Back from Dr Ernst Ablation

Hi All

After 7 years of vagal LAF I decided to take the ablation route and was booked in with Dr Sabine Ernst at the Royal Brompton in London on Weds this week.

After quite a bit of trepidation leading up to the date the flow was pretty smooth in the end:

Day T-1: "checked in" Tues afternoon for blood tests and CT. Actually was in AFib that day after 26 day gap from last one. Did not lead to good start as fainted when they took the blood samples!!
- Day 0: Had first slot with team and was taken down to the lab for 8.30. Dr Ernst came in at that time shook hands and was gone to prep. Last thing I recall was the cold carto mapping pads being stuck onto my back and the GA sending me off...
Came to about 3 hours later with report that all was well. Pretty spaced really so took their word for it.
Back to recovery ward and lots of attention and care. Check was sore in a sore of none specific way as they said it would be.
EP from Dr Ernst team came later to say that the ablation was quite normal and considered an "acute success" with isolation into and out of the atria. I asked about my anatomy and any quirks and nothing there just that transmural puncture a little tricky as my LA was a normal size.

Must say all the staff were superb and very attentive and friendly and the hospital has real good feel being heart specialists.

Clearly proof will be in the pudding as we say on the Afib front but have a non scientific feel that my heart is really "solid". Only had a few PACs since and now Friday. Still some check soreness and still bit week but looking forward to relaxed recovery.

On Xaralto or Rivoraxaban as it is known in UK for 90 days and a PPI to stuff reflux into esophagus for 6 weeks.

In all very pleased that I took the plunge and very happy with results so far from Dr Ernst and her team.

Here's to NSR!!!

Phil

Wonderful news Phil!

All sounds like it going as planned which you should expect from an experienced team for paroxysmal AFIB in particular. All the steps you describe sounded textbook, though Im not entirely sure what the EP who came in to brief you was saying " ..with isolation into and out of the atria" .... the 'acute success' part of the main thing to hear at this point, of course, and I do realize British English .. especially British 'medical-ease' .. can sound a bit peculiar to US ears as, no doubt, 'Americanization' of your native tongue can sound a bit funny to UK ears as well. :-) I assume they mean that there was good isolation on both sides from the left atrium and PVs viewpoint with entrance and exit block achieved acutely by the end of the procedure.

There is no doubt Dr Sabine would recognize any anatomical quirks you inquired about, had there been any. I'm about half way through right now reading her excellent textbook titled 'Anatomy for Cardiac Electrophysiologists - A Practical Handbook' that she and Dr S. Yen Ho wrote together two years ago. It's very interesting and lays out all the nooks and cranny's of the heart in relation to all the EP and ablation issues and locations we are always discussing, so I figured it was worthwhile to garner a better understanding of that whole side of the coin too for when sharing things on this website.

Anyway, when you go in for your checkup, pass along to her my appreciation for a job well done in creating that book, it's thoroughly understandable for a non physician and the color photos are pristine and highly revealing.

Take it easy this next week or so and if you have some motrin like over the counter non steroidal anti-inflammatory or access to any good natural anti-inflammatories as noted in Hans post ablation care recommendations found in the AFIB Resources like at the top of this page, be sure to avail yourself of one of more of those agents these next few weeks to help with the healing and inflammation reduction.

And best wishes on a speedy recovery and long term NSR!
Shannon

Phil, Best wishes for rapid recovery and long term NSR.

Shannon, I believe Ernst can handle persistent and chronic cases too. A couple of years ago at Natale's Venice symposium, she had the podium and talked about difficult cases that took repeat procedures. She gets global referrals for cogenital and cases with structural issues so I am not surprised she did a nice job writing about heart anatomy.

Hi researcher,

Yes I agree, and am fully confident that Dr Sabine addresses persistent cases as well. She is a well-known long time EP with a good track record from all that Ive heard. My reference above was simply to Phil being paroxysmal, and in cases like his, it makes for an even greater likelihood of being 'one and done', and also a better chance for generally having less activity in the blanking period (but not always). In any event, regardless of whether Phil is already finished with this business, which we all dearly hope, or has yet another step to go, typically the odds of having a quieter and less eventful blanking period are higher after a straightforward textbook paroxysmal case than after more extensive ablations usually required for persistent AFIB or even long-standing paroxysmal AFIB of many years with long duration episodes, and that was what I was implying, or at least trying too. And that is generally the case whether it's Sabine, Natale, Jais and even the more typical EP who is at least competent in ablating at least paroxysmal AFIB.

The easier the case, the smoother the landing is more or less the norm. Though as we see here from time to time, there are exceptions. And the less experienced the operator the odds increase not only for needing more work, but also for more complications even with a straightforward paroxysmal procedure. Hence, our continued focus on being very discriminating in one's choice for ablationist which Phil clearly was in his country.

Cheers!
Shannon

Thanks Shannon - indeed I think they were referring to PV isolation - most likely my spaced recollection! And yep got the zyflammend etc in stock to ease inflammation.

Thanks Researcher - yes Dr Ernst mentioned congenital world wide referrals at my consultation when I asked about robotic navigation (I thought that was all she used but she said used it for tight space cases/unusual anatomy where high maneuverability is needed - normally she manually navigates the catheter). She gives the impression she is pretty much on top of her game as they say.

There is an interesting article on how she got to where she is starting on p2 of this PDF: <[circ.ahajournals.org] She is clearly a gifted person.