I am curious as to why some people are put all the way under (deep sedation) for an ablation while others are still conscious.
Anyone know if there's a medical reason to do one or the other, assuming the patient could tolerate either one?
I've spoken w/ several people who have had ablations, and so far it's a real mix of which types of sedation they've had. And most of them were not given a choice by their doctors.
Also curious if any of you who have had ablations were given that choice, what you chose, and why.
Thanks!
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acordeon
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The EP who performed my ablation in 2013/2014 (things may have moved on since then) was keen on sedation over GA simply because of fewer risks. He wanted to use a particular anaesthetist who used a hybrid method - sedation was kept carefully controlled and for a part of the procedure when the EP needed me to not move, gave very light anaesthesia to induce paralysis. That meant I drifted in and out of consciousness but had no pain or any sense of time. I went privately.
My experiences with NHS in other situations is that you rarely get choices and it’s what your EP decides. Many prefer GA because patients cannot move and they want the patient absolutely still. Many patients prefer sedation because it’s less risk and you recover very much faster. Some people are really anxious and don’t want to be awake during the prodedure - I’m a very curious person so I found it fascinating and at times was responsive, if not chatty.
In my view it should be a conversation between doctor and patient and after review with the anaesthetist and choices made accordingly. But I am living in a fantasy world I think these days………
" He wanted to use a particular anaesthetist who used a hybrid method - sedation was kept carefully controlled and for a part of the procedure when the EP needed me to not move, gave very light anaesthesia to induce paralysis..."
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Hats off to this anathesiologist. Brilliant approach! I wish I could find one to work like this in the US, but they simply do what the ep's say and in the US for afib ablations, the ep's almost always will use General or something similar (MAC). No conversation.
My understanding is that it depends a lot on both the EP and the type of ablation. Many using cryo will use sedation whilst I think it fairly universal that GA is used for RF due to the need for absolute stillness on the part of the patient.
In my case, I had sedation for both my Ablations which I’m sure were both RF (for A Flutter - Dr Lencioni at Birmingham QE). Drifted in and out of consciousness - interesting to be aware at times what was going on. At one point it became very painful and I had to tell the anaesthetist and he just immediately upped the dose and I drifted off. I should have spoken up earlier to avoid the unnecessary discomfort. Strange feeling having your heart zapped from the inside.
After having a very bad experience with sedation on the 3rd occasion when I was virtually awake when the did electrical cardioversions. I am sure they were trying to use the absolute minimum of sedation
After that the last 4 ablations were done under General Anaesthetic which for me was far more acceptable. As the last one lasted about 7 hours I was very grateful.
I have been free of AF since March 2022 after my last ablation in 2017 my condition improved significantly so whist many may not agree I don’t regret anything having previously been in Paroxysmal Atrial Fibrillation since about 1990.
We are all different what suits one doesn’t suit others.
I was talked into sedation for my first ablation and it was awful.! I got told off several times by the nurse who was sat on my ear.? She told me to stop fighting the sedation and to please behave myself.! I can’t have even been sedated properly because I was in near full conversation with her telling her I can feel uncomfortable feelings in my chest and I wanted them to stop. She said I can’t have anymore sedation and it will be over soon and I had to be quite . Months later on seeing another EP it was on my notes saying became talkative through procedure and advise GA on any other procedures if needed.!! I had two more done under GA and it was a breeze.👍
Sounds like sedation was not given by a anaesthetist in the room - which seems to me to have been the real problem. That seems to have been a common experience, judging by the number of similar posts I have seen about this type of experience with sedation.
the anaesthetist was in there with me sat directly behind my head, but at some point through the procedure I was told by a nurse who was sat with her head at side of mine that he was unable to give me anymore sedation and it would be over soon and I had to behave myself.! Iv read posts of people saying sedation is brilliant and they were fine but goodness knows what happened with me?
I would have thought so yes. It wasn’t a pain as such, it felt like a sparkler firework had been placed a foot above my chest and I could feel tiny sparks sensation on my upper chest, no pain but very unnerving and uncomfortable.!! I was more concerned because at the time i remember thinking I should be really sleepy or nearly out of it but I wasn’t. My next ablations we’re under GA and it was brilliant.👍
Well I had neither despite asking for conscious sedation! If I need any further top ups I shall insist,as I had to stop them when they did the cti line for Atrial Flutter as it was excruciating. I asked why not and the answer I got was that I presented as calm ,and they prefer as light a sedation as possible sonthey can gauge responses better.
I believe there are several contrasting theories though!
I didn't know they hadn't given me any! Pain relief, but didn't work doing the cti line and I stopped them and said if you carry pm I'm getting off table! Xx
When an anaesthetist administers pain relief and sedation I do think it’s a different story. I think the real reason for light sedation is that nurses are not competently qualified. The other advantage having an anaesthetist present is they can use other drugs. I know when I had this it was experimental but worked so well that my EP of the time continued using this method.
That makes sense ,am going to ask at my appointment on Friday,as I'm curious. It wasn't too bad doing the AF bit much as I had expected but when the cti line began just too much. I only had about 30 seconds of bad pain,then they tried again, same them last time I lost the plot!Heard something about Fentanyl then all was OK. Thank you xxx
I asked the question and was told it sometimes comes down to cost, a GA is more expensive and with the budgeting problems in the NHS they are able to make the money go further and treat more patients. I had sedation for my 2 ablations which suited me, in at 8am out at 5pm with very few after effects, which wouldn't have been the case if I had had a GA.
Multiple reasons. General anesthesia (GA) requires an anesthesiologist. Sedation can be done by the doctor performing the ablation or a nurse. So there's a logistical/economic issue. Also, some ep's like their patients out cold so prefer GA, especially with RF PVI's.
I do not tolerate GA very well, so would prefer sedation, but true conscious sedation is almost impossible to find in the US as most ep's use GA. In the UK and Europe, easier to find.
If you look at CDreamer's post in this thread, you will see described the almost perfect approach to anesthesia in my opinion. Wish I could find such an anesthesiologist in the US.
I had GA for both my ablations. I was given choice first time and almost knocked EP over saying GA please. Second time, same EP he just said GA? I said a polite yes please instead of …too b§@@dy right!
my first ablation was carried out under sedation because the EP suggested it and preferred it.!! My second and third ablation was carried out under GA because a different EP said its what he preferred plus it’s safer because there’s no risk of movement whilst he’s ablating.!!
I had an ablation procedure 3 years ago and it was an awful experience. I’m convinced to this day that I had no sedation whatsoever. My consultant told me it had to be done with sedation not GA so I had no choice. It was utterly hideous. I felt absolutely everything. But… I think in hindsight this was more down to the actual consultant - I ditched him in the end.
That’s awful. I felt every single thing - the first experience was being stabbed in the groin - my left leg shot up in shock and the consultant actually shouted at me to keep still and put my leg down. Not one of the nurses or theatre staff spoke to me at all during the whole procedure. I had bouts of excruciating brain freeze like when you eat an ice cream too quickly, horrendously violent hiccups - I could go on!! In hindsight I should have put in a complaint.
I had GA for both of my ablations the first one I had he said he liked his patients to be very still when he did it and the second my husband asked if I could be sedated this time and was told it would hurt too much so GA it was.
I wasn't given a choice for my RF ablation, it was under GA and lasted over 5 hours. When I came round from the GA I was in so much excruciating pain that I had to be knocked out again for a few more hours.
The second ablation I had was a surgical ablation carried out during OHS for AVR so obviously GA for that one!
Yes, it was pericarditis and oesophagitis from the heat. Not so bad when I woke the second time but I had been given i/v fentanyl. I still needed regular morphine for a day or two.
different patients different needs? I was told the intervention would be relatively brief, GA was more risky, meant staying in overnight. My sedation was fine, sensitively done, by an anaesthetist in the team. No problem
I’ve had two done, both under sedation and pain management. On the first one the only thing I felt was when they put pressure on the groin when they’d finished to stop the bleeding, second one was awful! Had sedation but felt very painful so they stopped the procedure, I had no explanation about this until I got the discharge letter, which annoyed me a bit as it was a waste of my time and their time and resources, looks as if I may be in for another one soon so will definitely explain my predicament and hopefully get some better results.
I don’t know who did the sedation as I was so anxious I just wanted it over and done with 🤨🤨 I don’t think it was the cardiologist but maybe a junior!! I had morphine and intravenous fentanyl but don’t no the strength, but do know that it made me feel very sick when I got back to the ward!! Ughhh ☹️☹️
For my two ablations in Bordeaux in 2018 and 2023 (January) I had conscious sedation. EP Prof Pierre Jaïs not at all keen on GA. RF for the first ablation (PVI) and mainly PFA for the second ablation with RF only for a typical right flutter line (a precautionary measure - I've never had Aflutter). For folks worrying about PFA with conscious sedation, don't worry - I couldn't feel it at all. I could, however, feel the RF.
I made sure to ask my EP at initial meeting, for GA before all 3 of my ablations as I know my own body and have a very low pain threshold and a tricky lower back, neck and shoulder situation and I know I couldn't keep absolutely still for any length of time. He was happy with GA but warned that I would have to wait a bit longer than average as he would have to get a team together for GA 🤷. The last ablation was in Aug 2018 and gave 2 years free of the scourge that is AF. I have now had another 3 years where it's gradually increasing in frequency, and duration but nothing like as debilitating as it was prior to 2018. My pacemaker will need to be replaced at some point in next 10-12 months but will probably be like for like, nothing that can do "extra's". I will have to ask to be referred back to my EP as he took me off his books back in 2019, might be a looong wait.
Hello there - I had an ablation in March this year but sadly it didn't work for me as I have multiple atrial tachycardias and they also picked up A Fib. I was sedated and I was totally relaxed during the whole process. I have an excellent E.P and I cannot sing his praises enough with the exceptional care I have been given. I wasn't given a choice as to whether I'd be given a general anaesthetic because he wants me to have a sleep apnea test. [I am overweight for my height, but continuing to diet succesfully]. I have complete trust in him and his choice of how my procedure would be carried out. He is going to try a Cardioversion early August as I am still symptomatic and it is affecting my ability to undertake most forms of exercise which will help with my dieting/overall health.
Hi, I've had 3 ablations, 3 cardioversions, pacemaker insertion, operations for cancer and heart valve repairs, plus 3 colonoscopys. As far as I know only with major operations have I had GA, everything else had been sedation, often using a version of Rohypnol which means you can be partially awake and I've been told I was, but I don't remember pain or discomfort afterwards. Pacemaker was done with only local A in shoulder. As others have said decisions made by medics, who should ask and take account of your previous experiences with GA/sedation. GA will often mean overnight hospital stay, with sedation there is more chance you will go home same day.
I've had both. The first unsuccessful because I was sedated only. They told me right away that even when I'd lost consciousness I was still showing a pain response by twitching and wiggling. I later found out there were around 135 burn sites done during that procedure. 10 months later I had it redone. Work on 3 of the pulmonary veins had been breached. This time the 35 burn sites did the trick. No AF since May 2022. I'm petite and they were limited as to how much analgesic they could give me.
I have had two ablations at Papworth (UK) by very experienced EP, both times using conscious sedation. No pain at all, but occasional weird sensations which I was told was because he got close to the vagal nerve./ Both times I also had an AF episode during the procedure and everything had to stop dead until I was back in NSR! This was not a long wait as I received intravenous flecainide. I was happy not to have had GA, and was well enough to go home the same day.
Just had my second. Had GA for the first and sedation on the second. Reason for sedation was it was part of a EP study, so they wanted me awake for reaction. Certainly got one when they did a cardioversion after going into persistent AF. Thought I'd been shot!
Just met with my EP and found out my upcoming ablation is going to be GA, no choice in the matter. Reason given was that he's doing cryo and apparently they do some sort of stimulation of the phrenic nerve (my.clevelandclinic.org/heal... during the procedure to make sure they aren't ablating too close to it. And he said that it's very difficult for patients to hold still when that nerve is stimulated, so they need you knocked out.
FWIW, GA is fine with me. Being awake while the inside of my heart is scarred did not sound like fun. And he said that advances in GA as well as controlling the bleeding at the catheter sites mean that I can go home same day even after GA, which has only been true very recently. (This is at a fairly large hospital in a major US city)
Curious if others have heard of this phrenic nerve concern.
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