Looking around at various hospitals,it struck me just how much variation of proceedure there is. I wonder what drives this ,cost or getting through large lists?
Eg UHCW (Coventry) does no TOE,no pre proceedure stay, no overnight stay ( unless there is a problem) They only offer sedation no GA except in ' exceptional ' circumstances.
At busy periods they can also send you to a unit in the car park at Rugby St Cross!I'm sure it's all a decent set up but even so...
This is in complete contrast to the Royal Brompton and Harefield ,according to their fact sheet .
Interestingly,Brompton and Harefield also insist on two weeks on Warfarin prior to proceedure ,EVEN if you are usually on an NOAC. You can then return to usual afterwards.
Interesting I thought....
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And all the ablations I have had at RBHT have been under GA. They like an anaesthetist to be looking after you.
I do know that things change over time. My first I had to be anticoagulated for three months and then stop warfarin to be injected (self injected ouch) with heparin for five days whereas now you stay on warfarin throughout. TOE was only done if not anticoagulated when I had a DCCV there once and had stopped my warfarin.
I think as EPs learn more they may adapt their techniques as technology progresses.
As an example the last two occasions I had arterial lines in a wrist which I was unable to understand till last year they showed me that it was for an instantanious blood pressure monitor. I was also shown an electrode strip they put on my forehead to measure brain activity to ensure that I was still playing with the fairies and hadn't sneaked back. All very re-assuring.
Hi Dawn. I have just had ablation with sedation and it’s fine. I was hardly aware of the procedure and it was at least 2 hrs. You have to lie still for 6 hours afterwards. My op was late afternoon and my 6 hrs finished at 3am. I was able to walk fine at 4am for bathroom visit! I assume at Cov it would be a morning op. I know everyone is different but it may not be as bad as you think I would guess that after your 6 hours you would have something to eat etc. So although not staying overnight I doubt you will be staying less hours in hospital. I was out by 10am next day but felt good to go at 8am after breakfast/wash. The paperwork always takes a bit longer! Good luck with whatever you decide
Having had 3 ablations.....1 x GA and 2 x sedation I would just hate the set up you describe at Coventry.
I stayed overnight for all 3 and don't know how I would have coped without . I think the general idea now is to get patients in and out the same day if poss.
I'm on the waiting list yet again for a 4th ablation but will not be taking this up unless things really deteriorate. Certainly would not be happy having an ablation in a car park...
I've had three ablations all at Derriford Hospital in Plymouth. I live about 30 miles from it so for the first two I went in the night before the procedures (had my own en-suite room), these were carried out under sedation and the second one took 6 hours and the person due an ablation after me had his cancelled. After the procedures I was moved into the main ward.
The whole of the cardiology floor area was modern and scrupulously clean (I watched the cleaners).
For the third ablation I was told to be there early morning, which meant leaving home at the crack of dawn. When I arrived I was told I'd been expected an hour earlier, had my pre med quickly and then went straight to have the ablation. My EP and his Registrar had devised a new piece of equipment that went down my nose and to the outside of my heart to detect rogue pulses. I had a general anaesthetic which I far preferred to the sedation. This was my most successful ablation and although I still get AF and flutter, it's nowhere near as bad as it used to be.
After each ablation I spent the night following in hospital.
A few weeks before my first ablation, I had (cant think what it was actually called) perhaps a cardio MRI scan.
Can't remember what I did re my warfarin, probably just stayed on it.
Is it a mobile unit that's in the car park? That sounds very odd. Are you waiting to have an ablation at Eg UHCW (Coventry)?
I believe a TOE is only carried out if you haven't taken the required anticoagulant for a period of time..
My AF nurse once told me that if I was on one of the DOAC's I would have to switch to Warfarin for at least 4 weeks before having a cardioversion, but that was a few years ago.
Hi jean, I had TOE before all 3 of my ablations even though I had been on Warfarin for years with steady INR . Mind you this was 2009, 2011, 2013 so I dare say things have changed somewhat ! ( Rather sounds like it with the car park business...no thanks! 😕😨)
Mine were in the summers of 2011, 2013 and 2016. It was the 2016 one that made things a lot better, so my dates are not too dissimilar to yours and my last one was only three years after your 2013 one.
Do you have flutter now or is it AF again? My AF nurse says I'm in flutter and over the last 6 weeks I've had two ECG's that show that, but I know that my heartbeat is often erratic and I thought flutter was an even, but fast beat that stuck at a rate like 130 or 150 (it does for me).
Hope your heart behaves and you don't need the 4th ablation.
Hopefully your EP would have a good idea of the best place to have your ablation carried out. Though I guess if all the equipment needed is there and the EP is experienced, with a good ratio of successes that's what is more important than where it's sited. The portacabin could have all the very latest ablation equipment. So difficult to decide what to do, isn't it !
That's a good point Jean ! I shall take extensive list of questions ( again ) when I see Proff Osman or his colleague.Havent seen him in clinic for about 18 months
He probably sees my name on the list ,sighs and says "it's that bl**dy woman again ...always got a list of questions with her.."....and passes me on!
I don’t blame you researching all. How much choice is available to you ? One of the lovely ladies here had one in Wolverhampton recently , are you here today Och?
I’m due one this Friday, am booked in for GA & an overnight stay . Lucky me, I know & trust my EP & thankfully as I’m on Rivaroxaban, it’s only one day without it . I’m usually treated at the Royal Brompton, but this time they’re using Harley Street Clinic , but I’m told I have the same Team 🤞🙏❤️🙏
Just found your post- my ablation was done under sedation at New Cross hospital in Wolverhampton. I was told by my EP that he 'had to do more than he expected' what ever that meant.! Anyway, I understand that the procedure took a little over 5 hours. I can only remember looking at what seemed to be a wall of monitors, then drifting off . I have a degenerative lower back problem so was a bit worried about having to lie flat for so long, no problems there. They put a pillow under my knees to begin the procedure, I was totally relaxed and my back didn't hurt at all. I then just drifted off , glad to say I have no memory of anything else until I arrived back on the ward, all over and done with.
Initially I was to have an overnight stay following the procedure, but I had a little wobble afterwards so ended up staying in hospital a bit longer- 3 days in total.
I was commenced on Edoxaban a few weeks before the procedure and was told to continue taking the prescribed dose as normal, with no breaks at all.
I have no problem with differing procedures as long as I have a choice as to which one will suit me personally. In fact I think it a positive that there is difference. I had sedation both times, wouldn’t have a GA but had an anaesthetist beside me for pain and sedation control and ready to use a full GA the whole time, so best of both worlds. But I went privately although the EP & clinic where it was performed were doing ablations & other procedure on behalf of the NHS so there was absolutely no difference in procedure between the 2.
But that was 2013 and things have moved on.
I know some people find the ability to keep very still difficult, which is why some EP’s prefer GA which is totally understandable.
As to a/c’s - I wasn’t on any before the ablation but told to start Dabigatran and be on it for 2 weeks prior to the procedure (2013 it was the only NOAC then available).
Yes a few things bother me here,a) I don't have the choice of GA or sedation b) I have neck problems and would find it difficult to lie still for long I have told them this .c)if I ended up in the car park unit,it is quite a way off from the main block( and hence resus etc)
My Mg always flares in heat so not up to much to be honest. We are praying for some rain as the grass is now tinder and I’ve never seen leaf fall in August as we have here at this time of year so it’s obvious all the plants are very stressed, not just us!
I can understand your reluctance - is there anyone you can talk regarding choices and your concerns? I awoke from ablation with sedation to find a nurse pumping away on my chest, thankfully my heart stopped for only a few seconds but they had all the equipment on stand by so I assume they will have a protocol for emergencies. If you were aware of that would that help?
The neck problem - no getting away from that I’m afraid - either way GA or sedation you will need to be very still for the whole of the procedure but as far as I can remember, I could turn my neck slightly. I also have neck problems as result of car accident in 1992 and I think because of the sedation, I didn’t get any of my usual muscle spasms, least I don’t remember having them but it is 7 years ago.
Sorry to hear the heat is affecting you...it's quite unpleasant here.
I hope to speak to Proff Osman in October in clinic,but if I get a registrar again, think I may book a private appointment and really go through all my concerns.
Yes I think if I knew who would be present it would help reassure me
There is another hospital within 20 miles, Glenfield ,which seems to have a good reputation.. possibility of referral maybe?
Eeeek! I had my ablation at Harefield, no choice of sedation, and had to stop all my meds cold turkey the day before, including Rivaroxaban so the Warfarin thing must be new since 2015. Wasn’t impressed with cleanliness - someone left an open bedpan on the floor of the bathroom - and the Ward was in a prefab, no clue where Resus was but I would hope all units have a defibrillator? I had to stay in on-site accommodation overnight because there was no bed in the hospital and the procedure could still have been cancelled if there was an emergency meaning a 2 1/2 hour drive home again. But all turned out well in the end. Anyway my experience is totally out of date but just shows how difficult it is to have a good experience. Best wishes.
Up here in North of Scotland we have no alternative except to go to Aberdeen, for me that means a half hour car drive followed by a 3 hour train journey. All three of my ablation were done there under GA at my insistence as I have back and neck problems that make it impossible to lie still for any length of time. I had to stay over night before each ablation but not in hospital, I chose RedCross boarding house which is now closed down. Twice I was discharged after the procedure, same day. Once I stayed overnight again at Red Cross but the next one I got on a train and came home. The third time I insisted on staying in overnight and went home the following day. I have variously been asked to stop Rivaroxaban 2 days before, to continue taking it throughout and once told to take it right up to but not on day of procedure. Most confusing.
I had my ablation last year at the Brompton. I had to be there at6.30 am, and had my procedure at 10.00 ish. I only stopped apixaban that morning and Warfarin was never mentioned. It was done under a GA, and although I have severe arthritis it did not cause me any problems. The procedure took 4 hours, but the lying still afterwards was the most difficult because of my arthritis. I was tilted as soon as possible, and every care was taken to support my back and neck. I was back on apixaban that evening, stayed in overnight and went home early next morning.
I am likely to have an ablation at Guys. What is Mg and TOE.
Cardiologist said I would need to go on warfarin and I thought he said after the procedure. I would prefer GA. ( I know what that means). I worry that I am starting a rocky road by needing multiple ablations.
Mg = Myasthenia gravis an autoimmune disease which means both GA & sedation are incredibly risky for me. Heat (+25C, cold 5C or below exacerbated the condition.
TOE - Trans Oesophageal Echocardiogram.
So up & out early to the beach this morning for walk & paddle, forgot our togs this morning so early swim tomorrow & then sit beside the fan for the rest of the day!
Had mine at Hammersmith without GA. Was ruddy painful and they wondered why I was sweating so much ! Had no pre op . If i had it done again I would definately have GA.
Totally unrelated: Having listened last night to the album A=MH2, (for the first time in several years) I couldn't resist reading your post only because of the title. Variations on any theme always brings that music to mind. I have the vinyl LP somewhere, though sadly no record deck any more.
Interesting indeed. I'm expecting to be treated at Blackpool Victoria, but my procedure is deferred "until the pandemic situation is resolved". That might be several years away yet.
I'm under UHCW and waiting for cardioversion number 3 in a couple of weeks and also on the ablation list. I thought that UHCW is a cardiac centre of excellence? I certainly would not be going in a portacabin at St Cross. Where can you look up the information you have? I have to say Dr Yousef has been excellent so far but would be interested in seeing what other units do.
Proff Osman told me about the unit ,when we discussed the length of waiting list.Its also on the hospital website on the cardiac bit.Refers to the " mobile cathlab" at St Cross.
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