etc., is it necessary to go all the way back to the hospital or can you go to your local cardiologist?

Have any of your been on a medium to high dose of Flecainide and then gone off of it right before the ablation - and if so, how was that? I've been on 300 mgs/ of Flec/day for about 5 years and am scared to go off of it for the 5 days before...but am told that's what I need to do. Any suggestions for making that go any easier or do I just need to bite the bullet and take more Atenolol when the Afib inevitably kicks up (maybe BIG time)?

I am currently helping my husband, Doug, go through all that one goes through with cancer, and I need to have some idea what HE can expect from me during that time. I am praying all goes smoothly as he really needs me right now.

I know alot of these things have been addressed in the past, but until you are about to sit in the saddle yourself, they don't always "sink in".

Any encouraging words, suggestions, etc are welcomed ~ Barb

Since a lot of these things have been addressed, as you said, you need to review the answers. If you find yourself in the last minute 'hysteria mode' it may help to write down your questions and then the answers you already know. For unanswered questions call the EP office where a nurse has been assigned to you to help with your specific questions.

My Natale ablation was 8 weeks ago. I was pretty scared too. I gathered up whatever little bit of courage I had left and checked myself into the admitting office for the procedure. The rest is history and I am well.

Best wishes.
Betty

Betty - I thought it would be alot easier to get all of these questions answered without having to sort through many different posts to find them. I'm not feeling hysterical - just having the normal jitters that many people have. I had called the hospital to get some answers and hadn't heard back from them until today - which is the reason for the post.

Glad you are feeling well now. Continued NSR to you ~ Barb

Barb, you very much need to talk to your EP.

I was told no drugs for x days prior to the ablation -- that can interfere with the probing they do during the procedure.

Also, for me, nil by mouth for 12 hours prior, and overnight afterward in the hospital hooked up to cardio monitors.

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Barb,

I was ablated in austin but I would think things are done the same in NYC. Upon arrival you will change into a gown and then they will put in an IV line and draw blood, then hook you up to check your heart. You wait there until they are ready for you and then you will be brought to the EP lab where they will put you totally out for the procedure. You stay overnight and will be released the next day. I had some chest pain for a couple of days but the motrin took care of that. I remembrr flying back from austin 3 days after the procedure and felt fine. I took the next week off from work just to rest but felt good all week. I didn't have any tachy or anything else but I would have had to go to my local doc as I wasn't flying back to austin. I hope this helps to put your mind at ease. Your going to do great.

Kenh

Hi, Barb,

Having had an ablation with Dr. Natale at St. Luke's a little over two weeks ago, I'm happy to share my experience. I'm on leave from my work at the moment and we're at a place where internet access is sporadic for me.

You do need to talk to Julia or Patti at Dr. Natale's office at St. Luke's. They can tell you about your meds. I was on warfarin, and, of course, he keeps you on this through the procedure. I'm not sure what he does with Xeralto. Again, you should call the office and speak with one of the nurses ((212) 523-2400). You will be completely out, since they want to minimize movement of any kind. You will likely have a less-than-restful night after the ablation with some dull pain in your chest as a result of the burns. You will also have taken on a good bit of fluid in the procedure because the catheter is water cooled. They will put you on Lasix and potassium for four days to get this out of your system. I had no adverse effects to any of these meds. When you wake up they will take you to the 10floor of the hospital (from the recovery rooms in the EP lab) and you will spend the night there. The rooms are private and quiet and the staff was great. Don't eat a lot the first night, and don't drink a lot of fluid, since you are trying to get rid of the fluid from the ablation catheter.

I was discharged by around noon the next day after meeting with Dr. Natale in the morning and going through the discharge procedure. You will be walking but you will still be under the influence of the anesthesia and certainly not anywhere near full strength. If you are an hour and a half away from St. Luke's, I would imagine that you would be OK to ride home(with a driver, of course), since there is no doubt you would heal better at home. Again, all this will depend on how things go for you and how you feel the next morning.

I felt exponentially better each day and after a week I was definitely getting back to normal in every way with the incredible added gift of NSR. At about two weeks I feel completely back to normal and better, of course, because I was in persistent AF when I was admitted for the ablation. I am following the sage counsel of many on this list to take it easy, even with feeling great. There is a lot of healing in the first 3 months.

My wife was diagnosed with cancer this time last year, so I have some experience with worries about whether I would be able to provide care if I had an ablation. Fortunately she is doing extremely well after surgery, so she was able to support me through the ablation. What I can say is that I believe you will be in a much better position to care for your husband by taking care of yourself and doing what you need to do to have your AF burden behind you. You've made a great decision to go to Dr. Natale.

Also, I have to travel three hours by train to get to NYC, so I have coordinated my continuing care (warfarin, etc) through my local cardiologist. I'll see Dr. Natale again in four months if all goes well.

I think you should focus on the benefits to your own health at this point so you can be in a better position to take care of your husband. You will be able to do most things you need to do very quickly after the procedure as long as you respect your body's need to rest when you feel tired.

I hope this helps. As others have said on this list, getting the ablation with Dr. Natale was the best health decision I've made.

Best wishes,

Robert

Barb,

I'll just add a few items to Bob's excellent post.

<<Will they be giving a blood test beforehand?>>
My procedure was with Dr. Natale in SF. I had pre-op work on the day before the procedure which included blood work, a CT scan and an Echo. Most people have the Echo and CT scan done earlier but I choose to do it this way since I was going to be there anyway.

<<Do they knock you completely out>>
Yes, I was out like a baby

<<How soon can I expect to be back on my feet and going about my business?>>
That depends on a lot of personal factors. After my ablation I felt terrible but I returned to work two days after discharge. However, I work at desk, so that helps. Productivity wasn't ideal but by day 3 I felt pretty good. It's usually a slow ramping up of activities.

Good luck.

BruceS

Hi Barb,
I posted the following a few days after my ablation. I hope this answers some of your questions. It has been over 6 months. I am off all meds and best of all NSR. Best of luck!
Chuck

February 18, 2013 06:48PM

I would like to share my story for those who are contemplating an ablation and may be fearful of that procedure. First and foremost, as has been said many times on this forum, choose the best doctor and facility that you can. There is enough information on this forum to make an educated decision. For me, I chose Dr. Wharton at Medical University of South Carolina. If you choose a doctor/facility that has performed many of these procedures, you will be in good hands.
On my arrival at 5:10 AM I checked in at central registration for admission and was directed to the Heart and Vascular center on the 3rd floor. The waiting room was empty but a nurse came out and brought my wife and I back to my cubicle where I would prep and be returned to following the procedure. After a few questions, I was given my gown and weighed. Once dressed, the nurse shaved my chest and groin area. I was visited by the anesthesiologist and Dr. Wharton’s assistant who explained the procedure and asked if I had any questions. I had an IV inserted into my right arm. Blood pressure, temperature and pulse were checked. EKG pads were also attached. Around 7 AM, I was moved back to the EP lab where the ablation would take place. I was placed next to the operating table in the lab. They rolled me to my side and placed a board under me and moved me onto the table. At this point anesthesia was started and that is all I remember until recovery back in my first cubicle around 2 PM. I learned they inserted the catheters into my groin, one in my neck, a blood pressure monitor into my right wrist, a urinary catheter and a breathing tube. When I woke up in recovery, all except the urine catheter was gone. They phoned my wife at least every two hours to update her. 8 AM they phoned my wife to let her know that the catheters were in place and the ablation would begin shortly. 10 AM they informed her all was well and I was about half way done. 12 PM all went well, I was done and on my way back to recovery. About 10 minutes later Dr. Wharton came out to talk to my wife and discuss what was done. He told her she could see me in about an hour and a half. They had to remove the catheters and allow me to come out of the anesthesia.
It was actually around 2 PM by time I saw my wife. My wife said I looked puffy. I later learned that I gained 10 lbs. from the IV fluids and water used to cool the catheter. I was told that I had to lay flat on my back and not move for 6 hours. This, for me, was the hardest part. I was moved to my room. I was allowed to have something to drink and eat. My throat was scratchy from the breathing tube. I had pain in the middle of my chest, especially when taking deep breaths. None of the puncture sites hurt. I was given pain medication to address the back and chest pain and encouraged to breathe deeply and not take shallow breaths. At 7 PM I was allowed to sit up, I ordered food and felt pretty good. Dr. Wharton stopped in to check on me. The night in the hospital was pretty uneventful. My wife stayed in the room with me. 4 AM I asked for pain medication for my chest and sherbet for my scratchy throat. 6 AM the urinary catheter was removed. Not as bad as I had expected. It wasn’t pleasant but not excruciating pain either. No pain afterwards. I had breakfast. Was taken for an echocardiogram around 10. All went well. My nurse went over all my discharge instructions and I was finally released shortly after 12:30 PM. I have a follow up with Dr. Wharton scheduled in 4 months. I am back on Multaq for 6 weeks and Xarelto with a baby aspirin until my check up with Dr. Wharton. I have not noticed any irregular beats or A Fib. My resting heart rate is up about 10 BPM; now mid 60s, prior to ablation it was mid 50s. I was prescribed Percocet for the chest pain, only needed to take 3 pills total for the first two days home. Pain is completely gone 4 days after.
I would like to thank Hans for this site which has been so helpful in dealing with my A Fib. I would also like to thank the many people for words of encouragement, prayers, valuable information and insight regarding A Fib, in particular, Tom P., Gianfranco, Bill C., Michael S. and Shannon. A special thanks to Lynda who I have spoken to several times on the phone and who called me after the ablation to see how I was doing. I am extremely grateful to you all.
Regards,
Chuck

Thank you all for your input here to help answer my questions. You have done a really thorough job in getting it all down, Chuck! I didn't know about the fluid build up - thanks for sharing that as that could take someone by surprise when they look 10 pounds heavier!

Robert - glad to hear your wife is doing well. I'm sure you were both happy she coudl be there to help you through your own health challenges.

Glad everyone who responded is now in NSR ~ Barb

Hi Barb,

You've got about everything you need from the handy posts about including Roberts excellent summary,

For the Flec at 300 , don't worry about going off but you can start to taper two days before the 5th day from the procedure by cutting the dose in half those two days and then stop it on day 5. they want the Flec ( and other AAR and rate control drugs too) our of your system before the ablation so there is no masking of possible trigger spots.

If you should trigger into an episode its no big deal as it just saves them once extra step of having to induce AFIB during the procedure.

The pain isn't bad, it will be MUCH MUCH less then your imagining or what it might be, Mostly a mild to moderate dull soreness in the center of the chest that can feel a bit more acute when breathing in deeply the first few days and to a milder degree the first week or two. It very rarely needs anything more than a Motrin for the inflammation, though once you get home you can add a few natural anti-inflammatories too to help the cause.

Don't be too concerned by Bruce's description of feeling terrible for a bit at first. His first ablation with Natale was far more extensicve than yours is even remotely likely to be after his six prior ablations plus being still in persistent AFIB.

I know just what Bruce is speaking of having had a similar very extensive 'Soup to Nuts' first ablation for persistent AFIB as well. Still, relative to the concerns you have expressed I'm sure you will find this far less of an issue than what is going through you head right now and you will likely chuckle a few days after getting home at what all the fuss was about!

You can do easy errands on day three and gradually expand from there, but just take it easy the first couple weeks. No need to try and set any marathon records here.

Its all going to be fine. Be sure and request a copy of the full Ablation Report signed by Dr Natale ASAP so that they get it to you within a few days after the ablation. That you want to keep as it explains in detail all that he did inside your heart and it will come in very handy, not only so that you fully understand what your ablation consisted of, but that any other docs you may interface with in the future you can give a copy to as well.

Over and out ... what day and time is your ablation Barb?? Will be sending special afibbers.com mojo vibes your way while you are in dreamland and in the hands of the maestro ... :-)

Cheers!
Shannon

Shannon Wrote:
-------------------------------------------------------

> The pain isn't bad, it will be MUCH MUCH less then
> your imagining or what it might be, Mostly a mild
> to moderate dull soreness in the center of the
> chest that can feel a bit more acute when
> breathing in deeply the first few days and to a
> milder degree the first week or two. It very
> rarely needs anything more than a Motrin for the
> inflammation, though once you get home you can
> add a few natural anti-inflammatories too to help
> the cause.


Shannon's description is very accurate. Only took pain meds for 1 day. I would not hesitate to do it all over again if needed. You will do fine.

Chuck

Hi Barb, You ablation date is this week i believe. All of these excellent responses give you all that you need to know so all you have to do is show up. My experience is that after a rocky start I am doing well and, so far, am happy with my decision to have the ablation with Dr Natale. I hope the same for you . Keep us posted on your experience. Dennis

" I've been on 300 mgs/ of Flec/day for about 5 years and am scared to go off of it for the 5 days before...but am told that's what I need to do"

Hey Barb, I know what you mean about being frightened about getting off Flec 5 days before but it is of course essential.
I wasn't on daily Flec just PIP but leading up to my ablation I was having twice or three times a week AF incidents that I terminated with Flec. So 5 days before I got off Flec and I had just one AF incident a few days later that self termimated after a few hours. Quite a pleasant surprise. The main thing is, you're on a countdown to a good thing.

btw the ablation caused me ZERO pain.

Hey Barb,
NSR at week 14 today, looking back it seems such a long time ago.
I'm off the Multaq now for about 11 days too and heart holding steady.
Best decision of my life. Give my regards to Natale for a job well done.

Best Wishes,
McHale

Post-ablation, I had no need of pain medications, not even an ibuprofen. I had a slight ache in the chest region for a few hours, that was it for pain.

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Post-ablation, I had no need of pain medications, not even an ibuprofen. I had a slight ache in the chest region for a few hours, that was it for pain.

Prior to the procedure, I asked whether pain medication was prescribed for recovery. The nurse seemed surprised at the question. Apparently Steven Hao's patients rarely have significant pain post-ablation. (Dr. Hao was trained by Dr. Natale.)

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.