Ablation and Anesthetics - confused of Wiltshire

Hi, can anyone explain under what circumstances ablation procedures are performed under general anesthesia? I'm pretty sure I'm going to have the procedure recommended to sort out my WPW Syndrome and quite frankly, given the choice, I don't want to know anything about it therefore I want to have a general even if it means a longer recovery.

The information on the UK NHS Choices website is ambiguous - says it can be done under local or general and looking at the many ablation-related posts here it seems like that's very true but I'm not sure if that's a decision the patient has any part in making.

Thanks for looking... (sounds like an eBay ad - LOL!)

50 Replies

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  • ps - forgot to say that I'd normally ask my Cardio about this but I've still another three weeks to wait for our appointment!

  • Why not phone your cardiologists secretary to voice your concerns. I've had ablations with both sedation and GA and can understand why you want to be ' out of it' but really you are very well sedated and don't know a great deal about it.

    Sandra

  • I think it's a case by case thing and sometimes down to what the EP thinks is best.

    I had mine under GA due to a pre-existing back condition, there was no way I would be able to lie still flat on my back for 4.5 hours with just sedation . Any movement and they would have to stop the procedure.

    Waiting time was longer but it was without doubt the best choice for me. I woke up in agony with my back, the actual ablation didn't hurt a bit.

    You may be able to ask your consultant if you contact his secretary , I have done this before, but my EP is wonderful

  • Thanks Mikee69, I also have a weak back so I've got that to look forward to as well! Don't have an EP but I'll see if I can get a message to my Cardio (who may be an EP as well - are they mutually exclusive titles?)

  • good luck,

    An EP is a specialist cardiologist so could well be the same. I guess it's how they like to be addressed.

    My EP came and sat on the end of the bed when I had been in hospital for 10 days wondering what the heck was going on with me. He said " Hi, I'm Alex , I'm an electrician" he put me at ease within 10 minutes . I wish all Doctors could be like him

  • I had a GA for a RF ablation. I asked the EP why I would be having a GA. He replied that he wanted the anaethetist to look after me whilst he concentrated on the ablation ---------- because of my weight.

    Mmmmmm! I'm not that big! People tell me that I'm in proportion ( for a 6' tall woman )

  • "People tell me that I'm in proportion"

    And of course, you are I'm sure! :-)

  • I was told I would have GA, no choice but just as well because I have a fused spine and get uncomfortable lying flat on my back. Having said that I have had a couple of procedures under sedation and don't remember a thing.

  • Thanks Buffafly - I don't remember lots of things but its got nothing to do with anesthetic! :-)

    It's strange but I have a recollection that in the video on NHS choices which shows an Ablation being done under local, the patient is sitting upright - I'll have to go and look at it again... Told the memory is shot!

  • I was given a GA because if my long and complicated history of different heart problems and procedures.

  • Thanks wpw62. I'm assuming that you had wpw - has the ablation worked for you? Sounds like there's been other things going on so perhaps you don't know?

  • Yes I had WPW since an early age. Had extra pathway ablated and subsequently had first pacemaker fitted. this then led to atrial fibrillation. Has that ablated 2014. This then led to total hear block and had second pacemaker fitted 2016.

    I had had numerous ep studies,a ablutions failed and successful but these hurdles in life just make us stronge in determination to get on with things.

  • Well done - makes me feel quite humble and lucky not to have something as complex and ongoing as your conditions. Good luck!

  • Hi I also had sedation and a GA 10 days ago which I didnt want but had no choice but in hindsight it was the best decision and for me the recovery has been quicker no bruising either!

    Best wishes

    Ingrid

  • Thanks Ingrid - see my next post please!

  • Hi Ingrid, thanks for posting. I hope the ablation worked for you. Are you fully recovered from the op? The reason I ask is that I work for a school and it would be useful to know how long I'll be off from work. If its a significant amount of time I can see if I can get the ablation done in the summer holidays as I'm running out of sick pay!

  • I took three weeks off work for my ablation. Make sure you do absolutely nothing in your time off but rest. Good luck

  • If you can tolerate under sedation then I think it is better for your body than GA. I had one ablation under 4 hours of sedation. I was very aware of everything. There were aspects of the prep for that op and how comfortable I was during and the fact the consultant kept saying it was for flutter and NOT AF and then I went into AF at the point my head was wanting them to stop that I vowed never to have ablation again. When in the end I had a 2nd ablation I asked for a GA and there was no query about it. I would say for me personally I much preferred it under GA and after I was in less pain physically in chest area which is interesting or was it purely less stress on me because I was oblivious. There are many people who have this procedure under sedation several times and its very straight forward so if can tolerate it - its probably better but if you are mentally fighting that you can cope then GA is something you may be better considering and talking about with your consultant. I personally don't believe there would be any difference in your time off work after. I think I have read somewhere its typically recommended to take a week off.

  • Thanks Kate444 - Yup, I think its generally acknowledged that you should avoid GA if you can but I think the stress, even with sedation (thanks for that one Upsky!!!) of being semi-conscious during a long procedure would more than equal any negative effects of GA. I've started feeling shakey just thinking about it LOL!

    And a week? That's great in the context of having been off work for seven months - and that's just to get a diagnosis! I'll be having my say at the ballot box in a few weeks...

  • I'm not a wimp about operations and I tolerate a lot day to day but I think we all know what we can tolerate and even though we do cope often better with things when we push ourselves through them. Having said that I think I have got a good handle on what is good for my body and what would be detrimental so go with what sits right with you. If you have been off work for 7 months already then you will probably already be a bit worn out physically. There are many comments on this site about people returning to work 2 days after an ablation and saying I am for example 69 and breathless and in pain what is going on and I am amazed because my AF whilst not thought serious is seriously affecting me and turned my life upside down. I don't work. Clearly AF affects everyone totally differently is what I pick up on this site. When you said you worked for a school I didn't realise you had been off work - sorry. You will have to go with the flow on how long after before back to work. It might well be it will give you a new lease of life. Good Luck

  • Thanks! Well now I've been diagnosed, I'm hoping the DVLA will give me my license back (I'm a driver) as I'm being medicated with Bisoprolol to control my WPW (not that there was much to control quite frankly). There's no reason to keep it revoked so the plan is to go back to work asap while I'm waiting for an ablation. The time off has already transformed me - literally. I've lost 3 stone and have taken up running at the age of 62. Yup, I'm on my way to being Certified! :-)

  • Well done you - age 62 and not running and needing to loose weight you have my admiration. I was under the impression that bisoprolol wasn't helping me with that so clearly excuses on my part! Hope you get your license back I gave up driving a couple of years ago due to how I feel - just a sensible decision I knew I had to take. It's all sounding positive for you and that op will hopefully be the key and give you benefits.

  • Thanks Kate, good luck and I hope your problems resolve themselves.

  • Just be sure they remember to give sedation, I wasn't given any until the doctor spotted tears rolling down my cheeks and told the nurse to top my sedation up, which is when I knew someone had F****d up 😢

  • Jeez....! Thanks for posting Upsky - I think! :-( Glad you're still alive after that one.

  • I recently had a cryoablation under GA and if I had been working I think I would have needed two weeks off. I am 66 years old and retired. I guess it might be a shorter time the younger you are but as previously said by others everybody reacts differently especially to GA.

  • Thanks Nanabrodie, I hope it worked for you!

  • Just tell them you have a bad back and you want a GA. It's a cost thing. My EP does ablutions under GA privately but is not allowed to routinely with NHS

  • Ah! The mist is clearing - makes sense. Thanks Barb1!

  • I had a GA glad I did as it took almost 6 hrs

  • That's what I call getting your money's worth!

  • Lordy! I hope it was worth it! Thanks Mazza!

  • Yes he did a good job have had some runs but all have resolved EP wants to do touch up but I feel better so don't know what to do still on allmeds

  • I have had 2 ablations, 1 for AF, 1 for flutter, both under GA. I think it depends on your age and other health/heart related issues. AF ablations can take several hours, some patients just cannot tolerate being sedated that long. My AF took much longer than the one for flutter and the recovery time did too. Stayed over night only for the AF. All in all, pretty easy and quick recovery ( I am 57). Thought the TEE recovery was the most annoying to deal with after.

    Good luck with your procedure!

  • Thanks Chaben - TEE? Is that Transesophageal echocardiography?

    Sounds unpleasant!

  • Yes, that's what it stands for! Needed to make sure there are no clots in your heart before they do procedure. It was inserted after I was under so that was easy. It just leaves you raspy and sore!

  • Gosh! Something else to look forward to. The moral to this is "if you don't want the answers, don't ask the question!" Lol! :-)

  • Def ask for a GA for me recovery was quicker, I know under NHS in Northern Ireland you cant get one for an ablation but because I was private I got one 2nd time around 1st under sedation but didnt cope well, I still have the ectopics just hope they ease off the consultant says it just takes time so just have to be patient! As everyone on this site says we are all different and maybe for you recovery will be speedy I also have been off work for 7 months and want to get back for my sanity! Good luck and keep posting.

    Ingrid

  • I had a cryoablation three months ago under sedation. They topped me up with sedative twice during the procedure but I can honestly say I was awake the whole time and felt really scared. I was actually watching the procedure on the screen next to me. No-one explained what was happening and I could hear them talking about things 'not working properly' and 'might have to abandon it'. It was quite painful at times too. When they started to shock my heart I thought I was having a heart attack. I've since been told that they stimulate the phrenic nerve. I would never ever have another one under sedation although I know some people actually sleep through it. My EP told me later that there were technical difficulties during the procedure and it was the machine, not my heart, that wasn't working properly. For three weeks afterwards I was in afib and felt tired and breathless. Now I'm in nsr, off the amiodarone and hoping to come off all meds soon. Fingers crossed it will have been worth it.

  • Thanks for posting Hellie. That's a terrible story, poor you! Yours and some of the other posts I've seen about having ablation under sedation have made me pretty determined to insist on GA or I'll just forget about it and carry on medicating. They can't force you to do it.

    Hope you recover completely after going through all that!

  • I really hope I haven't put you off having the procedure because I can honestly say that I feel better now than I have for months. (Well years really). There's no gain without pain, as they say and how wonderful it would be to be afib free and drug free at long last. Just absorb as much info as you can and take with you the advice and support of the lovely people on this site.

  • It's OK Helli54, I've got an open mind and as you say, I'm in "data assimilation" mode at the mo' :-). But unlike most of the people who are on this Community, I had no idea I had a condition - apart from one incident that found me on the floor after a dizzy spell which my Cardio says could have been completely unrelated anyway. I think the term is that I am "asymptomatic" - who's a lucky boy! So, the temptation that I have is to say, "what the hell? I'll just carry on like I have been for the previous 61 years!". But I am pragmatic and I know I'm not getting any younger so I can't ignore it and now, since they stuffed me full of adenosine to diagnose the WPW I actually DO feel a bit peculiar, not helped by starting to take the Bisoprolol - which is supposed to control.... what? It's a funny old world!

  • You sound very similar to my big brother whose afib was diagnosed after a mild stroke twelve years ago. He takes warfarin and digoxin and is also asymptomatic, perhaps because his heart rate has always been on the slow side. He's as fit as a fiddle apart from the afib (which he is totally unaware of) and has never considered having an ablation. He's even got a much younger girlfriend so his heart is serving him well ha! Hmm now there's s thought....

  • LOL! Best not tell my missus! :-)

  • I'm in the States and had my ablation under general anesthesia. It was not even discussed as to whether I had a choice. I am very happy that it was GA and I wouldn't have it any other way. This is a somewhat long procedure and I can't imagine being up for it.

  • To add to that I wanted to say that I have a very healthy heart and no health conditions other than needing an ablation.

  • So what were they ablating you for?

  • Paroxysmal afib. What I meant was that other than an electrical problem, I have no blockages and a very strong heart muscle.

  • OK, I understand. Thanks Jomama.

  • Having seen my Cardiologist yesterday, I thought I ought to update this thread for future views and for those that have followed it. I will post a new thread which will duplicate some stuff but it will probably just get lost if I only post it here.

    Anyway, I cannot have general anesthetic for an ablation for WPW Syndrome because GA masks the signal from the secondary pathway (people with WPW have an additional electrical pathway in the heart) and they need that to be able to accurately locate it to perform the procedure. Apparently the ablation for WPW is a lot less complicated than other AF conditions (I'm still not sure even if WPW is classed as an AF condition) and would only take about 90 minutes.

    90 minutes conscious? I'd rather stick wasps up my bum! :-)

    However, we discussed the "do nothing" option which is basically "keep taking the tablets". I was expecting a very strong push towards the ablation procedure but didn't get it. Instead we had a very balanced conversation covering all the issues for and against each option. The case for ablation is lessened in my case as my symptoms were minimal in the first instance and my reaction to Bisoprolol is pretty undramatic as well. Had that been different, things might have been more black and white.

    So, I have to make a decision (nothing unexpected there) but knowing that I'll be awake (albeit heavily sedated) for the ablation doesn't do anything for me... and worth noting if do go down the "do nothing" route, I can always opt for ablation at a later date.

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