RF ablation of Atrial Tachycardia

 

EDIT: I added an image of the ablation sites in the gallery.

Friday was my RF ablation. When he came in I told him about an episode the night before after going upstairs and starting a bath that lasted for over ten minutes. He said he thought that sounded more like an AVNRT type of thing. While interrogating the device he says "3 ventricular high rate episodes, thats new for you!" The initial plan was to have me awake for the first half but was changed last minute and I was out for the whole thing. Not sure if the new episodes had to do with the change or not.

It's stated that I was "going in and out of ectopic atrial rhythm with a clear m shaped p wave in most of the limb leads." "Retrograde conduction of the AV node is present and concentric. With single extrastimuli, we were able to deduce the patient had dual AV nodal physiology with the AV node fast pathway ERP 600/360, slow pathway 600/340 and 400/360 from the left atrium. This was left alone for now. " 

They then turned to the atrial tachycardia. "Dense mapping revealed this was coming from the low lateral right atrium near the crista terminalis. Later fluroscopy showed this was near the heel of the ventricular lead." "Here a 50 watt protocol was used resulting in a flurry of SVT and elimination. This was readily present at the start of the case and was totally eliminated at the end despite 30 minutes of waiting." 

They then attempted high frequency stimulation along the posterior right atrium to look for vagal responses and maybe were able to achieve something in the posterior high right atrium and delivered a brief lesion. Because I was given dobutamine beforehand, they couldn't be sure how effective it was. 

I'll go back in 2 weeks to see him. I'm super curious to hear more from him about the procedure. Part of me is happy I was out the whole time and part was curious to experience it. I'm also somewhat anxious to hear his thoughts on the high ventricular rates. 

 

 

2 Comments

Lots of useful information - thank you

by Gemita - 2023-08-14 05:58:32

Mae11,

Thank you so much for sharing your experience of your ablation for Atrial Tachycardia.  You have received some useful feedback and you and we have learnt a lot from your procedure.  I hope you are recovering well and that your heart is quiet, although following an ablation, most of us can expect a healing period of up to six months, I believe, so don’t get dismayed if you have the odd run of tachycadia from time to time.  It doesn’t mean the ablation has failed.

I have had an EP Study, without ablation, and learnt a great deal from it too.  I was actually in Atrial Fibrillation throughout my study which they were unable to stop until they administered IV anti arrhythmic Flecainide.  I received sedation which knocked me out completely but it had no beneficial effect on the AF.

I hope your high ventricular rates will not be a cause for concern.  I have non sustained runs of VT.  Many of us do (especially healthy active members).  Non sustained VT can be fairly common as long as episodes end on their own and do not last more than 30 seconds.

Gemita

by Mae11 - 2023-08-14 10:03:34

Already, the sensation of my heartbeat does not feel so choppy and strange. I believe that the frequent back and forth between sinus rhythm and my ectopic atrial rhythm were causing some of the more constant symptoms I was experiencing.

Healing is going fairly well. I am quite sore and bruised in the groin area on both sides where they went in. It was noted that my veins are very small, so maybe that has to do with it. 

As for the ventricular high rate episodes, he didn't seem too concerned. But that was all he said and one of the last things I remember before being sedated. So we shall see..

Thank you for your thoughts and also sharing your experience. I'm excited and hopeful that we are beginning to turn a corner.

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