Post ablation report

It's now 16 hrs since I came to afte my ablation at Royal Brompton Hospital. I await an echo to make sure there's no cardial effusion, and if that's clear I should be free to go. I have just been told that Sabine Ernst 'supervised' the procedure but it was carried out be one of her staff. This, as you can imagine, is VERY frustrating. All day yesterday in the lead up to the event I asked for reassurance that she would be doing it. Even when I was in the Catheter lab I asked if she was doing it. 'Yes, they said, in fact she's behind you', I was unable to verify this because next thing I knew I was asleep. They tried to stimulate AF before during and after, but to no avail - apparently this is quite common, but it's an illustration of the elusive nature of the beast!

I mentioned this because I know other Afibbers have been assured they will be treated by her, but be aware that she may just supervise.

The procedure lasted 4 hours. It as a standard PVI process. Because I've had no history of A Flutter, the didn't do additional burns.

And that's about all I can say at this point.

I have some mild pain in the groin, and my throat is sore (They always do a TOE here to improve the image) My hearts feels absolutely normal, and I've had no ectopics since the op. They resumed my medication as per before the ablation (I was really hoping they'd stop the beta-blocker) but they say to keep on all of them until the blanking period of 3 months, is over.



It's a strange feeling- something of a let-down, because I feel like I could have gone to my local hospital if I wasn't going to be either her clinical trial (which I ruled myself out of after they had ethics clearance problems) or be a later by her. However, if I stay Afib free, I'll have no complaints.

Wait and see, as ever!

Hello David - the good news is that you are safe, functional, no complications were noted and in blessed NSR.

However, I can certainly understand your frustration. There are similar situations here in the US when teaching hospitals are involved and in spite of pseudo-"guarantees"... the expected EP is mostly supervising rather than doing the actual hands-on procedure. But don't rule out the value of a well-seasoned supervisor ....it's still better than being at the mercy of relatively inexperienced EP with no guidance for the refinements or nuances so important for success.

Relax and begin the recovery process. Keep us informed of your progress.

Very best wishes to you,

Jackie

Thanks Jackie.
I'm now on the train travelling home and feel great. I got a few more details of the procedure from notes:
TOE and AF RFCA, using Lassoo 15-20 mm Decapolar x 2 ? And Carto mapping
Double transeptal TOE guided
2 right veins plus common ostiom left side isolated (I suspect this is the important bit!)
And DR Ernst signed the procedure 'a success' though of course we won't know that for sure.
Apparently I stayed in NSR throughout . Typical.....

David, glad to hear you are doing well after your ablation. Unfortunately, as Jackie said, it is fairly common at teaching hospitals that although ablations are supervised by the head EP, they are often performed by a student in training. I don't know for sure, but I think that was done in my case also. However, I have been fortunate in that my PVI was a one and done with minimal problems. Wish you the best of luck and a speedy recovery, with continued NSR.

Jim

David,

Good to hear all went well.

A little disappointing to learn that Despite prior assurances to the contrary that Ernst did not undertake your procedure. I must admit that has rocked my confidence somewhat in heading to Ernst as and when I decide my situation warrants an ablation.

Please continue to keep us posted s to your progress and everything crossed for you in that regard. You do seem to have got off to an excellent start!

Regards,

Mike F

Re-reading your posts, I guess the distinction here is that you were assured that Sabine Ernst was performing your procedure because she was supervising it. Maybe as and when referred I'll ask for her assurance that she'll actually be performing the procedure rather than supervising it. In the final analysis I suppose she'll have to perform rather than supervise the procedure if that's what she says she's going to do?

Hi Mike,
Until I see her, I've no reason to doubt she wasn't overlooking every step of the way, and may even have taken the reins at some point. I'm sort of full circle, anyway. I started off by suggesting to afibbers here that the only way we ever get more than half a dozen of the world's best carrying out all the ablations is if we give others a try. Shannon and others convinced me to go to Royal Brompton and to Sabine Ernst. So, in a sense I guess I'm helping the next gen of ablationists, and there's no guarantee that even with Dr Ernst actually doing it, I would have had a successful outcome.

I can't help but wonder if her interest in me waned once I pulled out of the clinical trial, but she seems like a woman of integrity and high professionalism, so maybe that's unfair. However, if you sign up for the trial, I'm sure you'd get her. I've now had another day of absolute calm in the heart, no pain while coughing, breathing or burping (a big trigger for me) so I'm not complaining!

The fact that they are doing multiple ablations seemingly everyday suggests to me that the hospital may be as big a choice as the ablationist. The care I received at Royal Brompton was exemplary throughout.

DavidPrice Wrote:
-------------------------------------------------------
> Hi Mike,
> Until I see her, I've no reason to doubt she
> wasn't overlooking every step of the way, and may
> even have taken the reins at some point. I'm sort
> of full circle, anyway. I started off by
> suggesting to afibbers here that the only way we
> ever get more than half a dozen of the world's
> best carrying out all the ablations is if we give
> others a try. Shannon and others convinced me to
> go to Royal Brompton and to Sabine Ernst. So, in a
> sense I guess I'm helping the next gen of
> ablationists, and there's no guarantee that even
> with Dr Ernst actually doing it, I would have had
> a successful outcome.
>
> I can't help but wonder if her interest in me
> waned once I pulled out of the clinical trial, but
> she seems like a woman of integrity and high
> professionalism, so maybe that's unfair. However,
> if you sign up for the trial, I'm sure you'd get
> her. I've now had another day of absolute calm in
> the heart, no pain while coughing, breathing or
> burping (a big trigger for me) so I'm not
> complaining!
>
> The fact that they are doing multiple ablations
> seemingly everyday suggests to me that the
> hospital may be as big a choice as the
> ablationist. The care I received at Royal Brompton
> was exemplary throughout.

Many thanks for the additional helpful comment David and hoping your positive outcome continues short, medium and l o n g term!

Might not be too far behind you having had 2 daytime episodes 6 weeks apart just recently. Had 3 daytime episodes before in 03, 09 and 11 but vast majority have been nighttime. Thankfully always convert to NSR in an hour or so with 200mg Flec but even so. On the plus side my episodes have become less symptomatic over the last 16 years, so now merely moderately unpleasant rather than totally debilitating!

By the way, what trial are you referring to David?

Best regards,

Mike

Mike this was/is a trial that Sabine Ernst is involved in looking at people who have vagal AF. The idea was to target pulmonary veins, plus some ganglia identified through nuclear imaging. She said they early results were really promising. But when I asked for a date, I was told there were problems with the ethics committee, and I wouldn't be done until end of January at the earliest. It was then I asked for the normal PVA ablation and, to their credit, they fitted me into to the one week I specified. Considering how busy they are, I was grateful.

It's your choice, of course, but I've just been reading about long-term outcomes of AF ablation, and there's little doubt that having an ablation while you're paroxysmal, not persistent greatly improves your long-term outcome!

David,
Thanks for that.
Agreed best get looked at whilst still paroxysmal. My mother (now 75) started with PAF in her 30s, but didn't go persistent until aged 70 (no ablations), so having started myself at 39 (now almost 54) I hopefully still have a year or two yet to 'play' with. But sooner rather than later for me I think.

David I completely understand your frustration.
I suspect she felt your were a very easy case and therefore used you for training her staff.
So try to look from the positive side that she probably felt you were an easy case.
Not trying to trivialise your frustration just giving a view.

Mark

Mark,
I really hope so! I'll see her in 6 weeks, so hopefully things will be clearer then. Certainly, if my post-op symptoms are anything to go by (nil, touch wood) your theory makes sense.