Ablation?

Hi,
Found out last week that another ablation attempt is in my near future (Dr. wanted to do it the next day...I walked out without scheduling). My last EP study never got to the ablation part because they couldn't induce the arythmeia for a long enough period of time to map it and fix it. It was an aweful experience and not one that I am looking forward to repeating. My question is what is the liklihood of it not working a second time?

Anybody had more than one not work?

18 Comments

ablations

by golden_snitch - 2009-11-23 01:11:36

Hi!

I have had several ablations, but never one that wasn't successfull in the sense that the arrhythmia couldn't be induced and mapped. Nevertheless, it happens.

What kind of arrhythmia do you have? I mean, if it isn't bothering you too much, then just leave it, or take meds. You could also take your time and get another opinion. Sounds a bit like the whole procedure was a nightmare for you, and it really doesn't have to be.

Ablations are a cure in many cases, technology is well advanced and procedures have become routine; I'm mostly pro ablations because in the long run the meds are worse for your body than the procedure and the little bit of heart tissue that is destroyed. Yes, it is irreversible (though for example parts of my ablated sinus node have grown back), but in most cases it really is a very, very small area, and the tissue that is destroyed won't affect the stregth of your heart muscle etc.

Best wishes
Inga

I had two ablations

by janetinak - 2009-11-23 02:11:11

as the 1st didn't completely work I had a 2nd a few months later & that worked & I am happy. But I certainly agree with the above comments. I was really miserable & waited two yrs & kept trying new meds. None worked & neither did 5 cardioversions so I did it.
I think if you can wait ,get a 2nd opinion & then really realize that it probably will be permanent esp if its an AV node ablation like I had. just get all the info you need.

Good luck,

Janet

arrhythmia

by justme - 2009-11-23 02:11:42


I have SVT. If it wasn't bothering me I would never have ended up at a cardiologist or having an ablation attempt. I pass out randomly and can't breathe, and am banned from driving, and can hardly function. The meds did work, but the side effects were aweful, made me like a zombie and I am not all about taking additional meds to combat side effects.
I trust my EP and know that he is the best in the region, but I just want to be prepared for how much of a possibility it is that it won't work this time.

???

by pete - 2009-11-23 03:11:50

Firstly you need a very good experienced EP to carry this out. Ablations are not without risk, for example burn through , burn out of something that your heart needs and of course failure. Failure is common and although it works long term for some, for others, the problem it is trying to cure returns with a vengence . Remember the doctor is being expected to perform a near miracle. Imagine trying to shoot a specific spot on a shaking coconut with a gun made of india rubber whilst wearing dark glasses in a room lit with a 10 watt bulb. Ive had an AV node ablation but that is the simplest type of ablation and only takes 20 minutes. The more comprehensive ablations take hours and leave the heart pretty much scarred. There is plenty of room for improvement in medical science. Cheers Peter

awake

by justme - 2009-11-23 04:11:38

am I the only one that was not put out for the EP study/ablation? MY EP said that with the type of arythmeia that I have sedation can mask the arythmeia so I was COMPLETELY awake and aware the whole time...shocks and all for the first attempt...otherwise I don't think I'd care about doing it again. I didn't get sedated until afterwards...I literally begged to be sedated about 3 hours into it to no avail. I'm going to ask to listen to my IPod during it this next time, because hearing everything and feeling it and being aware and experiencing the whole thing just really sucks.

Hi!

by tcrabtree85 - 2009-11-23 05:11:16

There are multiple people on here who have had multiple ablations. I have had three of them and have been awake for all of them talking throughout the entire thing. There are risks with any surgery but when you don't feel good and want to feel better then ya gotta do something to make you feel better. I wish you luck. I would say go for the surgery one more time. Sometimes they are able to detect things the second time a lot more. I wish you luck and if you have any questions feel free to private message me.

Tammy

I was puzzled when you said you were awake

by Ashregan - 2009-11-23 05:11:56

To the poster who was conscious during the procedure:

you know, before I had this ablation, I read about what it entailed at a lot of web sites, often sites for different medical centers, and I too saw that sometimes people are awake.

When I asked my doctor about it, he said I would be completely out for the whole thing and that he would use some technique or other to trigger the electrical reaction he wanted. When I asked him about what I had read concerning people being conscious for this procedure, he paused and stated that he would call that "unfortunate"---he's a very soft-spoken person--I don't know if he was not wanting to criticize another professional or what he meant by this exactly, but he definitely did not want me awake.

I only guessing but perhaps with another situation or another type of tachycardia it would have been different but he didn't mention that and he was quite clear that me being conscious was not something he was considering.

Marchlinski Ventricular Ablation

by mrag - 2009-11-23 10:11:25

Apparently Dr. Marchlinski has "written the book" on ventricular ablations. He does have a number of "fellows" studying under him. The doctor who did my Nips test was from Australia who came to Univ of Penn to "work under the world recognized expert" Dr. Marchlinski. He is very down to earth, nice guy. During the ablation procedure it seemed yet another research "fellow" was doing all the 'work' with Marchlinski in the director's booth or something. I kept asking while under sedation where he was only to hear he was in the room. As soon as the procedure was over, he was right there-whether he was doing the actual work or closely supervising it I don't know. He later showed up in my room with two assistants-he took his time, explained things with a style like I could have been Bill Clinton or David Letterman. I am sure there are other places that are "as good" however if it was my only daughter that needed such an ablation, there is only one doctor at one hospital that I would consider and that is regardless of where she lived (mine was a total 4 day hospital stay).

good experience with ablation

by Ashregan - 2009-11-23 10:11:34

After I got my pacemaker, it turned out that I had an area in the right ventricle that would take off and beat too high with exercise.

Happened within weeks of getting the pacemaker put in, and the thinking was that it had been there for some time, perhaps as the result of an unrecognize infection, but that with heart block (which I had had for a while) it wasn't expressed. Ergo, once the pacemaker was in place, connecting the atrium and the ventricle, that little area could go wild under the influence of adrenaline/exercise.

They talked about medication but I didn't like that option. So I asked the EP straight out if it was him, would he use medication or get the area ablated. He laughed and tried to be differential to medications of course but admitted that he would choose ablation as a first approach at least.

I did learn one thing: all EP's doing ablations are not created equal. I found out that only a few centers have the most advanced methods to detect the problem area although a lot of hospitals seem to be doing these procedures. I really asked around (other docs, detailmen) if my provider was the most capable.

I also found out that it matters where the area to be ablated is, vis a vis risk. Mine was way in the ventricle not near anything markedly crucial. I asked my EP about some of the stories I'd heard about wrong areas being injured etc, and he said that he'd heard about this too and he couldn't quite figure out how some of these things happen but I think the type of mapping equipment has some role in risk management.

During the procedure which took about 2 or 3 hours, I was out of it the whole time, I don't remember pain or shocks or anything really, except coming to, I was on the Michael Jackson drug (Propofol or something maybe) and I felt fine when I came to. I had to lay still for a couple of hours, stayed in the hospital overnight and went home the next day. No pain at all, much easier than the PM. Went to work in two days. And it seems to have worked, although he told me that if it didn't work to "kill" the area totallly the first time, sometimes a second or additional ablations are needed. That would be a drag of course, but nothing horrific based on my experience.

This EP has done many hundreds if not thousands of these procedures so I expect that may have something to do with my comfort level too.

Pete, I like your description

by ElectricFrank - 2009-11-23 11:11:18

I would only add one thing. While the amount of tissue destroyed is very small and shouldn't affect the heart muscle significantly, the real issue is that by its nature ablation is targeted at a nerve bundle. That does have the potential for serious side effects.

If they are successful at removing the tissue that is the source of the errant electrical activity all is well. If it happens to severe a nerve path in the heart a pacemaker can be used to route around it. The problem is that severed nerves have this bad habit of becoming irritated and generating new signals of their own. A familiar example is phantom nerve pain when a nerve in the spine is severed.

I'm not against ablations and agree that it is likely to be better than long term med use. I just think a person should know the risks(without minimizing them) as well as the benefits before making a decision. Then if it doesn't go as well as hoped you can accept that you made your best decision.

frank

Ventricular Ablation

by mrag - 2009-11-23 11:11:24

Had mine done in June this year, so far so good. Was on amiodarone as I had gotten 8 shocks in the past. Was in OR for about 6 hours, doctor said "looks good" we can stop the amiodarone. Felt like a new person. Had a NIPS done the following day and that went very well. I was warned beforehand there was a possibility, first try might not work.

The trick is to find the area to ablate when you cannot induce the arrhythmia. I live near Philadelphia and went of Univ of Penn Hospital. My EP (Marchlinski) apparently developed the method to find such areas. I'd highly recommend you go to the largest research university hospital and find the best EP there. As stated above, you need a real expert.

go for it!

by golden_snitch - 2009-11-23 11:11:49

If it's that bad, then go for another try. I mean, there is not really an alternative, is there? No one here can tell you for sure that the second attempt will work, but with a highly symptomatic SVT like yours, I would even go as far as saying: try again, and if it doesn't work, try for a third or even fourth time (some SVTs as for example ectopic atrial tachycardias can be very hard to find/map). BUT, you need a real expert for this. If I were you, I would go for another opinion if the second attempt fails, too.

Best wishes
Inga

Marchlinski

by Ashregan - 2009-11-23 12:11:10

mrag--

Dr. Marchlinski was the exact person I would have tried to go to if my current EP hadn't been able to correct the ventricle problem. I've been able to talk to a lot of people in the field and he's got a dynamic reputation in the cardiac community.

A reputation for expertise and also for thinking outside the box and for not being "ruled" in his recommendations by static standards of care---ie he's of course very familiar with standards of care but can also take into account the individual patient's needs and circumstances. At least that's what I've heard. I wasn't aware that he actually did the procedures anymore---the value of "young hands" directed by the master and all----but it sounds as if he did your ablation and with stellar results.

BTW I do see the value of working with new people starting out in their fields of interest in many spheres of life and of medicine---you get energy and the brightness of beginning and new thinking an dknowledge and so on---but when it's your heart, and an ablation that is not reversible particularly, it's just got to be someone who has lived and breathed cardiology and these procedures--- and with success---for a good period of time.

Anne

Ablations

by ElectricFrank - 2009-11-23 12:11:23

If they can't determine the location of the problem, then it is just a Las Vegas crap shoot to do an ablation.

Just keep in mind an ablation is just a procedure where heart tissue is deliberately destroyed in the hopes that things will be better. Even if the location is fairly well know, it must be done on a wildly beating heart and with no assurance that it won't make matters worse. To make matters worse it is not reversible. Just read the paperwork that you are asked to sign before it is done.

Having said that there is a legitimate place for ablations where an arrhythmia is bad enough or risky enough to be worth it. The problem is that ablations have become a routine procedure that is casually done.

Those who have had it done successfully are very happy with the outcome. Those who have had poor outcomes wish they hadn't jumped so soon.

That's my 2 cents.

frank

thanks

by Ashregan - 2009-11-24 01:11:42

Thanks Tammi

If I ever have to do another ablation--- especially if I somehow do end up planning to be awake for it, I may have questions which I'll send to you. Thanks,

But still don't quite get why some people are awake and others aren't. It wasn't like I was given a choice or anything. The doctor I use is very very good at answering my questions I have to say, I'd be surprised if he wanted me asleep just to keep me quiet but who knows? I definitely will clarify when I see him again.

Pain does absolutely nothing for me, if I can sleep through such events, that's my first choice barring any compelling reason to do otherwise!

Anne

I don't have the answer

by tcrabtree85 - 2009-11-24 02:11:06

Anne,
I don't have the answer to why some people are and some aren't. I thought it was just the fact it is a local sedation that some people don't fall asleep to that. You are numb and usually the medication does do the trick at least for me. I learned a lot more from being awake there are pros and cons.
I recommend that you don't stress about being awake or not. The likely hood is you have slept through them so far that you will from now on.
Take care of yourself.

Tammy

A question about Marchlinski and sedation

by Ashregan - 2009-11-24 09:11:27

I'm still curious when and why people are conscious during these ablations (I mean if I was ever in a position to consider getting this done this again, I'd REALLY like to sure about this).

To the poster who worked with Dr. Marchlinski, I notice you say you were "sedated" but apparently still conscious because you were asking where the doctor was.

Did you feel pain? Were there reasons given as to why you were not put completely out, I mean such as the particular kind of tachycardia, the location of the area, etc?

I just rechecked the web site for the hospital I was at and the procedure is described as having the patient completely under with a type of drug that gives a quick0-acting and rather shallow effect I guess. This was pretty much how the doctor explained the process to me too.

Any information on that subject? I'll really have to check this out with my doc on my next visit.

Awake

by tcrabtree85 - 2009-11-24 11:11:30

I have been awake for all three of my ablations and would not have it any other way. I appreciated being awake and knowing exactly what was being done. They tried to give me medication to put me to sleep but that does not work for me.
So after my first one and that not working I requested that they only give me it if I asked for it. Why have all that garbage that makes me throw up after in me if I was not going to fall asleep.
My second surgery I did feel it sometimes when they would be burning and yes it was painful but my great pain med nurse was my friend through the surgery I would just ask her for a little more drugs during those times and it would be fine.
So Ashregan the likely hood of you being awake is not very likely and Dr's do like you to be asleep b/c it can get annoying to them if you start asking them what they are doing. The nurses I have had are very awesome and will point out things to me.
I don't know if this helped you or not but if you have more questions you can private message me.

Tammy

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