Cardiac Ablation

jnette, ASN, EMT-I · Mar 8, 2004

Was advised to consider this myself a little over a year ago... but the tachycardia was a one time thing... wore a holter for a week... stress tests, the gamut... never recurred.

But ablation is a really painless procedure, and from what I hear, a quite successful one. Have recommended this to my sis, as she ALWAYS gets the tachy.. out of the blue.. for HOURS at a time. Like in the 200 BPM range.

Nothing to fear. Check it out in your nursing books.. medsurge, etc.

Then, if and when you have it, you get to come back here and tell us ALL ABOUT IT !!!

Seriously.. wish you the best, and keep us posted ! :)

time4mydream · Mar 8, 2004

hi. my 15 year old son had a EP study/catheter ablation done in december. he had a wonderful doctor who we were very confident with. the worst part of the entire day(for me) was waiting for the doctor to do the procedure. once they took him downstairs, it took roughly an hour and a half for the ablation. my son said it was a piece of cake. he drifted off sleep(not a general anesthetic) and woke up hours later cured of his SVT. he was on his feet about four hours afterwards and we were back home roughly 6 hours from start to finish. he followed up a month later with a holter monitor and a visit with the doctor two weeks ago and it is all behind us. looking back now, i am glad we made the decision for my son to have the ablation.

Dinith88 · Mar 8, 2004

These days, ablations are routinely done and are highly successful, minimally invasive, and you'll get good drugs so that you wont care what they're doing

Apparently, your fast heart-rate is being caused by an irritable focus or 'spot' in your heart (in your right atrium). PSVT's (paroxysmal supra-ventricular tachycardias) of this type are most frquently Wolf-Parkinson-White ('WPW') or AVNRT's (av-node re-entrant tachycardias). In either case, they can be cured by ablating or 'burning' away this focus with the use of ablation catheters.

The procedure is similar to an angiogram, but rather than an arterial stick it's venous. They'll puncture your femoral vein (in your groin) with an introducer sheath and advance the ablation catheter into your atrium. From there they'll manipulate the catheter under flouroscopy and 'burn out' your irritable focus. (before doing this, they'll 'map' the conduction pathways in your heart w/an EP-study (electrophysiology-study)...(i'm betting you've already had this done) in order to locate the spot they'll need to ablate.

After the procedure you'll probably stay over-night on a telemetry unit for rhythm monitoring (pac's and short bursts of svt are actually common post-ablation due to the irritation but usually resolve in a day or 2). You'll be required to stay in bed for a few hours after the procedure to avoid breaking the clot in your groin, but otherwise you'll have no real restrictions.

When i worked step-down i took care of LOTS of patients who had this provedure and everyone does well. Rarely, a patient's focus will be very near the AV or SA node...wnich will exclude an ablation (unless the doc is brave and/or quacky) because of the risk of 'blowing a node'...in which case the pt will need permanent pacing. You wont need to worry about this, as the doc's would know from the ep study just how close this 'focus' is to a node.

Good Luck to you!

unikuelady, RN · Mar 8, 2004

My daughter had the EP study and Ablation at the same time. She was 10 years old. She had "3" accessory pathways- WPW, with 1 directly next to/connected to the SA Node. The 1-3 hour prodedure lasted 9 hours :uhoh21: She ended up staying the night in the hospital. EKG showed 1st degree heart block for 2 months post procedure. She also ended up being diagnosed with "temporary Glaucoma-which lasted for 6 months" due to the interruption/decrease of blood flow to her head due to the canulation. She required canulization of both femerol arteries and right carotid artery for the procedure. 2 days post procedure the right femerol clot opened-up with arterial bleeding. Quick pressure drsg took care of it. Had to stay laying flat for 1 week to let sites heal. The Cardiac surgeon informed me that she was one of the most complicated/difficult case he has encountered. This was done almost 10 years ago when only a handful of medical centers were doing this procedure. I'm sure the procedure has improved greatly...especially if it is now an out-patient procedure. Today you would never suspect that my daughter had an MI when she was just 10 yrs old. (2 years of svt wore her out).

She lettered in high school on the boys wrestling team. Has had her first pregnancy without any complications and is doing well health wise. This was a live saving procedure for her.

PS Sorry if I am worrying you. It's the first time I've seen a thread about this issue and had to tell my story. I have been told that this procedure is much safer on adults than on children.

My thoughts are with you

Dinith88 · Mar 9, 2004

:... She required canulization of both femerol arteries and right carotid artery for the procedure....Had to stay laying flat for 1 week to let sites heal....I'm sure the procedure has improved greatly...especially if it is now an out-patient procedure. QUOTE]
AS they say "..We've come a long way baby!..."
Thats very interesting, and thanks for the post. I'm glad your daughter is doing well!
Do you know why all those arteries (no veins???) were involved??? Man, it's so very different now. EP-doc's do it (rather than surgeons), Arterial sticks aren't done (was she having an angiogram in the process?? for her MI???..Arterial circulation gets you to the left heart..not the right...hmm.)...and people are up and walking 4hrs afterwards.
Ah, technology. You wait..in 10 more years they'll probably be doing it in 5 minutes at the bedside...or over the phone..or...

Louisepug · Mar 9, 2004

Hi! I had the ablation done 4 years ago. I'm still here, it went fine, and was a breeze! :) I understand being scared though! If you want to pm me I'd be more than happy to talk to you about it. Louisepug

heart queen · Mar 9, 2004

Our facility does 10-20 of these daily... but it's different if your the patient and I recognize that! all the above advise is excellent. You'll be taken to a cath lab or EPS "suite", the doc will enter your groin with a 6 or 7 french cath, after numbing the site with lidocaine.

Are you nervous? heck yes, that's why you have an RN specifically assigned to you through the whole proceedure, who's job is to keep you comfortable. We use fentanyl and versed through an IV, conscious sedation. You won't be "knocked out", but few patients remember the proceedure, due to the versed, most if not all say it was not as bad as they expected.

Now assuming the doc, can ablate the irritable spots via the right groin, you're all set. 4 hr.s most bedrest, some facilities use a 10 lb. sandbag to the groin, others use an occlusive seal. If they ned to enter the left groin which is rare, you'll have two entry sites, and naturally, the docs, and staff are a bit more cautious with letting you sit at a 90 degree angle and walking around until they are sure that stable clots have formed in your femoral veins, and it is safe.

Now Worst case senario, the irritable focci is in you SA or AV node, and they must ablate there.... you'll need a pacer. This is very rare, but very real. You'll have 6 weeks of activity restrictions, not lifting more than 10 lbs, not lifting the affected arm higher than your shoulder, (the wires need time to adhere and heal to the myocardium, lifting up pulls at their insertion point).

But again, you are the patient, you can always refuse a pacer, but this will lead into a life of meds not only for rate controll, but anticoagulation for the obvious, as well as weekly and monthly lab work to monitor, not worth it in my book, just fix it!

Hope this helps, this is one of my areas of expertise, feel free to PM me at any time

unikuelady, RN · Mar 9, 2004

Dinith: The Doctor informed me that they had to place a catheter into all 4 chambers of her heart. That supposedly was the reason for using the arteries. The doctor also told me that they had a very difficult time finding all of the accessory pathways. He said they found extra trouble causing pathways in 3 of the 4 chanbers of her heart. As soon as they ablated 1 accessory pathway...another one showed up. He also informed me that she has 30+ pea sized scars from the ablation procedure in her right atrium and 20+ pea sized scars in her left atrium. It seemed like alot of scar tissue to be made in such a tiny heart. He also explained that she will have the 1st degree heart block for several months until the heart has a chance to repair itself. I was not a nurse at the time of her surgery....Otherwise I would have asked alot more questions regarding what was found and corrected. We only saw the MD 2 times....for pre-op and the day of surgery. We had to travel to a distant major medical center where they specialized in this procedure on children. Her follow-up was with our local cardiologist. As a side note. From age 8 to the day of the ablation my daughter was taking digoxin po. The MD stated that she was LUCKY to have had so many accessory pathways...because they did not find the WPW until half way through the procedure. Thats when he told us that Digoxin given to pts with WPW can cause sudden cardiac death. I'm just glad we all survived.

unikuelady, RN · Mar 9, 2004

Oh I forgot to tell you that they left the accessory pathway next to/on the SA node alone.

OCCHCanada · Mar 9, 2004

Thanks all for your input and experiences. This is a long awaited procedure, but I'm hoping to be medication free after its all said and done.

I'm tired of the lightheadedness, GI problems and hair-loss from the medications I've been on for the last 3 years.

The biggest bummer has been not being able to drink "beverages". I do miss my wine!