Ablation procedures and anesthetic

[Tractorman]

This is really just an update on my "Confused of Wiltshire" post but I though it might be worth a new one for those who never saw the original - which was me basically asking whether you get a choice of having general anesthetic or not for ab ablation procedure.

Having seen my Cardiologist yesterday I am now clear - 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.

[jeanjeannie50]

Having had two ablations under sedation and one with GA I feel I can comment here.

With sedation you are 'out away with the fairies' and mostly totally unaware of what is going on. As soon as I started to become aware, sedation was increased and I'd drift off again. These ablations under sedation lasted about 4-5 hours each. So, honestly, one lasting only 90 minutes would be a complete doddle!

My last ablation in July 2016 under GA lasted for the same hours and I knew nothing about the whole process and my recovery was a lot better, but then that may have been because the procedure was more successful. Certainly I preferred the GA, but in your case if your condition became worse I'd say go with sedation as you'll still not be aware of what's being done.

Best wishes

Jean

[Tractorman in reply to jeanjeannie50]

Thanks Jean - I can't think of anyone who IS more qualified to comment than you!

[jeanjeannie50 in reply to Tractorman]

Potty Pete is, he's had about 5 or 6 ablations.

[Tractorman in reply to jeanjeannie50]

That's not a contest I'd want to win!

[BobD Volunteer]

Well one has to live with the decisions one makes and you seem to have weighted it up so well done you. My understanding of WPW is that atrial signals can by-pass the AV node and directly affect the ventricle. Like you I'm not actually sure that WPW is AF although the two often go hand in hand.

[Tractorman in reply to BobD]

"atrial signals can by-pass the AV node and directly affect the ventricle."

You are correct Bob and the Cardio' did cover that possibility as if it did occur it would most likely be apocalyptic. He countered that statement with the fact that I would have to be extremely unlucky for that to happen. It's a bit like the line in the "Dirty Harry" films - "You have to ask yourself - Do I feel lucky today?"

The answer is, yes mostly - but never take anything for granted!

[Hidden]

I had two ablation under sedation lasting 4+ hours each and one under GA. I can assure you that you will be given sufficient sedation to relax you and painkillers are topped up as necessary. Nowhere near as bad as I had envisaged and I have quite a vivid imagination.

I found GA took quite a bit of recovery although it was nice to be out of it. It would not bother me to have a further ablation under sedation.

Sandra

[Tractorman in reply to Hidden]

Thanks Sandra. Your comments, as ever, are appreciated!

[pottypete1]

In answer to Jean's comment she is right I have now had 6 ablations and I am now teed up for a 7th.

Having had the first 3 under sedation and 3 under GA, GA is for me every time. For me the sedation became less and less effective hence their change of emphasis.

As you cannot have GA because of your type of rhythm you have no choice but accept sedation, however, as I always say, we are all so different and for most sedation is totally acceptable and effective.

You will read no end of posts where others on our forum have had no issue with it. I too have had numerous procedures with sedation that were totally successful it just seemed that the longer the ablation process went on the less effective it was for me in those circumstances.

I hope this is helpful and wish all the best for your procedure when it happens.

Pete

[Tractorman in reply to pottypete1]

Thanks Pete. You ARE the Head Honcho of Ablation. I'm not worthy!

LOL!

[pottypete1 in reply to Tractorman]

Not the accolade I sought but somebody has to do it.

Pete

[Tractorman]

Wow, they must have given you the good stuff!

[Upsky]

Wfw once ablated is no longer anything. Like having a wort removed it's gone never to return no longer a heart patient or needing to be medically recorded.

For me fully conscious no sedation ablation was horrific, (perhaps there's a claim in that mistake somewhere 😜) but I'm still begging for ablation over life long drug use.

Weigh it up, 90 minutes of what I am now told isn't horrific torture or a life time of risky drugs, hmmm no brainier for me x

[Tractorman in reply to Upsky]

Yup, I can't fault the logic. Emotions are rarely logical though!

[Hidden]

I can totally understand you decision and whilst the procedure might well be better than you expected or even at another time you will feel able to try it you have to go with your gut on these things. I had Ablation for flutter and I said never again. It was supposed to be for 2 hours. The consultant made a point of telling me it was only for flutter and not AF. I did not find my sedation was anything like what has been described above. I had 5 lots of morphine given. I was wanting to say to the doctor stop (and I am not a wimp) when I went into AF and in the end the op was 4 hours. I swore never to do it again but did have one under GA earlier this year. Its now 5 months down the line - had 2 lots of AF and now off flecanide and blood thinner my body is back misbehaving ie not in AF but lots and lots of horrible symptoms which I suspect are the build up to me going full circle back to AF and drugs again. It's hard to decided that is right or wrong for each of us. Ii think we put ourselves under pressure thinking that a procedure will be a cure or will make things better and there is a lot to be said for listening to your gut and doing what is best for you. I'm glad you feel you had a good conversation and I understand your decision.

[Tractorman in reply to Hidden]

Thanks for posting Kate and I'm sorry you had such a rotten experience - moreso that it doesn't seemed to have helped. Lets hope you're wrong about going back into AF...

As for me, I'm not saying "never" and it may be that the DVLA will insist I have ablation before they give me my licence back. I live in a village with only two buses a day in each direction and they only go to market towns. Real civilisation is very difficult to get to round here!

Good luck and thanks for your input.

[Hidden in reply to Tractorman]

I was told to stop driving the first time I had the problem. I was 300 miles from home at the time so I had to get a friend to come down to me on the train and drive me home! I was then able to drive but when I got worse again gave up myself. Just my own decision but sensible one. Now everything comes to my house. I thought I had a lot of patience before AF but it certainly teaches you more. Good Luck

[Momytrout]

90 minutes you can do it. I was awake for 6 hours

[Tractorman in reply to Momytrout]

!