Long awaited ablation not quite to plan

[Surreyhunni]

After over 13 month wait I finally went for my cryo ablation on Friday. Whilst being prepped the Dr came in and said "you know what you are having done an ablation?" I said "yes a cryoablation" he responded oh a cryoablation??? I said yes! that is what my consultant said is the best option for me with the highest success rate for my PAF .... he said oh! well we shall have to see what time we have! To which I responded well if you are not going to do the cryoablation then I don't want anything done today. I had opted for a GA as I was too scared to just be sedated.

They carried on with the prepping and walked me down to the cath lab and sat me outside .... me still unsure of what was going on but determined not to go ahead unless I got what I came for .... after about 5 minutes they called me in and I made sure it was indeed the cryoablation that was to be done. I was reassured.

However it didn't all go smoothly ... firstly they had trouble getting the breathing tube down my throat .... I was told there was an obstruction ..... no other information than that. I've had 6 other operations and this has never been mentioned, should I be worried? My throat paying the price now.

Also during the ablation apparently my phrenic nerve isn't where most peoples is and was too near one of the PV's so they wouldn't ablate it, saying it was too risky as it may paralyse the nerve. However they did the other 3 pv's. We are just hoping it isnt the one they couldn't do that was why I have the PAF. Time will tell.

I'm just wondering if anyone else has been met with the strange situation of going in to have one type of ablation but being told they were going to do another? It seemed very strange to me.

I only wanted this procedure once (hopefully) and so surely it made sense to do the one with the highest success rate for my type of PAF and also the one recommended by the consultant? Thankfully that is what I got but had I not stood my ground as some might not, then it may end up costing the NHS more long term. In time and money!

I cannot fault the staff or professionalism and so far so good with the outcome. I know still very early days but my groin wound is hardly noticeable, not at all painful. Hardly any bruising and although the expected tiredness and breathlessness, I couldn't be better at this stage.

[BobD Volunteer]

I think it important that you understand why Cryo ablation was your favoured option. It is not necessarily the best option for everybody BUT is can be very effective if the rogue impulses are ONLY coming from the four pulmonary veins. It can not address other areas in the atrium which may be firing off so has its limitations.

RF ablation has by far the most flexibility in that respect and many who have a primary Cryo ablation need a touch up RF ablation to tidy up any extra areas.

The most important point is that cryo ablation is a much quicker procedure than RF and most EPs can do two in the time taken for one RF which is why since cryo became more universally available more and more people have cryo the first time. It is not always the most appropriate as you found out since people's physiology is often "different" making it unsuitable . Sadly this is not always known till the procedure is under way.

The good thing about cryo and the reason that you thought it best is that because the burn is made by extreme cold using a small balloon, that burn is usually more complete within the entrance to the PVs than a ring of dots made by RF .As the old song goes, "It ain't necessarily so".

Sorry but I can't offer any insight into the intubation problem.

[MarkS]

Bob's given a very good reply. I had a combined RF and cryo ablation. A balloon was used on 3 PV's but the 4th was too large and the balloon would have gone in too far so they used RF on that. They also used RF around the ligament of marshal which is a frequent cause of AF. I've been AF free since.

[Vony in reply to MarkS]

Wow. That sounds great

[CDreamer]

I think Bob has given a comprehensive explanation of why you cannot insist on having one type of ablation over another.

In my case I could never have a cryoablation because of the physiology of my PV - I have one enormous one and only 2 others. This can be quite common and doesn't always show up on scans so was only discovered once catheter was inserted and mapping completed. All procedures need to be adaptable for the unforeseen circumstances such as you describe.

As a matter of interest why were you so fixed on only cryo-ablation? And was the explanation Bob has offered not explained to you prior to the procedure?

Be very, very glad that you have not had a damaged phrenic nerve.

Sounds as though you had an excellent team.

I had a TOE get stuck in my ablation which left me with sore throats for some time and a dry cough. It happened because my eosophagus spasmed. Very I uncomfortable I agree. I was sedated but remember nothing about it.

I do hope that despite the set backs you have the desired outcome. Now rest for healing and recovery.

Best wishes CD.

[Surreyhunni in reply to CDreamer]

Hi CD

Thank you for your response, in answer to your question ....

I was fixed on the cryo because my EP had said it was the best procedure for me at my consultation. He explained why and also said it had the highest success rate as opposed to heat ablation for one time ablation. I then did my own research and thoroughly agreed. I understand there is no guarantee. On my letter prior to admission it said I was going to have the cryo. It turned out the Drs doing the procedure wasn't my EP but from his team. The Dr was very surprised when I said I was having cryo and at first responded with well we shall have to see what time we have! If cryo is quicker than heat ablation why would that make a difference, it would give them more time for others? I wanted the best chance of only having the procedure done once. I was very anxious and not being sure which it was to be right up to the point of going in the cath lab made me much more so.

[Icenae]

I had an ablation (3rd) last year. Dont know which method ??? But afterward I had difficulty swallowing anything, had a scan and they found a large haematoma caused by the tT O E.

Very painful. Took weeks to heal.

At least I lost weight 🙂

[Surreyhunni in reply to Icenae]

Dr said the TOE made things more restricted and further damaged me but if I am still coughing up blood after two weeks to consult my gp. I have a very painful stabbing pain in my back just under my shoulder blade every time I swallow anything, even water. I guess this is the area that needs to heal and I just give it time. Who knows I may even have the advantage of losing weight like you

[Hidden]

My only comment is to offer my understanding of the fact that you did not have the 'best possible preparation' for the procedure! I know what that is like. I have a problem in my last ablation with the tube but different to yours. I hope your recovery goes well it sounds promising.

[Kjab]

I too had a cryoablation last July. But I'm curious if anyone else had to have a Cardiac CT Scan prior to it. My EP had me do one and I had to bring it to the hospital the morning of my procedure. I assumed it was for the EP to look at when he went into my heart to see what he was going to do.