ablation

i go for my first ablation,for my fast heart rate,what to expect,and how long is recovery.i do have a icd in me,is abaltion,like a cazeration

9 Comments

Ablation

by turboz24 - 2009-11-12 09:11:09

During an ablation, they either will sedate you or place you under general for the procedure.

They usually place sheaths in your "groin" veins and place the catheters through there. They then stimulate your heart and cause the arrhythmia, while a large pad placed on your back immediately behind your heart measures where the electrical impulses are originating from. They then use a radio frequency emitter on one of the catheter tips to "burn out" the area of your heart causing the misfire. There are non-irrigated tips, irrigated tips and they can also use alcohol to ablate the area.

Once the ablation is complete and the doc feels that he has removed the areas causing the arrhythmia, they remove the sheaths and hardware, place pressure on your entry wounds, and they will essentially seal with 15-20 minutes of pressure.

Once you return to your room, you will either be wearing a compression garment to keep pressure on the sites, or they will just require you to lie still. After 6 hrs, they will want you up and walking around.

I looked like I had been hit by a bat on my groin for a couple of weeks, but the pain was never bad. They will want you to not exert yourself for a week just to make sure the wounds close. I was pretty much fine after 2 weeks, went back to working out 1 week after the ablation.

one more thing...

by turboz24 - 2009-11-12 09:11:50

You will have to be off any anti-arrhythmia drugs for the procedure. How soon you have to stop the drugs depends on how long they stay in your system.

Depends

by lenora - 2009-11-13 01:11:01

Protocols for use of conscious sedation drugs require that the patient be able to maintain their airway during sedation. With some respiratory conditions a patient may not be able to breathe on their own under sedation and may require general anesthesia and intubation. There is also the possibility that a patient is allergic to propafol or midazolam (Versed) which is the conscious sedation drug of choice here in the U.S. and neither could be used. Ablation can be a lengthy procedure and the patient has to be able to breathe during it.

ablations

by golden_snitch - 2009-11-13 10:11:44

Hi!

Most of what has already been said is right, but for ablation procedures you will not be put under general anaesthesie; it's either sedation (usually with something like propofol) or you stay awake and get local anaesthesia only (where the catheters are put in). Then after the procedure it's as far as I know - I've had had 6 ablations myself - usually a compression garment AND lieing still for at least six hours.

Yes, it's like a heart catheterization, but in most cases more than one catheter is needed, and it's sometimes necessary to puncture both groins and/or the subclavian vein below your collar bone. An ablation also takes longer than a normal catheterization. My Mom had one done that took about an hour or two, my ablations always took much longer - between 4 and 10 hours - because I have a very complicated rhythm problem. The doctor will first do an electrophysiological study (EP study) using a mapping system to see where your arrhythmia originates. To map the arrhythmia, he needs to induce it, either by stimulating the heart or by injecting a med that'll make your heart rate speed up. Then after he's got the map, he'll go ahead and perform the ablation. In most cases radiofrequency energy ("heat") is used to ablate, but there are two more possibilities: cryo-ablation which uses cooling energy or HIFU which is high intensity focused ultrasound. HIFU is pretty new, cryo is getting more and more popular. After having ablated the spot he'll try to induce arrhythmia again. Ablation is finished when he can't induce it again.

I was up again six hours after the procedure, walking around and feeling nothing except for a tiny bit of pain in my groins. Sometimes I was back at school just a few days later (two or three), sometimes I got a week off before returning. It's nothing compared to an ICD implant, you'll surely be fine again after a few days.

Best wishes
Inga

General for me

by turboz24 - 2009-11-13 11:11:10

I was placed under general for my ICD implant as well as ablation procedure, breathing tube and all.

I know a lot of docs use concious sedation, but I actually would prefer to be out cold anyways.

ok

by golden_snitch - 2009-11-13 12:11:21

ok, but highly unusual i would say. i know loads of ablation patients and ep specialists, do not know anyone who was put under general for this and no doc who would order a general for an ablation patient. i was totally knocked out with propofol, i slept but was not intubated. there are different meds to make you sleep during the procedure, it's not that one can only sleep through when being under general anaesthesia. did you talk to an anaesthesist before ablation?

best wishes,
inga

Maybe my info was wrong...

by turboz24 - 2009-11-14 07:11:57

I spoke to them for just a minute or 2, but there was a anaesthesist present during my EP study/ICD implant and ablation procedures.

If propofol knocks you out completely, as in they can slice and dice without any local and you don't have to be tied to the table, then maybe my information was incorrect.

I had to stay overnight and went into recovery before I went back to my room both times.

Propofol etc.

by golden_snitch - 2009-11-15 10:11:25

I would say, if you didn't sign a sheet for general anaesthesia - in Germany before getting general anaesthesia you talk to an anaesthesist, he listens to your heart and lungs, asks lots of questions - then it wasn't a general.

Propofol is a hypnotic agent (induces sleep) and it's used for procedural sedation which is defined as "a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function." However, as soon as the Propofol is stopped, you wake up really quickly and you don't feel as sleepy as after general anaesthesia. I have had one ablation where they actually let me wake up in the middle of the procedure and I had to tell them whether the arrhythmia they had just induced felt as the one that bothered me; afterwards I slept again and woke up when they put me back into my bed.

Propofol is usually combined with other meds. For my EP studies and ablations I always got Propofol, Dormicum and Fentanyl. Dormicum is one of these agents that leaves you conscious (you can answer and all) but you can't remember afterwards (I think "retrograde amnesia" is the term); Fentanyl is a strong painkiller. I think when they actually need to "slice and dice" they will add a local anaesthesia.
After my ablations I always stayed overnight up to a few days.

I know a few ICD patients who had general anaesthesia for the implant, but really none who has had that for an ablation.

General anaesthesia always is more risky than sedation, especially for patients in heart failure etc. So I would think that they do not administer general anaesthesia for procedures where the above mentioned drugs are sufficient. Of course, as Lenora pointed out when someone can't maintain the respiratory function and intubation might be needed. However, intubation still doesn't require general anaesthesia. Lots of patients who are in the ICU and need to be intubated are "just" sedated; they seem to be sleeping, but they are not under general anaesthesia.

Sorry, I'm harping on this, but I just think that if others here who are going for an ablation read that they will be put under general anaesthesia, it might scare them - that's all.

Best wishes
Inga

Find it odd..

by turboz24 - 2009-11-16 09:11:44

I asked the cardiac nurse today and he said that they typically use Propofol to sedate you, but on a long procedure will intubate the patient. They do administer enough to keep you unconcious, but you can breath on your own, that's why I think conscious sedation is a little misleading, since to me that means you are awake, thus the term conscious.

I can't ask about the ICD implant procedure, since I "fired" that doc.

I have not asked about sub-pectoral ICD implantation, which is what I will have done once this ICD wears out. Once I Get that done, time to swim again and put mirrors back in my bathroom. Woohoo!

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