Tuesday, October 12, 2010

What to expect during a cardiac ablation and electrophysiology - Part one

I searched for a blog post about a having a Cardiac electrophysiology or a Cardiac ablation, especially from someone who was an athlete, before I had my recent procedure but I couldn't find anything- so I figured I would write it out

Some background

When I was younger I would feel palpitations during running but I thought I was just out of shape. But after age 30 they increased in number and intensity. During these episodes, I would feel light-headed as if I was going to pass out, and the only way to stop them was to stop running, crouch down and hold my breath. This would stop the episode in less than a minute usually. However if I ran a race that was very hot, long and where I got dehydrated (Bull dog 50K 2007, Ohlone 50K 2009)- then I would have episodes where I could not reduce my heart rate for hours.

I was only a little bit worried about this in the back of my mind until I got a Garmin 405 GPS/Heart rate monitor for xmas last year. I wore it during a race where I had one of these episodes and I noticed by heart rate was 242! The usual rule of thumb for maximum heart rate is 220 minus your age so 242 is definitely out of the normal range. On other runs I saw heart rates from mid to high 200s.

example of a tachycardia event

My wife didnt like this at all, so she asked me to take care of it before we had a baby.

I went to the Stanford Preventive Cardiology center where they took my history and saw my graphs printed out from my heart rate monitor. They gave me a heart event monitor which is like a EKG machine which you wear for 3 weeks, and every time you feel the symptoms- you press this button which sends the last 5 minutes and the next 5 minutes of your EKG to your doctor (no wonder healthcare is so expensive- no?) It also has a small cell phone running this java application which asks you your symptoms and the company who runs this service calls you to make sure you are ok.

I wore the monitor for a couple of weeks, and eventually reproduced my symptoms. My doctor, (Dr Paul Zei from Stanford) recommended an electrophysiology where they insert a catheter into your heart and try to pinpoint the origin of the arrhythmia and- if they find it- they can burn the 'faulty wiring' which is causing the problem.

Preparing for an Electrophysiology

The day before the procedure I had to come to the center to get my blood taken. The night before I wasn't allowed to eat or drink anything after midnight.

I arrived at the hospital at 6am. While my wife waited in the waiting room, they preped me for surgery in a large room with about 12 beds. There I changed in a hospital gown, they took a medical history, put a patient bracelet on me, inserted a IV plug in my left arm, and shaved my pubic hair into an mohawk shape since the groin is where the catheter goes in. This took about 50 minutes, and afterwards my wife could join me as I waited for the time for surgery.

While we were waiting the anesthesiologist, and later the attending surgeon dropped by to introduce themself, and a younger doctor came by to explain the procedure again and answer any questions. He explained that the procedure would be 1-2 hours for the EP, and maybe a couple of hours for the ablation although in 'very rare circumstances' some procedures take as long as eight hours. (foreshawdowing?)

We were scheduled to start the operation at 8:00. Right before the operation, they ask you to go to the bathroom, so you dont have to pee during the operation. At 8:30 I said goodbye to my wife, they wheeled me into the operating room where a couple of nurses transferred me to the operating table. It was really cold in the room, so they covered me with some warm blankets. They then shaved some big patches of my chest in order to attach EKG pads.

Later in the procedure the doctor needs to know exactly where his instruments are inside your heart- so before the procedure begins they tape a  coin to your back, and then they take an xray of it. They use this point on your back as a reference point or an 'origin' and can then calibrate where exactly the instruments
are inside your heart in relation to that point on your back.

Once that was done, they covered my 'beans and franks' with a dish rag thingie, and tied by hands to the table. I guess some patients wake up during the procedure and try to grab the tubes which are going into their heart- and that is no good- so they tie your hands down, and offer to scratch your face whenever you have an itch.

The Procedure begins - inserting catheters

The first step in the procedure is to numb the area where your legs meet your trunk.
Then they insert the stints (which is like a small hollow tube) into your leg, into the femoral vein. This hurts. It takes a lot of pressure to drive the stint thru your leg- the doctors said it is the most painful part of the procedure but I found other parts to be more painful.

After that step, there isn't much physical discomfort. Next, they thread the catheters thru the stints into your femoral veins. This actually tickled abit. During my procedure they didnt thread a camera into the vein, so they had an X-ray type device called a flouroscope over my chest and I could see a monitor with a real-time view of my heart. They inserted two catheters into each side of me, so in the monitor I could see four wires in my heart and could watch them move while my heart beat.  This was odd to see while totally awake.

A typical EP lab setup












The next step is where they begin mapping the heart. This will be covered in Part two.



1 comment:

  1. Awesome blog. I enjoyed reading your articles. This is truly a great read for me. I have bookmarked it and I am looking forward to reading new articles. Keep up the good work! Afib ablation

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