Thanks everyone.
The urinary catheter was a godsend as suggested by Carey. Stung a little coming out but that’s the only drawback since I was under when it was put in. Also used George’s and Susan’s idea of recording the EP. Although the good part was I had access to the procedure notes about two hours after the ablation ended. The procedure lasted about three hours. Unfortunately, as usual, I didn’t catch a nice buzz from the anesthesia, he just knocked me out!
Verdict success! Isolated the PVIs and no need for any other areas. Feel great, no pain, or even really tired. The only discomfort after the fact was sore throat and I was warned about that since the tube was going to be in the for three hours.
Here’s the final notes for anyone interested. Personally after reading as much as I can, including here, and watching YouTube video of an ablation I find the notes readable! One interesting thing they do here is use fluids to keep the esophagus cool during the procedure.
Procedure Description
Informed consent obtained after procedure and sedation explained in full, including indications, benefits,
risks and alternatives. Patient transported to procedure room in fasting, non-sedated state. General
anesthesia administered by anesthesiologist. Temperature probe advanced to mid-esophagus through
nasopharynx. Catheter insertion sites prepared and draped in usual sterile fashion. Local anesthesia
achieved with 2% lidocaine and 2% bupivicaine. Hemostatic sheaths placed percutaneously under direct
ultrasonic visualization using modified Seldinger technique. 12-lead surface ECG and intracardiac
electrograms displayed in real time and recorded. After baseline recordings obtained, sinus node, atrial,
node, His-Purkinje, and ventricular functions evaluated by incremental pacing and programmed
extrastimulation. Programmed pacing and recording repeated during and after IV isoproterenol. Etiology
arrhythmia determined with pacing maneuvers. Decision made to proceed with catheter intervention.
Intraprocedural Anticoagulation: Heparin bolus initiated prior to completion of transseptal punctures and
further boluses given to maintain ACT >350 sec. Intracardiac Echocardiography: AcuNav 10F intracardi
echocardiographic catheter inserted via left femoral vein 10.5F sheath and advanced to RA. Catheter
maneuvered within RA, and RA, tricuspid valve, RV, intra-atrial septum, LA, left and right PVs, mitral val
LV, and aortic valve visualized. Transseptal Punctures: Two transseptal punctures performed with NRG
needle under fluoroscopic and ICE guidance and LAMP and SLO sheaths advanced into the LA. Proper
positioning in LA confirmed with fluoroscopy, ICE and LA pressure tracings. At end of the procedure all
catheters removed and sheaths removed. IV Protamine 50 mg administered to reverse heparin to ACT
prior to sheath removal. Hemostasis achieved with vascular closure devices at both femoral vein acces:
sites. Patient extubated without issue. Patient transported to monitored recovery area in stable condition
Comments:Mapping and Ablation of AF (PV Antral Isolation):
Endocardial and 3-D electroanatomic mapping performed with PentaRay catheter and Navistar 3.5-mm
SmartTouch SF F-curve ablation catheter utilizing Biosense CARTO 3 system. CT image of LA and PVs
integrated into CARTO system. No significant LA scarring noted at onset. Vein potentials localized
endocardially in antra of all PVs using mapping catheter. Targeting vein potentials with ablation resulted in
isolation of all PVs. High dose isoproterenol infusion to induce additional arrhythmia (20 mcg/min for 10-15
minutes) demonstrated no recurrent conduction into PVs, no induction of extrapulmonary triggers, no
induction of atrial arrhythmias. Adenosine infusions (12-24 mg per vein) did not reveal recurrent or dormant
conduction into PVs.. Bidirectional block into and out of the PV's was confirmed with pacing. Ablation points
guided by fluoroscopy, 3-D CARTO image. Intracardiac echocardiography used to monitor positioning of
catheters, effect of ablation, and pericardial space. Radiofrequency energy directed from the ablation
catheter tip to surface patch electrode(s). Temperature was limited to 40C and power was titrated 40 W
depending on effect on targeted electrograms. Saline flow of 2 mL/min maintained at a minimum while
catheter within vasculature. Flow increased to 15 mL/min during ablations.Phrenic nerve stimulation not
present with maximum output from sites of ablation near right PVs and LAA. Continuous esophageal coolin
was performed during catheter ablation energy delivery.
Addl Comments:
Conclusions
EPS/Ablation Summary
1) No LA scarring noted at procedure onset.
2) Successful isolation of four Vs for treatment of paroxysmal atrial fibrillation, confirmed bi-directional
block with pacing.
3) High-dose isoproterenol challenge (20 mcg/min for 10-15 min) for induction of separate arrhythmia: no
reconnection into the PVs, no extrapulmonary triggers, no induction of atrial arrhythmia; programmed paci
and recording performed during and after isoproternol infusion.
4) Adenosine challenge (12 mg per vein); no reconnection into PVs.a
5) No inducible SVT/AFL.
