surgery for inappropriate sinus tachycardia

I was wondering if any of you has had surgery to treat IST. I've already had 3 ablations for accessory pathways and 2 sinus node modifications. Last time my rate dropped to the 60s but then the tachycardias came back. On March 17 I had a pacemaker implanted in anticipation of total sinus node ablation, but the doctors say that doing it through the traditional way will not work because of the proximity of the phrenic nerve. My EP suggested combining endocardial ablation with surgery and referred me to a cardiothoracic surgeon. He suggested doing it through the ribs, but not the way I've heard of. He's not going to do many small incisions, but one big incision to insert a clamp and ablate a very big area between the atria and the ventricle. I'm not sure if this is pulmonary vein isolation or the mini-maze procedure. The doctors are in the Cleveland Clinic and I live in Puerto Rico, so I only go there for my appointments. I'm a little bit scared because the surgeon said he would need to deflate a lung and that I would need to be in the hospital for more days than usual. But, after seeing about 12 specialists and traveling to different parts of the world looking for a solution I'm finally seeing hope. My EP says that this is the best option right now, but if it doesn't work, then I will need to have sympathectomy. Do you know anything about this surgery I'm talking about, about deflating a lung or about sympathectomy? I've tried to look for information in the web but it's very confusing. I want to know the opinion of someone who's been through this and can tell me his/her experience. Please, help me, as I'm heading back to Cleveland soon to have this done!

6 Comments

Sounds like the best option

by ElectricFrank - 2009-05-03 01:05:06

Sorry, I don't know much about the procedure. It sounds like it is well thought out though and the Cleveland Clinic has a good reputation.

One suggestion though. Unless it is very urgent I would consider waiting until the current flu thing settles down. It would not be a good thing to pick up the flu virus on an airplane and have it complicate the surgery.

best wishes,

frank

You're in good hands...

by chip - 2009-05-03 02:05:43


The thoracotomy you’re referring to is a pretty common invasive technique that gives access to the heart for many different procedures. The plus side to this method is that an incision down the middle of the chest is not required simply a 5 or 6 inch entry on the left side.

I had this type of thoracotomy done and while it is not pleasant it is a tolerable surgery. The healing time is much faster then with the traditional center chest method. Your post surgery pain is very manageable and my need for pain medication only lasted 3 days or so. I spent 5 days in the hospital and it took about 10 days more to recover at home.

As Frank said Cleveland Clinic has some very reputable surgeons you are in very capable hands.

I have never heard of a Sympathectomy being used to treat a heart condition but then I’m not a doctor. As with any surgery I would give it some serious thought before I agreed to it. But once again you are in very good hands and the same advice from multiple physicians would carry a lot of weight in my book.

Best of Luck and please let us know how you’re doing.

God Bless

Please........

by Angelie - 2009-05-03 07:05:45

Whew wee, I'm sorry, but I have to speak up.
I have had heart arrhythimias all of my life. I have IST, atrial tach, atrial fib, atrial flutter, and SVT.
I have had 5 ablations, and have tried every drug known to man. I'm 33.
After one of my ablations, I ended up with phrenic nerve damage, but it's getting better after a year.
After all that I've been through, I would give you this advice. Please think very hard what you're getting yourself into. My doctor was able to re-ablate areas very close to my phrenic nerve without hitting it. The first time he accidentally hit it with cryo-ablation, but the 2nd time he was able to get my IST corrected without affecting the phrenic nerve by constantly pacing my phrenic nerve while using low radio-frequency.
Cutting into your ribs and going in through your heart, to me, seems a little drastic.
Just make for certain that you have exhausted all other options first and I would only have any "open heart" procedure as a LAST resort.
I would ask your doctor about phrenic nerve pacing during a repeat ablation. It is possible. I am proof.
Good luck,
Angelie

thanks

by mereiriz - 2009-05-03 09:05:43

Wow, you really answer quick! Thank you guys for your advices. It seems like everyone's got a different opinion. Angelie, I totally agree with you in that surgery should be a last resort to treat this, but I think it is in my case. I already had the phrenic nerve pacing during my last ablation and it didn't make a real difference according to my EP because the area she needs to ablate and which is in contact with the nerve is too big. She wouldn't risk ablating all of it (not even with cryo) because she says that sometimes paralysis is reversible but sometimes is not. She definitely doesn't want to risk it and the surgeon has the same opinion. It was a blessing that it worked for you. Right now I'm not considering sympathectomy because I know it has some other issues, but I think the surgical ablation is a good choice. But I definitely don't want open heart surgery, of that I'm sure! My experience in the Cleveland Clinic has been great so far, so I know I'm in good hands. I think I'll give it a try, because I'm really tired of thinking the ablations worked and having to come back in a few months to repeat it! I'm just 25, I'm in Med School and this is affecting my life. Thanks Chip for your input, I really appreciate it. And yes, I will wait until this flu things resolves!

Thanks again

3nd that motion

by kcruz - 2009-05-03 10:05:14

I have to agree with Angelie, really think hard about what you may be agreeing to. I have had 6 ablation, including left and right side ablation and although there was some relief I am still facing challenges everyday and not able to do what I use to. I have experienced complications with procedures and would just worry about what they are suggesting to you. Yes CC is a good facility I can say that usually the doc you see is not the one that does the procedure as I have been there, it is a teaching hospital and they have many hands involved in each case. Just really really be sure this is your absolute last option is what I would recommend.

Be careful of desperation

by ElectricFrank - 2009-05-04 11:05:18


After reading some of the others comments as well as your reply I thought I should comment more.

As I said I don't know that much about the procedure and mainly based my comment on the reputation of CC. I'm not surprised that with a large staff the skill of the doc you get may vary quite a bit.

The more important issue though is that I hear a hint of desperation driving your decision process. That is a sure recipe for disaster. There have been a few times in my earlier life that I came all too close to making a decision on the pain I was in rather than looking at the possible outcomes (once where severe back pain kept my in bed for 3 weeks. turned out the problem wasn't the disk they were going to fuse).

Yor present condition is affecting your life, but a procedure gone wrong could end your medical career.

good luck,

frank

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