Ablation under sedation? Had really bad ex... - AF Association

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Ablation under sedation? Had really bad experience with pacemaker insertion and sedation.

CONNY45 profile image

Can anybody let me know how they fared under ablation with sedation? The first ablation was done under general anesthetic, but now the second ablation is planned under sedation. The insertion of a dual-chamber pacemaker under sedation a year ago has left me pretty shaken and I am very apprehensive about the next procedure in three weeks' time!

47 Replies
BobD profile image
BobDVolunteer

Apart from DCCVs all my procedures have been under GA so I share you concern. Why not speak to the team concerned and explain your anxiety. I'm guessing that you will be having cryo ablation as RF is mostly done under GA? Seems odd though to have two cryo.

CONNY45 profile image
CONNY45 in reply to BobD

No, Bob, the first one was a 3 1/2 hour do under general anesthetic, not a cryo. This second one, not a cryo one either, is supposed to be a ""mob" up, which will not take as long. I did mention to the specialist my apprehension and problems that I had with the pacemaker insertion ( done by another specialist). He did say I would be asleep, but that is what they told me for the dual-chamber pacemaker insertion, and boy I was awake pretty well awake all of the whole procedure.

I've had 3 ablations, all Radio Frequency. The first 2 were under sedation and the 3rd, 8 years ago was under GA. On balance I would probably prefer sedation. I felt truly awful after GA and so took longer to recover. I too have a further ablation planned for 3 weeks time ( should have been last week but was cancelled...) and this will be RF under sedation. We will have to compare notes !

I understand that pacemaker insertion can be particularly uncomfortable with all the pulling about so don't compare the two.

CONNY45 profile image
CONNY45 in reply to Jalia

Jalia, were you conscious during the sedation? I could feel, see and hear everything that was going on during the pacemaker procedure!!!

Jalia profile image
Jalia in reply to CONNY45

I had sufficient sedation so that I was drifting in and out of consciousness. I was able to indicate when it got uncomfortable and they gave me a bit more painkiller. Both of the sedated ablations lasted 3 -4 hours but time went very quickly so I must have spent quite some time in the land of nod !

CONNY45 profile image
CONNY45 in reply to Jalia

Thank you Jalia, hopefully, I will be drifting in and out of consciousness this time.

CDreamer profile image
CDreamer in reply to CONNY45

How did it worry you that you were awake? Did you have pain or just not want to know anything about it?

I quite liked being aware of what was happening & had a good chat to the Physiologist who did the pacing checks.

CONNY45 profile image
CONNY45 in reply to Jalia

I was only given 1 valium tablet one hour before the pacemaker procedure.

Jalia profile image
Jalia in reply to CONNY45

I see that you are in Australia but I would think that procedures are similar and you would be offered more than a Vaium ! Maybe one of our Aussie members can reassure you?

CDreamer profile image
CDreamer in reply to CONNY45

Sedation here would be via IV & your consciousness state monitored by a anaesthetist. Often, to keep costs down, an anaesthetist is not requested so an oral tablet is all you may be offered. Discuss with the team doing your procedure prior to the ablation & say you don’t want to be conscious.

Jalia profile image
Jalia in reply to CDreamer

I hope I'll be offered more than a tablet...😱

I'll soon find out.....

CDreamer profile image
CDreamer in reply to Jalia

Discuss with your medical team prior to your admission.

Jalia profile image
Jalia in reply to CDreamer

Thanks CD . Have just contacted very helpful arrhythmia nurse who is investigating and getting back to me. She thinks I would be GA.

CDreamer profile image
CDreamer in reply to Jalia

Hope that’s put your mind at rest.

CONNY45 profile image
CONNY45 in reply to CDreamer

That is what I told the pacemaker team before the procedure, but it did not make any difference, and one valium had to suffice. There was no IV and no anaethetist. This time a different private Hospital, maybe more luck!

CDreamer profile image
CDreamer in reply to CONNY45

That’s usual for a PM insertion but not for an ablation.

CONNY45 profile image
CONNY45 in reply to CDreamer

That is what I told the pacemaker team, but no notice was taken. One valium had to suffice. There was no IV and no anesthetist present. This time a different private Hospital, so I hope for more luck!

I avoided all sedation & just had local anaesthesia & IV Paracetamol for the PM implant & revision - which was uncomfortable but tolerable.

I am surprised you had sedation for PM implant as I was told it would under a local anaesthesia only - then in Cath Lab I was offered it ‘if you are very nervous’ but declined as did my husband.

I had sedation for 2 ablations and don’t remember much but suffered after affects of the sedation. I struggle with both GA & Sedation so avoid both. I use advanced relaxation & breathing techniques to put myself in a very relaxed state.

Jalia profile image
Jalia in reply to CDreamer

I think you are a 'one off ' CD !! 😀😁

CDreamer profile image
CDreamer in reply to Jalia

I don’t think so. Sedation for me is FAR scarier, given the consequences to me.

I had 3 by sedation but as I had a particularly difficult time on the last one they subsequently used GA for the 4 subsequent procedures.

I maybe classed as a woos but I did not find the experience with Sedation either interesting nor did I want to engage in conversation during the procedure.

We are all different of course so this too must be borne in mind.

I had a letter today from my EP once again threatening me with a pacemaker which I have resisted so far. Should the inevitable happen I am not quite sure how I will cope with being wide awake during that procedure.

Pete

CDreamer profile image
CDreamer in reply to pottypete1

It’s less invasive in some ways than ablation, even though there is a wound. Everyone has different pain threshold, the implant I didn’t feel much - sensations of pushing & pulling that’s all. The revision was different as they had to remove the PM to replace the wires & by the end fo 3 hours I could feel quite a lot as the local wore off but not the worse pain I’ve ever experienced - that was shoulder dislocation and you do need to keep calm & very still. Everything is tented so you don’t see anything or what they’re doing other than the monitors which guide the catheters which place the wires. It’s a day procedure- I think if you insist on sedation you may need a longer stay.

The gains of improved QOL make it so worth an hour’s discomfort but it’s about getting your mind in right place.

We do all handle things differently.

Like you my pacemaker insertion was prob the worst thing I’ve ever felt in hospital,I was in agony getting it done even letting them know I could feel everything,which felt to me like someone was using a power tool to cut me opened , they did give me local jags all over that area but didn’t seem to help ,that was in January ,,however I’ve had ablation under light sedation and found that no problem at all ,even stents fitted the same way was not an issue ,,, they will give you something to help if you ask ,,good luck

CONNY45 profile image
CONNY45 in reply to Truckerclark

Thank you. Sorry to hear you had the same problem during the fitting of your pacemaker. This time a different private Hospital and specialist. Maybe more luck.

Truckerclark profile image
Truckerclark in reply to CONNY45

All the best

I have had a PVI cryoablation and an RF flutter ablation under IV sedation . At both I could ask to increase if necessary. It was not. The pain on the cryo is not felt in the chest, it is like the brain freeze you get biting into a very cold ice cream on a hot day. It lasts a bit longer and there are four separate freezes for the 4 veins. Its not a problem. Like others i found it interesting, esp watching on the screen.

The RF was a bit more painful bit not much This prcedure was in my right atria, again the pain is not on the chest but my right shoulder. I have had worse at the dentist.

The groin entry site was a local. I felt nothing. The catheter was in my heart before I knew they had started the procedure on the cryo!

I was out of hospital the same day for both which is also good.

Dont worry. Relax both now and during the procedure. Best wishes.

CONNY45 profile image
CONNY45 in reply to KMRobbo

Thank you for your reassurance. Now it is just a wait and see. After a very bad , first experience with the pacemaker, I am still trying to convince myself that this one is going to be a walk in the park.

I have a huge fear of GA so had my first ablation under sedation it took a long time 4 hrs and it was actually really interesting but also a bit unsettling and uncomfortable. For a cardioinversion between ablations I was told I must have GA my I spoke with the EP and the anaesthetist and explained I was terrified of GA ( childhood dental work under GA) They really reassured me so I had a short GA and inversion without any discomfort at all

After that ablation 2 was under GA and if I need number 3 that will be too, I’m sure if you ask they will offer that option, but if not and they sedate you it is not an awful experience by a long chalk

Good luck and try not to worry dentistry is worse

Steve

Gosh I am a bit scared now after seeing these comments I am having a pacemaker in 4 weeks then ablate. Has anyone had any ok experiences? please

ETFCfan profile image
ETFCfan in reply to Canada01

Hello, I’m 6 days post Pacemaker insertion and waiting for ablation in August. I was wide awake with just local anaesthetic. It was very uncomfortable just the shoulder part with pushing and pulling but not too bad. Mine took 90 mins and towards the end I started feeling more and told them and immediately they gave me more local anaesthetic. Don’t be afraid of asking for more and don’t put up with the pain, First two days my shoulder was very painful but it’s got so much better the last few days that I hardly feel it, Please don’t worry and hope it goes well for you.Ive had 3 ablations under G.A. and felt much better than when I had them.

Canada01 profile image
Canada01 in reply to ETFCfan

Thank u for this 🙂

dedeottie profile image
dedeottie in reply to Canada01

Eek same here! I had one RF ablation well sedated and can’t remember anything . A second attempt was very painful even though I was sedated it was obviously not enough. I was very disturbed by the pain in my shoulder because I couldn’t understand why it should be hurting there. I could feel the pain but was too dopey to ask questions. If It had been explained before the procedure, I think Ivwould have been ok. Now I’m waiting for pacemaker and later ablate so am hoping I can cope with whatever happens. I had thought it was not going to be a painful thing but maybe it is! Still , what has to be will just have to happen I guess. X

Golfer60UK profile image
Golfer60UK in reply to Canada01

Hello Canada, I had a pacemaker fitted 4 weeks ago, next week in for the ablation and the 'switch on'. No need to worry as it is not a bad experience and I have not taken any pain killers either. I play golf 3 x per week and I am 76

Best wishes

Dave J

Canada01 profile image
Canada01 in reply to Golfer60UK

Thank you Dave for your reassuring comments 🙂

My first was under sedation and was a cinch. You can read an in depth review on here if you are really THAT interested

😀😀

hhtafibathlete.blogspot.com...

Canada01 profile image
Canada01 in reply to Jajarunner

Thank u I will have a read 🙂

I think it's only fair to tell you that in contrast to many other people I suffered a lot of pain on both of the occasions when I had a cryo-ablation. The second occasion was particularly tough, the worst pain I have ever experienced - shooting pain from my chest, up through both sides of my neck, and into my skull. However, I asked for more sedative both times - which sent me to sleep - thankfully.

In other words, you're in control of how much discomfort you're prepared to put up with.

I believe my experiences are the exception to most people's almost pain free procedures.

For me, the test is, would I undergo an ablation again. Despite the pain, my answer is yes. As I see it, the benefits far outweigh the short term discomfort.

Sorry, but perhaps it's best you have as broad a perspective of people's experiences as possible. Good luck!

Canada01 profile image
Canada01 in reply to Challiefan

My first ablation was under local sedation and took 3.5 hrs its was a really unconfortable and painful proccedure . The 2nd ablation last year was under a GA but unfortunately at the end of the my femoral artery was severed resulting in a massive haemorrhage and cardiac arrest -which i knew nothing about , But because i cant take any more meds now I am happy despite my bad experiences to have a Pace and ablate to have a better QOL. Just didnt think the PM proceedure was as bad as some are saying.

4 femoral vein procedures over 11 months months. Cryo PVI under sedation (this was halted due difficulties) 7 months later an RF PVI ablation under GA. 2 months later an internal cardioversion under sedation. 2 months after that an RF flutter ablation under sedation.

Couldn't remember any of the sedation procedures, they felt just the same as the GA. (but my lips and throat were sore after the GA for about 2 weeks .) On the other hand the sedations were painless, so to speak !

From UK guidelines; "conscious sedation with intermittent midazolam and fentanyl reduces patient discomfort during electrophysiology study and ablation"

I had ablation under sedation a few years back. I woke with an irritated throat...thats it. Afib continued sporadically for a few months...nothing since.

CONNY45 profile image
CONNY45 in reply to kathie659

Thank you Kathie. Yes my sore throat continued on for one week after the first ablation 5 months ago, due to the esophageal ultrasound. It was uncomfortable. My first ablation, under the same Dr., was done under general, so I am a bit disappointed that this second one is not done under another GA. again.

kathie659 profile image
kathie659 in reply to CONNY45

Im in US. Cannot imagine it without HA

Hi CONNY45. Iv had three pvi ablations the first under sedation,the second and third under G/A. I personally found sedation was not pleasant at all for me.! ( but I am a man😂) I was aware of everything that was going on. I wasn’t laid there in agony or great pain obviously but I felt things and heard most of the conversations going on around me and even remember being told to not to move as you may hear a clicking sound but it’s nothing to worry about.!! I also found the recovery time from G/A was not much more than sedation. So it was a no brainier for me. G/A every time.

CONNY45 profile image
CONNY45 in reply to Jetcat

Thank you Jetcat, my sentiment too. Coming out of general has never been a problem for me. Felt more shaken after the so-called sedation ones. The pacemaker and one eye operation, leaving me feeling a considerable amount of pain throughout the procedures have been enough for me, and am not looking forward to a repeat performance. It does take a lot to knock me out I suppose!

😅😂

Jetcat profile image
Jetcat in reply to CONNY45

I hope it all goes well and smooth CONNY45👍👍

I had my ablations under slight sedation, with pain relief given intravenously if needed. When it hurt too much I asked for more and it was given. I had my pacemaker fitted under local anaesthetic and chatted the whole time to the nurse who was on my right hand side. I did say ouch at one point and they gave me a bit more. Overall not a bad experience and I will need a new one in about a year, so hoping that will go well.

CONNY45 profile image
CONNY45 in reply to Eastwick

Thank you Eastwick, you were lucky to have an IV . In my case, there was one valium tablet and no top-up offered!

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