Another Ablation For Me

In my thread back on Page 4, I related that I was probably going to be ablated a second time. There was a cancelation on the 14th, and I was called and offered the appointment. I had to think for a few long seconds, but it finally dawned on me that Ablation The Second was probably a great idea. ><

Wish me luck!

Wishing you luck!

Thanks, Mark.

Good luck, Gloaming !

Hope for pure NSR to you!!

Wishing for you the very best of outcomes and NSR forever after.
We'll all be watching for your news.

Jackie

Best wishes! Hold him to that comprehensive mapping!

Good luck, Gloaming. I will be looking forward to hear how it went.

Hope the best for you!

Best of luck!

Valentines Day.... I suppose that's the perfect day for a heart procedure.

Good luck!

Thanks, all of you. It looks like this can't happen soon enough. My heart has not been below 103 in the past two days, except during sleep at night. For some reason it will slip into NSR below 60 BPM, and I am damned if I can figure out why I only get that respite. I'm currently taking 150 mg of metoprolol, but I think my GP will ask me to up it. I'm running out of head room on that drug.

I had the second ablation. The EP, Dr. Paul Novak, found the gap in the previous work within minutes, zapped it, and I instantly reverted to NSR. Further, he couldn't get the flutter to reappear and figured that this was the Cat 1 AFL that happens often after an ablation. He stated that he didn't even have to cardiovert me before wheeling me out. I was fine with that simple touch-up. And how miserable I've been....TSK!

Thanks for all your good wishes.

Now, let me describe the current state of the Cath Lab at Royal Jubilee in Victora, BC. I assure you that it is highly representative of all hospitals across Canada. Contrast dyes are in short supply. Luckily, I got it this time, and actually had the pre-screening CT scan. Only had a chest X-ray for pre-screening before first ablation because of the dye problem. While we were waiting to be invited into the Short Stay ward, we saw four sets of paramedics bringing clearly unhappy people past us and into the ward. They were getting priority. I was the last person in the waiting room, there with my wife. We looked at each other after 45 minutes and concluded that we would probably be asked to return at a later date. Then, I got invited in and was prepped. Amazingly, I was the second case in the EP's lab.

Also staying at the Heart House residence for out-of-towners was a woman from the next town north of us, Campbell River. Her husband had developed acute and persisten VTach on the Friday, and she sat with him the entire weekend without returning home. Finally, on Sunday, they told her he would be medevaced to Jubilee. She followed directly in their car. When admitted, the staff at Jubilee told her he would be done among the early cases next morning, Monday. She sat with him all day Monday, and at 1700 a nurse came out to apologize and say they were not going to get to him. Come back tomorrow. She did, waited with him until 1700, and was told, again apologetically, that they couldn't fit him in. Last I heard, she was promised that he'd be done Wednesday. By then, she was six days in the same set of clothing. We returned to our home this morning, Wednesday, and can only hope she was finally afforded relief. When she saw me return from the hospital, vastly improved, she smiled most graciously and told me how well I looked and how glad she was for me. I could tell she really meant every word. Almost brought me to tears.



Edited 1 time(s). Last edit at 02/16/2023 01:04AM by gloaming.

Good news ! I wish you the best.

Wonderful ablation report! Here is to continued NSR!!!

Great news, gloaming. I, too, wish you the best!

Happy to hear! You must feel relieved. Best wishes for a healthy heart

Thanks, again, for all your good wishes. It's nearly Day 4 completed, and the heart has been gratifyingly, and reassuringly, steady in NSR. I am being scrupulously careful, too. I'm simply not going to second-guess any of the instructions and advice to go slow for about a week. There'll be time to change it up in the next few days and to begin to live again, but not just yet.

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gloaming
Thanks, again, for all your good wishes. It's nearly Day 4 completed, and the heart has been gratifyingly, and reassuringly, steady in NSR. I am being scrupulously careful, too. I'm simply not going to second-guess any of the instructions and advice to go slow for about a week. There'll be time to change it up in the next few days and to begin to live again, but not just yet.

Great news! I agree, listen to your body. I found that for a few weeks if I pushed it, I would get short of breath and an uncomfortable feeling in my chest. I had had 61 minutes of burning so there was a lot of healing going on. This did go away after a while, but pushing past this marker wasn't a good idea.

Great news! Keep us updated! I wish you a full success

That is great news, gloaming! I look forward to hearing about your progress.

I had a brief, eight hour, setback last evening. It is now two weeks post ablation, and I was in bliss. The heart was doing really well, but it went into a run of 148 BPM that had me back in the ER for the fourth time since New Years Eve. This took place partway through a slow walk with my wife that lasted about 50 minutes. I had waited a full two weeks before undertaking an effort like this as I wanted to be extra cautious.

To keep this brief, the tech read it as flutter, 2:1 block, but when I inquired during my final meeting with the internist, she said it was AF because the last three hours had the rate variable. It may have morphed into AF from flutter. Anyway, I was given more metoprolol, and they were just shrugging and about to send me home when the rate dropped to 56. Celebratory high fives, and then I was punted out of the ER.

My hope is that this was an anomaly, and not a sign that I still have underlying problems.

BTW, I learned from the outreach nurse that Dr. Novak had to re-isolate three of the four PVs. He found what she called a circular macro-re-entrant that had me in a 4:1 block.

Anyway, onward, and thanks for looking.

The first three months after ablation can be a rocky road. You're good. Shrug it off.

Thanks, Carey. Between you and Lindsey Ward, the outreach nurse with whom I have talked twice in the past 24 hours, you both offer encouragement and try to explain that a bumpy recovery is almost a rite of passage after an ablation. I am grateful for your looking in.

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gloaming
Thanks, Carey. Between you and Lindsey Ward, the outreach nurse with whom I have talked twice in the past 24 hours, you both offer encouragement and try to explain that a bumpy recovery is almost a rite of passage after an ablation.

I coached one member here to use the combination of an app, Polar H-10 heart rate strap & some old Polar software to do long duration monitoring with beat to beat heart rate data recording. The member had an ablation not long ago and recently contacted me to help interpret a recording. Basically it was a whole bunch of PAC's. If I zoomed out, you'd see relatively short PAC activity in the midst of a lot of NSR. I'm sure the PAC's didn't feel good, but the ablation was still working.

Thanks, George. I haven't seen anything like that before, but I did have an absolutely horrendous looking ECG from my Galaxy watch unlike anything else I have seen, This was almost like what you show, except very jumbled, chaotic, and no apparent rhythm at all.

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gloaming
I haven't seen anything like that before

Yes, not common, however in research these R to R data are sometimes extracted from Holter ECG data and presented as heart rate vs time as this is. It is called a "tachogram." Years ago, I put a strap on my demented mother and captured a short run of afib (I'd already felt it in her pulse, which is what prompted me to put the strap on & record). When I showed it to her doc (who was also my neighbor & friend), he had no idea what he was looking at. Fortunately, in her case it was paroxysmal & only presented when I was walking her up a mild hill near her care home. Back at the facility, at rest, she would revert to NSR.

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gloaming
but I did have an absolutely horrendous looking ECG from my Galaxy watch unlike anything else I have seen, This was almost like what you show, except very jumbled, chaotic, and no apparent rhythm at all.

Eyeballing your ECG, the most obvious thing is a wandering baseline. "Baseline wander (BW) is a low-frequency artefact in electrocardiogram (ECG) signal recordings of a subject. BW removal is an important step in processing of ECG signals because BW makes interpretation of ECG recordings difficult. The main cause of the BW in the ECG signal is movement and respiration of the patient." Source: [www.ncbi.nlm.nih.gov]

Looking closely, the R to R spacing actually looks mostly very regular (finding the R peak can be difficult at times), but the BW makes it hard to see.

That helps a lot, George, thank-you! I sent this to the nurse, but never heard back from her. Knowing her, she and my GP must have made an impression on Dr. Novak because his office called about a week later to book me for February 14th. And thank God, because I was on a downward spiral. As was my wife.

Cheers to you!

George, if I could impose upon you, would you have some links or files that might help me to understand more about the 'compensatory beats' you depict higher? The more I look at that graph, the more interesting it becomes to me, and I'd like to understand more. I did have a lot of PACs after the first ablation last summer. My heart rate was often near 95, and this might explain my own situation.

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gloaming
George, if I could impose upon you, would you have some links or files that might help me to understand more about the 'compensatory beats' you depict higher? The more I look at that graph, the more interesting it becomes to me, and I'd like to understand more. I did have a lot of PACs after the first ablation last summer. My heart rate was often near 95, and this might explain my own situation.

Making sure you know what you are looking at. The chart I presented is beat to beat heart rate (BPM) on the y axis and time on the x axis. It was probably 2006 when I worked this out, so don't have any links handy. Here is what I observed and I think was reported elsewhere, but I would not swear to it. For an example, let's assume 60 BPM or a beat every second (realizing there is actually variability around this, but for the sake of the example we will ignore that). Now let's assume you have a PAC that happens 1/2 second after the last beat, or 120 BPM. What I've observed is the beat following the PAC can generally be one of three types of beats:

1. a normal beat that occurs 1 second after the PAC
2. a compensatory beat that occurs 1.5 seconds after the PAC. In other words, it happens in time when it would have happened if there was no PAC.
3. another PAC, which could occur at any time, but less than 1 second after the PAC.

It turns out with the Polar straps - every one I've every seen since I started looking at beat to beat data in detail - do not "see" PVC's. Hence the beat following a PVC looks "slow" because the time to it includes the time of the PVC plus the time of the next beat. I actually figured this out by running a crude DIY ECG in parallel with the Polar years ago. PVC's have an "ugly" QRS signature which is pretty easy to spot. So while the compensatory beat is also shown as "slow", it would not have the PVC QRS signature on an ECG.

You can actually see quite a bit in just the RR (beat to beat data). A member here years ago gave me this file of recordings. He's an optometrist living in the UK. Unfortunately for him, he had many different rhythms to record.

Hope this is helpful. Let me know if you have other questions.

I did find this with a search: [www.healio.com].

There are four main characteristics of PACs:

1. They are premature. That is, they occur earlier than you would expect if you were to measure the previous P-to-P intervals.
2. They are ectopic. Meaning they originate outside of the SA node. Thus, the P wave morphology would be different than the normal sinus P wave.
3. They are narrow complexes. Since they come from the atrium, they will eventually travel through the AV node and use the normal conduction system to spread to the ventricules. Unlike a premature ventricular contraction, which is wide-complexed, since it does not use the normal ventricular conduction system.
4. There is a compensatory pause after the PAC. The extra atrial action potential causes the SA node to become refractory to generating its next scheduled beat. Thus, it must "skip a beat" and it will resume exactly 2 P-to-P intervals after the last normal sinus beat.