I have been waiting for my Pace and Ablate procedure since January of this year. It was postponed in June and then again in late July and I used to joke that I wouldn't believe that it was going to happen until I was actually walking through the door into the EP Lab.
Last Friday I did walk through the door and climbed onto the table where I waited nervously for the implantation to begin. I winced when the local anaesthetic was injected and began to enjoy the effect of the mild sedative.
I wasn't aware of the incision but did feel the EP pushing the first catheter into a vein, pushing it towards my Right Ventricle. Then the pushing stopped and I heard the EP and his colleagues talking about something. After a few minutes he came round to my side of the table and asked me to look at him - because of the sterile cloth over my head I could only do this by turning my head awkwardly to the right.
He informed me that they couldn't gain access to the Right Ventricle in the normal way because I had something called "Left sided SVC" - a congenital defect in the 'plumbing' on the left of my heart. Picture the scene. I was drowsy, in some discomfort from the surgery, which had been halted, and was receiving an anatomy lesson from the EP. He knew, from our conversations earlier that day, that I had an 'O' Level understanding of the anatomy and physiology of the heart and assumed that I would understand the nature of the anomaly which had been with me since birth, but which had never, until then, been spotted. I really did try to understand what he was describing but, since he couldn't show me a diagram, I nodded my head, as if I could visualise the quirk in my plumbing and understood what he was on about!.
He said that they could gain access to the SVC from my right side, but that would have to be done another day. He sewed up the incision, told me that I would eventually have a matching scar on my right side, sent for my bed, and wheeled me back to the ward.
When I saw him later we discussed when the repeat procedure might take place. He couldn't give me a date, of course, saying he would have to take may case to the Waiting List Team, who would make that decision.
As I write this I have nothing to show for my day in hospital apart from a very sore wound on my chest and an intense sense of disappointment that my return to some sort of heart normality was being postponed for weeks, possibly many months.
When I returned home that evening I Googled "Left Sided SVC" and finally understood what the EP had been trying to describe.
I hope the simplified diagram below clarifies the layout. The normal approach to the Right Ventricle is via the Left Brachiocephalic Vein into the Superior Vena Cava, the Right Atrium and then through the Tricuspid Valve into the RV. In my case blood reaches the RA through the Coronary Sinus and the Anterior Cardinal Vein - a vein which should have "regressed" or atrophied after birth into a ligament known as the "Ligament of Marshall". I am not sure if I even have a Brachiocephalic Vein, but if I do it is not big enough for a catheter to pass through.
HERE ENDETH THE ANATOMY LESSON.
Yer gotta larf, otherwise you go mad!
We made and fitted things for those less able too.
shortness of breath
3% Afib burden and proposed medication
breathlessness 
PVC’s and Travel
Afib/Ectopic Beats Nightmare
