Hybrid Ablation

[johnMiosh]

I had the first stage of my ablation two weeks ago, cox maze but with endoscope access through chest. Some of the time early on I felt truly awful, so decided not to post until I had time to settle down and give a proper account (I didn't want to worry anyone about to have the procedure). I had a large amount of notes, which may be tedious to read, so the upshot is that I had a few drug incompatability issues and a return of AF after a couple of days that made me regret having the ablation. However, after two weeks, I am in NSR, feeling better than I have done for a year and already back to relatively normal levels of exercise. Second part, normal catheter ablation is due in about ten weeks. For anyone interested, these are the notes I made each day.

Ablation day – 1

Hospital admission. I met Ian, my cycling club secretary in the waiting room, he was in for a heart valve replacement. We were both excited and optimistic; to be honest, I think we cheered the ward up a little.

Ablation day.

I started at 5:30 with a shower and a weird pre-op energy drink; it tasted like lemonade with all the water removed. I was so excited and enthusiastic the theatre staff had to calm me down, but they decided to let me walk to the theatre. The pre-op reassurance was brilliant and there was no anxiety. I woke up four hours later to find one drain already removed and staff in discussion about whether to remove the other. I felt spectacularly well, but this may have been due to the morphine and or tramadol; I am not sure whether I had either of these but recall them being mentioned to me. Then again I may have been on morphine and/or tramodol, so I have no idea what was really being said to me at this point.

I was removed to recovery after the second drain was taken out and seemed to be making good progress, I stayed in NSR throughout. I was told to drink much more water as my catheter bag was filling slowly; I seemed to be drinking a lot already, but I complied. Looking at my stomach, I thought I was retaining water and wondered whether the catheter was working.

I did not sleep well as a woman in the bed opposite was having breathing problems; they decided she needed a CPAP mask, but she refused and complained loudly about it for the next 8 hours.

Ablation day +1.

My family visited at about 5p.m. They didn’t stay long as I kept falling asleep. The physiotherapists made me walk 10m.

I was taken back to the main ward in time for the evening meal. Two patients were well established, but a fourth was brought in; he was in a very poor state and his breathing kept me awake, largely because I wasn’t sure whether he was dying. In NSR all day.

Ablation day +2.

The pain was becoming a problem by the morning; I was asking for more painkillers and then a short while later the pain was getting worse again. Opioids were the problem, they were causing gastro-oesophageal reflux; they were numbing the pain around my muscles and heart, but creating another one ten times worse. It is now added to my medical record that I am allergic to Oxycodone.

I was allowed to walk by myself and have a shower. The catheter bag was filling heroically, but I was still feeling quite bloated.

I discovered my friend Ian had not survived his operation.

The other ward residents were another problem; the one next to me was complaining loudly to himself about everything, and the one opposite had a very spiteful conversation with the nurses who wanted to give his adjustable chair to the new patient. I went to bed at 8 p.m. to avoid having to talk to them. I was woken by the new patient who appeared to think he had been abducted and was demanding to see everyone from his wife to the police. The reflux kicked in and I had to spend the rest of the night propped up in a chair. I believe that this is the worst I have ever felt in my life and was regretting agreeing to the ablation

On the plus side I was in NSR all day.

Ablation day +3.

It occurred to me early on that I may not have been entirely fair with the other two patients and that my perception of their moaning may have also been partly my own grumpiness due to the circumstances of the previous day.

The reflux had calmed down a little and things seemed better looking out at the sunshine. The physiotherapists took me for a short walk around the ward, up and down a flight of stairs and decided that I was OK to release. I also seemed to have lost 4kg over the previous week. Four stitches and the catheter were removed and I was finally allowed to leave at 7 p.m. clutching a drug bag the size of a weekly shop:

Amiodarone for rhythm control

Bisoprolol for rate control

Lanzoprasole for acid reflux

Colchicine for myocarditis

Rivaroxaban for anticoagulant

Codiene and Paracetemol for pain relief.

I had been fed in the hospital, so pretty much went straight to bed after returning home. On reaching the bedroom, I had uncontrollable shivering until I got into bed. Too tired to sleep, so drifted in and out of sleep watching Steve Coogan and Rob Brydon’s Trip to Spain. Mrs JohnMIOSH slept with the daughter. In and out of AF throughout the day.

Ablation day +4.

I woke up after a few hours sleep, best sleep for days. Still with reflux, still no real appetite. Taking on board what the physiotherapists said, I went for a walk, half a mile around the block; this left me exhausted. I have no idea whether I was in AF or not.

Ablation day +5

Better and more sleep, but still with reflux problems. Ambitious trip to the newsagents; one and a half miles, shattered and breathing heavily but no real problems. Constipation no longer affecting me. I did not check my AF this day

Ablation day +6.

Went for a walk around the Linacre Valley with family and a borrowed dog. Two and a half miles over one and a half hours. Constipation definitely not a problem, in fact, quite the opposite later in the day. In and out of AF during the day.

Ablation day +7

My heart and battered chest feeling much better, Lanzoprasole starting to sort out the reflux problem. Two and a half mile walk around the local park. Later in the afternoon, constipation became a distant memory and am now well acquainted with every flaw in the silicon sealant around the bath. I can only assume all the opioids are now out of my system, as is literally everything else. I think NSR all day.

Ablation day +8

Diarrhoea still a problem, but it is now at regular intervals not constant, I was able to get out on a different two and a half mile loop around the Linacre valley. NSR all day

Ablation day +9

Woke up in AF. Diarrhoea all but eliminated, went for a three mile walk with my son and the borrowed dog, stopping for a heart friendly fried bacon sandwich on the way. Back in NSR in the afternoon

Ablation day +10

I am now starting to feel back to normal, still bruised, still with reflux but feeling much better. Solo four mile walk in the local woods. NSR all day.

Ablation day +11

Woke up in AF, but NSR after an hour and remained in NSR all day

Off to the doctors to have stitches removed; wounds clean, scar tissue forming nicely, nothing more to do. Discovered that I should have been told to stop the colchicine if I developed diarrhoea. Oh wellm OK now so may as well continue.

Called in to work and let them know I would be off for another week.

Overall, I walked a mile into town to the Doctors, then a mile around town on a fruitless hunt for a non-embarrassing hat (for sun protection, needed because of the amiodarone), then home, followed later to the shop and back for bread. So approximately four miles in total. I was allowed not to use the compression stockings any more. Appointment with doctor in two days to get sick note for second week.

Ablation day +12.

This was the first day with no reflux. I generally felt really good, and had a three mile walk, calling in on a friend. Remained in NSR all day

Ablation day +13.

This was the first night where I slept all the way through. Had a chat with doctor in the afternoon, OK to return to work on Monday 24th. Three mile walk, including a couple of light hills, maximum HR 120. Still feeling good remained in NSR all day

Ablation day +14.

Good night’s sleep again. Considering first post-op drive and gentle bike ride. Went to do the weekly shop with daughter, without problems. My bike ride was along the valley, deliberately avoiding all climbing. Average was 12.3 mph; last time I did a similar ride (with AF), the average was 10.7mph. The significant element of this ride was the HR, a maximum of only 119 instead of 145. Bruising remaining visible on the two largest entry points and still feeling bruised internally, but nothing particularly painful. Early days, but now considering the first op to be somewhat of a success; I feel really good, the brain fog and lethargy appears to have gone and I feel much better than I have for nearly a year.

Remained in NSR all day.

[CaroleF]

..... interesting account of your ups and downs, johnMiosh and I was so sorry to read about your friend, Ian. That must have been a blow.

It's particularly good to read an absolutely honest account of your experience too and great to learn that you are feeling so much better.

With all good wishes for your return to work tomorrow. Try not to overdo it!

[johnMiosh in reply to CaroleF]

Ian was a real shock, he was a great bloke and although we were a couple of bays up from me, I could hear him joking with the other patients as I was being taken to theatre. We had a plan for visiting each other in the ward afterwards. We knew he was expected to be in intensive care for a day after I was likely to be back in the ward, so I waited a while before asking the nurses for any news, but they knew nothing. I found out about it by email from another friend. His family was absolutely devastated.

[robin5]

I thought I would write about my experience as it might be a bit less worrying than yours. I had the first part of my hybrid ablation 18 months ago ( I was 63 at the time) and had very little of what you described. No catheter, no reflux, no bruising and very little pain. My blood pressure was very low and I felt awful the first night but was allowed home the following evening, I felt very weak for about two weeks but was okay by the first time that I had my first check up.

After the second part ( catheter ablation )I was kept in an extra night due to inverted T waves. I felt okay but they weren't keen on letting me go. I have since had various tests which show that everything is fine.

I have been in NSR since the first day. Hopefully you will remain in rhythm and will feel even better when you have had the second part!

[Rellim296]

Thank you for this interesting tale, but it is a sobering one with regard to your friend.

[jeanjeannie50]

Interesting to read your story, thank you for posting.

[Lastec1]

My have in NSR since the 2nd part of my Hybrid Abalation and that nearly 2 years ago.

[meadfoot]

Well done John, you could write a book, very thorough and informative, thanks. So pleased you are now feeling so well.

[Mazza23]

The reason you don't have constipation is the colchicine I had to stop it chemist told me it is now used for bad constipation I only took it for 3days spent the 3rd day. On the loo

[johnMiosh in reply to Mazza23]

I didn't realise it was the colchicine until I visited the surgery and by then i was over it so continued to take it. However, the effects were back yesterday, so I have decided to stop taking it today.

[Mazza23 in reply to johnMiosh]

My chemist told me when I picked up the script they gave it me to control Uric acid I have had gout

[johnMiosh in reply to Mazza23]

A friend of mine is a pharmacist, he used to dread his mother's gout flareups, because he knew what colchinine was going to do to her, but it was the only treatment.

[Mazza23]

They have now put me on allopurinol

[VeeT]

An interesting account of the first part of your ablation. Good luck with the second part. I'm impressed at how many miles you covered so soon afterwards. So sorry to hear about your friend

[Ktomoph_]

interesting to read full account of your first-stage hybrid ablation John! And so sorry to hear about your friend - and deeper impacted by both of you being in hospital at the same time.

Reason for delayed response is because I have was also in for my second stage of hybrid ablation. The first stage was pretty straight forward particularly compared to yours. Second stage was straightforward, apart from being allowed to get up 10 hours after the procedure where they go in through the artery in the groin(was more than a bit squeamish about this) - as I stood, I thought I was wetting myself, but the incision in the artery had reopened!

I was 'slung' unceremoniously back onto the bed as the nurse placed intense pressure to stop the flow whilst shouting for assistance. I was then strapped into a device that had a valve-pressure controlled ball placed on the incision area for 12 hours. This was the only real awful discomfort I felt, made more so by the fact I had to lay flat, still, legs straight for that time - difficult because being active, I find it hard to stay still...

[johnMiosh]

Thanks Ktomph, that doesn't sound fun.

Just had my six-week review. Everything OK, they are very happy with the ECG. As I reported a couple of periods of arrythmia, I will be invited back to the hospital for a 72 hour monitor in the next week or two, followed by a three-monthly review mid-July and catheter ablation mid-August. Still on Bisoprolol, Amiodarone, Rivaroxaban and Lansaprozole.