Has anyone had their ablation abandoned due to phrenic nerve?

[Blondie1985]

On Wednesday I went into hospital for my fifth ablation since Dec 2016. This might seem like a lot but I have a congenital heart condition. I underwent five open heart surgeries in childhood. So my EP says my heart is quite scarred and irritable from the operations, hence me having recurring issues with AFL and now atrial tachycardia.

Anyway on Wednesday my EP managed to stimulate and map my atrial tachycardia but was unable to proceed with the ablation. She said the problem area was too close to one of my phrenic nerves. She felt it was unsafe to ablate because if she hit the nerve I could end up with breathing problems. I was under local sedation for the procedure and was aware of what was going on throughout. I've been sent home with different medication and told they won't be risking ablating the atrial tachycardia again, unless I become very symptomatic or my congenital heart consultant thinks it's causing problems with the size or structure of my heart. My EP said a pacemaker is also an option, but she doesn't like putting pacemakers into people as young as me - I'm 35 and don't feel young!

So far the new medication seems to be working much better than the previous medication. But I know it's only been three days. I've been quite symptomatic from the atrial tachycardia and unable to work since October. I work in a SEN school so my job is quite physical. I don't get much chance to sit down throughout the day. I feel I won't really know how well the new meds are working until I bite the bullet and go back to work. Which in itself is quite worrying. I'm just curious if anyone else has had their ablation stopped due to this issue?

[avma]

Yes,I was, 2 years ago, I was facing the same problem as you. The AT was too close to my phrenic nerve. So my cardiologist has sent me for a hybrid ablation so they could solve the problem of the phrenic nerve. You can look it up on my profile how this operation went for me. I am totally recovered from AT.

I have another possible hartproblem now, the cardiologist saw during my biketest 3 weeks ago my heart racing during the test to 175, and he saw that it came from my hartchamber, so it could be VT, but which one is still unclear, so at the end of February I wil get an mri and EP exam to look further into it.

I hope it will come to an ablation if necessary and not to an ICD or medication, but I can only wait and see.

But for your problem there is certainly a way out. Like I said, look my story up on my profile and if you have further questions, you can reach me through the chat.

[Blondie1985 in reply to avma]

Thank you for your reply.

My EP did say there was a way they could move the phrenic nerve while doing the ablation, but she went on to say she didn't feel that option would be suitable for me. I have a congenital heart condition so I've already had five open heart surgeries. She said she felt the method used would be too invasive given my history. I can only assume she was talking about the hybrid ablation which you discuss in one of your posts. But I will specifically ask about this though when I have my ablation follow up. It would be good to know if this was what she was describing.

Thankfully the Diltiazem is continuing to work. I still get runs of Atrial Tachycardia but it is no where near as bad as it was prior to the medication change. I'm hoping the medication will work long-term 🤞 but I would have much preferred the ablation to have been successful.

[Georgia1989]

Hi, I have this exact same problem. I was told I had SVT then it was pinpointed to AT, I had an ablation 3 months ago but after 4 hours my EP had to give up as it was too close to my phrenic nerve, he basically said there is no point in trying again because he won't be able to solve the problem. I was prescribed Flecainide which doesn't have the best side effects although I am kind of getting used to them but the thought of being on it for the long term gives me anxiety. Just out of interest how does you medication work for you? I wasn't given any other option as in hybrid abaltion ect and to be honest the whole experience of the ablation was pretty traumatic for me. I hope your feeling better now after your ablation.

[Blondie1985 in reply to Georgia1989]

The Diltiazem was working but over the last couple of weeks it's become less effective so I'm now back to square one. My HR during the day is running anywhere between 100-130bpm when I'm just walking around. It's slowing down at night and when I am at complete rest, but as soon as I move it's off again.

I'm trying to get in contact with my EP to get the medication reviewed. I was started on the lowest dose on the 9th Dec when I was discharged from the hospital, but my EP said she would review that in 6 weeks, so I am due the review now.

I wasn't offered the hybrid ablation. My understanding is they would have to go through your ribcage surgically to move the nerve out of the way, before they feed the catheters up through the groin. My EP has said because I've had five open heart surgeries they won't do anything more surgically unless it's life threatening. Atrial tachycardia isn't life-threatening, but I'm just finding it exhausting and so hard going. I've had no side effects from the Diltiazem but it isn't actually working atm so it feels pointless taking it.