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AF Association
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Questions?

I was wondering if someone could help with a few questions?

My ep said that he couldn’t sedate me for ablation as sometimes it settles the heart and makes it hard to find the faulty pathway? Yet I read lots of people having a GA. Why can some people have sedation?

Also my ablation was to top left chamber of heart. Which surprised my ep as he told me before ablation he thought it was bottom right chamber of my heart? Are they so unsure and don’t know until they do ablation?

Also ep said he needed to use to of the sheaths into my groin that is why I was so sore? Is this normal?

I am just trying to work out if I should have another ablation. I really did not like being awake during procedure.

Also does anyone else feel like their hearts shake sometimes? Mine feels like it shakes from left to right.

After my ablation I posted that I was sleeping like a log ( I think It was because my heart was beating beautifully for about 9 weeks) but now back to pre ablation and sleeping terrible again.

So really trying to decide whether to try drugs again or ablation. The drugs gave me such bad side effects and the arrthymia would break thru the drugs anyway.

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Sending you a cart full of care and hope you heal 100% soon. I wish I had good advice but I will tell you that you were quite brave and you got through it ok. Many have mentioned groin soreness. Some people have had several ablations and most have said it was worth it I believe. And some have stuck with the drug route due to not being a candidate for surgery. Whatever your course, I do wish you well. But I think it is too soon to determine anything for sure- give it time to settle in.

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Quite a few hospitals use sedation because its cheaper and they simply cannot afford GA especially, when there is a cheaper option.

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I wasn’t sedated until they burned. And I went private here. Hence why I am not in a hurry for a 2nd ablation.

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That is because you need an aneasthatist for GA.

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Recovery is easier and quicker after sedation than from an anaesthetic. Ablation are generally day cases. I’ve never heard of side effects after sedation but have certainly experienced them with GA post op. Ablation is not an operation it is a procedure that is done in a Cath Lab. Sedation makes you forget what has happened , that is how it was explained to me. I find a bit of meditation breathing to start off with helps too. I would not think cost comes into it.

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You can have a GA on the NHS if you want, but your time on the waiting list will be longer.

My EP said he preferred the GA because the patient couldn’t move and with ablations sometimes lasting 6 hours, that was a big factor.

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I am in Australia I went private as the wait list is years via the public system. And I was not offered GA at all. Was strapped to the bed. Was very scary I felt like an experiment in a science lab 😳

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So sorry to hear that. Can't imagine being strapped down and not sedated. Hopefully you will not need that again.

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Rather puzzled by your EPs comments as PVI (pulmonary vein isolation ) which is what is normally called an ablation is always in the left atrium i.e. top left chamber. Bottom right chamber is right ventricle. Flutter is normally top right (right atrium) Nothing gets ablaated bottom left ventricle.

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I was ablated top left chamber of heart.

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Then you had a normal PVI type ablation. Do not understand what he was talking about to be honest. Makes no sense.

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He said at a pre appointment visit at his office a few months before ablation that he thought that my arrthymia was coming from my bottom right chamber off my heart. But when he went and done the ablation he said it was in a awkward spot in top left chamber of my heart. And he needed to use two sheaths thru groin to access? I am just trying to learn more about everything. As I like to be informed. As I had a operation a few years ago and was placed in icu due to my heart. I just feel confused.

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There is some general information on sedation and ablation here:

jstage.jst.go.jp/article/ci...

You only need to read the abstract. I think you would need to ask your EP for information about your specific circumstances.

On the question of ablation v meds, this, again, depends on factors which may be specific to you. The only thing I feel able to say, is that you should base your decision on all the available information which you would need to obtain from your EP.

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My first ablation (for SVT) was under sedation as the EP said they needed to ensure they could trigger the arrhythmia which could be difficult under a GA. I found it a horrid experience. After 4 hours the EP pulled the plug as I was too uncomfortable, despite the sedation and pain meds. He tried again 6 months later with a general anaesthetic as he said he’d discovered that my arrhythmias were easy to trigger (unfortunately they discovered many and diagnosed Multifocal Atrial Tachycardia). I’ve recently had a PVI and atrial flutter ablation under a GA as well. If you’re in Australia (I am too) and going private ask the EP about an anaesthetic. With my insurance I haven’t had any major gaps in costs.

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How terrible for you to be laying there 4 hours then he couldn’t ablate. I have hospital only cover and for the procedure and overnight stay I only had to pay $500 out of pocket. So was happy with that. I know it would be a lot more for a GA but I am willing to pay the extra instead of doing another sedation ablation.

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I’d rather be knocked out 😉

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I wore a ten lead monitor for a month which revealed what and where's. If needed, would do it same way despite inconvenience. By the time they're ready to burn something don't want them probing around in my heart figuring things out. Mildly sedated, no pain and home ten hrs later.

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As I read your post you say that you had no sedation at all. That must have been torture and the reason your EP gave for not giving it ridiculous. How experienced is he? To my mind sounds like you need another EP.

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Yes, I was just thinking the same thing! I would try to find out more info. Had an Ablation 3 weeks ago at Royal Brompton, I was quite anxious, talked it through with my EP, sedation meant that I didn’t know a thing , just relief that I got through it all.

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Only sedation at end when he found where to ablate. He said I was talking to him thru sedation I thought I was asleep.

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I told the professor that did my PVI that I loved him when I was under sedation

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How funny can you remember saying that you loved him.

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His Specialist Registrar took sadistic pleasure in recounting every ridiculous thing I had said during the procedure the following morning!

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Oh, that’s not very kind! GOK what I may have said then.......

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I was awake but mellow...would observe camera, close eyes, wake if I felt something...just enough to keep me still and calm.

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I said to Dr that I hated the thought of a local for the procedure..I freaked out enough for the cardioversion! So Dr was happy to do GA for me but advised that waiting time would be longer.

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Please go for second opinion and third if necessary I found EP are so different with their knowledge and experiences re ablation with due respect to all!

Hope you will get well soon

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For anyone with access to Royal Brompton in London, can highly recommend Dr Jonathen Clague as EP and his team! They were great with me & I was very anxious beforehand

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Sounds awful. I was awake for my 4-hour ablation because, said the surgeon, it's important for him to guage pain thresholds as a guide to how deeply n for how long he should work on this or that area. Worked well. The considerable pain was worth tolerating.

You arrhythmia returned so soon and to that extent? And there was confusion about which area was in need of attention? And you're having to consider another ablation/more medication options? With due respect you might consider different practitioners?

Good luck in getting it right and wishing on you the return of a peaceful chest cavity and unbroken sleep.

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Sounds like your EP is a sadist. I have never in all my years heard anything so stupid! And by the way EPs are not surgeons and it is a procedure not an operation as others have said rescently. Change your EP.

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I have strong contraindications for sedation or a GA as they could exacerbate a breathing crisis for me and as I am waiting for an AV node am also a little concerned. There are some underlying conditions which can emerge after having such experiences which may be related.

I am thinking of asking for hypnotherapy anaesthesia which used to be quite common in the area I lived in during the ‘70’s and ‘80’s. I wonder if you could also investigate that option if you decide to go for another ablation. My second ablation gave me 3 AF free years but the sedation drugs second time around made me very ill.

If your EP is so reluctant to repeat sedation he may be fearful of the outcomes so I would want the why’s and wherefores. I have to say I would much rather have had the AF than have had to suffer the consequences of the sedation - but that is a retrospective view on my personal circumstances and unfortunately we aren’t blessed with foresight.

It is so hard to know and there are no certaintities and therein lies the difficulty. Ask for more information.

Best wishes CD,

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Bob is right about the cost of a GA. My EP said he wanted an anaethetist to look after me while he concentrated on doing the ablation.

In Liverpool they use ultrasound to find the vein in your groin. I had no bruising at all.

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Wow no bruising? Mine was bruising was massive. And they placed 2 sheaths up thru groin.

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Ditto here , no bruising! To be fair, I had reminded my EP that I bruise very easily, my 1st angiogram 20 years ago, with the same EP had huge bruise across top of thigh, like a map of Africa

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I too could not be sedated. Mine issues started around 1997. All of a sudden my heart felt like it was shaking but yet every single time I went to a dr. It would not do it. I would have. 24 hr halter monitor on and it was as if it knew to stay silent. I had about 3 studies done on me through the years with no success. They kept saying It was stress or caffeine or both. Which could very well have been but I couldn’t understand why it wouldn’t show up. They had me on toporol for all those years plus something for anxiety. I moved out of the area in 2004 and saw a new dr. He implanted a loop recorder and was able to pick it up then had another study wide awake. I agree about it being very unpleasant. What they found on me was atrial tachycardia with ventricular pvc’s. I wish I knew why it only showed up without any sedation. Mine was short lived as well as those flutters came back but not quite as bad. I notice it more when I’m upset or if I have had soda or greasy foods. Sometimes when I’m in a rush to get somewhere it would do it as well. I think it all has to do with how your body reacts to stress and diet. Some people are more sensitive to it. I am still on medicine but this time bystolic. It doesn’t make me as tired as the toporol did. So while I wasn’t able to answer your questions to why you can’t have sedation during a P E study. I can tell you that your not alone as there are many of us like you. I always wondered if my issue was due to me having preeclampsia With my 3rd child about 3 years before the flutters started.

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I posted about preeclampsia a few months ago and the link to electrical heart issues later in life. I had it with both pregnancies (very severe with my first). I had no health issues until I was in my 50s when I had an injury and surgery and developed multiple arrhythmias. If you click on my profile you should be able to go back and read the article I shared and the discussion.

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Thank You for the info. I am 52 now but it first started about 20 yrs ago. About 3 years after the birth of my son. Which was when I had preeclampsia. I always wondered if it was due to that. Sounds like it is possible.

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I’d love to see a bit more research in this area.

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I had pre eclampsia with my first child too. With my 3rd child I had such high blood pressure was on 8 tablets a day until they decided to induce me at 36 weeks. So maybe there is a link between blood pressure and a fib.

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One of the top EPs recently said that you get better results with GA simply because you are totally still - he refuses to use sedation for that reason.

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I had a GA as I react badly to opioids and it was great - no problem with the groin either which I think was probably because I was lying so still. I think it may be a cost issue. I apparently went into AF as soon as he punched through to the left atrium and he found lots of areas to ablate.

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I agree with others - get a second opinion. This one sounds like he hadn’t a clue!

I had ablation 5 years ago under GA and no AF since then.

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Even with modern anaesthetic procedures a general anaesthetic adds a small but still significant additional risk

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I'm horrified to read the shortness of time you were sedated. Please, do not go back to that EP as the way you were treated doesn't sound right at all and must have been absolute torture! You must feel totally traumatised by the procedure!

It's still early days for you after your ablation and I would wait a bit longer to see how you get on. I've had two ablations under sedation and knew little about it. My third was under a general anaesthetic which is far better. Really feel for you.

Could you have a cardioversion to get your heart back in rhythm. No more ablations with that EP please.

Big hug.

Jean

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Could it be that you have had PVI ablation in the top of your left atria, and that the new issue is another source of rougue electrical signals coming from the bottom right of the left atria (rather than the bottom right of your heart)?

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I don’t know?

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Professor Peter Kistler in Melbourne did a brilliant job fixing my PAF

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With an ablation and general anaesthetic

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What is GA?

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General anaesthetic

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Of course...just woke n having coffee so brain slow..

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I was mildly sedated but awake during ablation of extra node causing SVT. All went well and went home ten hrs later. I was sleeping 12 - 18 hrs a day for almost a year which I thought was Sotalol 40 mg BID but guess the heart needed to heal....then in ER for diverticulitis 3rd episode. Guess what slows the heart slows all. If ever need another ablation I'd do it but have prep for colonoscopy first.

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