My SVT ablation experience

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While it's fresh in my mind I though I'd give an overview of my experience. 

Let me just say that while I've heard plenty of people say it was a breeze, for me it was NOT a breeze at all. It sucked hard. But I would absolutely do it again. 

I was on the fence with this as my arrythmias were well controlled with metoprolol. I'd only had one episode while on it, and that was after foolishly smoking pot (pro tip: don't smoke pot if you have heart arrythmias). I got referred to an EP after a stress test ended with an SVT episode (had to stop metoprolo for it) and he suggested an ablation. While it might seem silly to go for it when things are well controlled, I still experienced a lot of PAC's and brief runs of tachycardia while on metoprolol and from what I've read this only tends to get worse over time. I made the decision to get it done before it was debilitating. 

My ordeal started with going off beta blockers cold turkey 3 days prior. This was HELL. While lots of people say this didn't trigger their arrhytmias, for me it did. My resting heart rate shot up (around 100), my blood pressure shot up (160 / 100) and I could induce tachycardia at a rate of 175 just by walking around. I spent a day just in bed because walking would set me off. It was miserable. But it also made my heart good and irritable and I knew my EP would have no problem inducting it. 

I arrived this morning and was totally freaking out. And I was delayed as the procedure before me took longer than expected. Scheduled to go in at 10:00 but didn't head back until 12:30. While getting wheeled into the cath lab I went into SVT so I had high hopes that it would be quick since it would be easy to identify. I got no sedation or anything prior to any of this. When I went back they put pads all over me, including shock pads to cardiovert if needed. I found this terrifying and my consent form listed possible cardioversion as something that might happen. The intake nurse told me this was quite common, though the lab nurse said it's very rare... They did assure me if they had to do it they'd fully knock me out first. 

Now on the table I got a very small hit of versed. It relaxed me slightly but didn't last too long. At this point they started to put my catheter in without saying anything. My heart was alternating between atrial bigeminy, atrial tach and random ectopic beats. The nurse at my head told me I was in atrial fibrillation which I thought was bad because I hadn't signed up for an afib ablation and I knew from my homework that they were riskier. 

At this point they started snaking wires up. No one ever told me anything. It was 100% terrifying. When my heart started to race or something hurt it was out of the blue with no warning. I had a guy at my head who was managing my sedation and was my hero, he would come over and put his hand on my shoulder when it would get bad and tell me everything was going according to plan.

Having to lay completely still with minimal sedation while my heart rate was getting paced to 225bpm and randomly going into various arrythmias really really sucked. Luckily they easily found the arrythmia and I was given some fentanyl and versed which was pleasant. At a few points I started to doze a bit but then they'd do something that woke me up. 

And let me say, yes you can feel the wires snake up. Or at least I could. It felt kinda like mild heartburn. Not bad but a pressure that let you know something was there. And the actual ablation. OUCH. I hurt A LOT even with fentanyl. And they never warned me when they did it though I quickly learned the sound of the machine firing up. They told me for some people it hurts and others barely notice it. Probably like how some people never feel ectopic beats but others feel every one. I'm in the feel everything with my heart camp. 

I was there for a long 3 hours. He easily found the source, but it turned out to be a focal point arrythmia on the tricuspid valve. Since it was on a moving heart valve this made it difficult to ablate and he had a real hard time. I honestly have no idea how they can ablate a moving valve... In the end he said they would stop beacuse it was too risky to do more. 

But at this point I was in sinus tachy at about 120bpm (which I attribute to beta blocker withdrawl rebound). The frequent PAC's were gone. The tachycardia was gone. Just normal, albiet fast, sinus rhythm. Amazing. 

When I spoke to him after he explained what he did and said that essentially, he couldn't really ablate it all as it was too risky, but he thinks he did enough damage that my attacks will be severely recduced and much shorter. Also as a bonus he said all the PAC's he saw originated from the same focal point so this should dramatically recued my premature beats. YES! He says he's pretty sure it's successful, as before he was easily able to induce tachycardia with Isoprenaline and without I was having frequent PAC's and runs of PACs, but after ablation he could no longer induce with Isoprenaline or pacing and the PACs were all gone. 

After that I got wheeled out to recover and had to lay flat for 2 hours. They then had me sit up for a while and then walk a bit. That was all fine but then I sat up some more and started feeling nauseous, tingly and hot and then my vision started going wonky. Hit the call button and they came in and lowered me down and took my blood pressure and it was 85/50. They kept me down and started some IV saline drip for a bit, then had me try again. Was fine for a while then started feeling hot and tingly and sure enough my BP was 90/65. So back down I went and got a full liter of saline. That seemed to do it and they said it if was due to something worst than dehydration and recovering from anesthesia there would be other troublesome signs. So far back at home no further problems!

I am back on metoprolol for now. Since the doctor couldn't ablate it all he says I'll likely want to stay on it especially since my blood pressure is on the high side. Luckily I tolerate it well so no big deal. 

So back at home and I feel pretty good. My groin hurts but is managable, sore to walk though. Ocassionally very slight chest pains when breathing deep or hiccuping or something but really almost unnoticable. So far no tachy, have had some isolated ectopic beats but they could be PVCs which obviously my atrial ablation will not fix. 

So yeah. I found the whole process scary and painful, but it was tolerable. And that's a lot from someone who is naturally anxious. If my results hold up I'd say it's 100% worth it. Honestly my biggest dissapointment was in my consultation when he said that an SVT ablation was unlikely to do anything for my premature beats, so I'm thrilled that the SVT source was also a major PAC source. 

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  • Posted

    Chadcf,

    Thank you so much for writing your experience. I have an ablation scheduled in July and I am very anxious about it. I hope you continue to do well. 

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    • Posted

      You're welcome! I realize it's not the most comforting or reassuring account, but I'm sure there are others out there like me who would prefer to have an honest assessment so they can mentally prepare for it rather than just hear "oh you'll be fine, you won't even remember it and will probably sleep through most of it" which is what the nurses all told me. And I will say that I am an extremely anxious person who has panic attacks from my arrythmias, but I did find this procedure tolerable. Very uncomfortable, but tolerable. They gave me just enough drugs to keep me from completely panicking, though not enough to keep me happy and unconcerned (it was certainly not the level of sedation I got for endoscopies for example). 

      But I do think it's worth doing, especially for SVT since it's about the safest thing to ablate (compared to other arrhytmias). Even if it didn't work I think I'd be glad I did it just for the knowledge of what type of arrythmia I had and that doctors saw all my hearts misfirings on a monitor and could confirm it was all ok (I've never had much luck catching my spells on a monitor), 

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  • Posted

    Also I'll note for a next day followup, I feel great today. I read lots of accounts of people saying they were exhausted and stuck in bed for a week. I feel perfectly fine. My groin is a little sore but not enough to stop me from being mobile. No chest discomfort, no fatigue, feel perfectly normal today. I am mostly sticking to bed as I was instructed not to spend prolonged amounts of time sitting or standing for the first 24 hours and I'm thoroughly bored, but overall recovery has been a piece of cake. 

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  • Posted

    Chad, I much appreciate your thorough, honest, and well presented report.  I, too, am deeply in the anxious camp, but you presented information that would have helped me successfully prepare for ablation. My first was not nearly as stressful as yours, but was not successful.  I'm scheduled for a redo in July, and am more than willing to withstand an experience such as yours with the hope of results you are now experincing.  Congratulations!   

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    • Posted

           Of course, Lola, and thanks for asking.  My doctor was expecting  one problem and 1.5 hours of work.  He found 2 bad pathways and spent 6 hours trying to fix them.  His biggest problem was the proximity of one to a nerve (phrenic) that's critically important to breathing.  He thought he was successful, and so did I (no problems for 2 months), but then my SVT returned, much more frequently than before.

        I feel nothing negative towards him, by the way. He's extremely capable, and my wife (a nurse practitioner) had fun relaying to me how excited my doctor was as he told her he thought he'd "fixed" such a challenging patient.

        Two years later, and after a few more Emergency Room visits (I can stop most of my SVTs with breathing  or body-positioning techniques),  I've arranged a redo on July 19.  Not nearly as optimistic as I was before the 1st, but hoping for help.

        Hope this info in some way helps.  Take care.

          

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    • Posted

      Thank you Gene. I wish your success on the 19th. Please keep us posted.

      Mine was unsuccessful a year ago. The Ep specialist thinks it was because of the anxiety meds I was on.  That just boggles my mind, as with all the thousands of ablations that are done, I am sure there were many many people of there taking some kind of anxiety medication.

      Coming off the beta blocker for that procedure was a nightmare. These doctors just say stop the beta blocker. You can not do that with out some side affects.

      I am in the process of weaning off the anxiety meds which are also a nightmare, but he will only attempt a 2nd procedure if I am free of these drugs. So I have been in process since March coming off and as I mentioned it has not been easy.

      My episodes seem to be coming more often. I just had one on Monday that lasted 70 minute.  Sometimes they are 2 minutes and others are hours.  I was told I had AVNRT 

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    • Posted

      Thank you, Lola.  I can relate too well to your challenges.  When I was told to stop my beta blocker before ablation, with no additional information, I thought my health care people were "nuts". My immediate reading gave me the solid medical reasons for that temporary withdrawal, plus assurance that I'd do OK without it.  Sure would have been nice to hear that first-hand.

      When my episodes are frequent and/or I can't stop one on my own, my SVT dominates my life.  Thus, I and others will deeply understand much of your experence.  I hope you and I will soon be able to write our "I'm fixed!" reports.  Take care. 

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    • Posted

      What a warm surprise, Lola.  I'm deeply impressed by your kindness.  I'll let you know how I fare as soon as I can.  My physician is expecting to be challenged, so she scheduled me as her last patient tomorrow.  I'm, therefore, expecting a long day.  Please take good care of yourself.  I'm confident that you'll soon have some good news about you for us. 

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