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My Ablation Procedure for Wolff-Parkinson-White Syndrome

July 6, 2016

Here is the story of my Electrophysiology Study and Ablation.

After seeing the Cardiologist at my local hospital in March 2015 and getting on the waiting list by the end of that month, I received a letter informing me that my Electrophysiology Study, plus or minus ablation, would occur 16 September 2015. I was advised I needed to be at the Big Hospital for a pre-op check the day before. I was then to stay the night in a motel and check into the hospital the following morning. I was expected to stay the next night in the motel also, so I would be close to the hospital in case something went wrong. I was also advised to bring someone with me. I phoned my mother, and she was happy to rearrange things so she could come. She’s been my hospital buddy my whole life, except that one time when I was four and she had another baby to look after.

The pre-op appointment featured a blood test and blood pressure check, pretty much. I don’t take meds, so they didn’t have to review my medication management for the procedure. A nurse explained that I would have four ports in my groin. I avoided all other knowledge of the procedure because I thought I would freak out if I thought about it too much (not a fan of blood). This was the first time they checked the form I sent in ahead and discussed the fact I don’t tolerate aspirin.

I woke before 6 am the next morning, because that was when I was allowed my last drink. I don’t tolerate dehydration well, so I was a little concerned about that part of things. I wasn’t allowed breakfast, of course. I had my kindle and my ipod with me, and was grateful for both before the day was out. I also took my own shawl, for warmth. It’s just nicer to have your own blanket in hospital and on aeroplanes.

Of course they wanted to put my line in right away but my left arm defeated the nurse and she had to get the anaethetist to come and put it in. Once that was done, I settled in and read a book on my kindle. I could see the whiteboard from my bed, and I could see that I was second on the list for my team, but I had no idea how long the first guy would take. I was 75% done with my book by the time it 1pm and my turn.

It always surprises me how many people are necessary in an operating theatre. There was the electrophysiologist that would be doing the procedure and two nurses to give me drugs- one seemed to give them and the other write them down. There was a second electrophysiologist monitoring me behind a glass wall, and at least two more people back there with her. I had stickies all the usual places on my chest, and stickies in case they had to use a defibrilator, and a massive big stickie on my back for monitoring purposes.

They put a drape with groin-framing cut-outs in the appropriate position and I thought: OK. They tried to tuck the spare end under my chin and my heart rate spiked over 100 as I freaked out about SOMETHING TOUCHING MY NECK. Phobias are fun. They folded the offending drapery over. Crisis Averted.

They gave me a drug called midazolam, which is a sedative that is supposed to make you relax and not care about things, and is also supposed to make you forget what happens while you are under its influence. The report, which I have a copy of, states ‘it took a long time to get her sufficiently sedated.’ I can’t remember what I was doing, but I remember them ordering midazolam, fentanyl, midazolam, midazolam seemingly one after another. It didn’t actually happen like that, as I learned when I read my chart later. It did work in that I didn’t freak out when I felt copious amounts of blood pouring out as the guy was putting the ports in. I just said to myself: That’s blood. Part way through the procedure I *woke up* and started keeping an eye on the clock. I turned my head to look at it right when the guy was about to do one of his frying jobs and he said, clearly frustrated, ‘Would you stay still!’ I’m not supposed to remember that…

Due to being awake and aware, I can report that an ablation feels like burning in your chest. There was pain relief in the equation, so I wasn’t in agony, but I could definitely feel it. At one point the fentanyl wore off and the groin ports activity inspired me to start saying f*ck a lot, so I got another dose. It definitely worked.

They had quite a lot of trouble getting the right spot to do the radiofrequency ablation. My heart has a natural hole in the wall between the left and right atrium called a PFO, which many of us have. That allowed them to into the left side of my heart without having to make a hole. They suspect there were two rogue pathways, very close together. They were located below and to one side of the mitral annulus, so they had to go down through the mitral valve to get to the right spot. According to the report, they applied RF 18 times over 635 seconds. I remember at least 4 of them. I remember the electrophysiologist asking someone to get another guy because he was having so much trouble. Then, just as he walked in, my guy said, ‘O. Never mind. Got it.’

The electocardiologist then retreated behind the glass and they started talking about skiing. Nobody said a word to me. After ten minutes, I heaved a dramatic adolescent-esque sigh. Apparently in midazolam aftermath I am emotional, with the dominant emotion being Supremely Pissy. The nurse asked me what was wrong. I informed her I was bored. She explained that they were leaving things for half an hour, after which they would try to trigger my heart again, to see if it was really fixed. Each time they had thought they had got it up til then, tachycardia had just started again when they had triggered it. After that I watched the clock- I knew I had 20 minutes to go.

Once they were satisfied that the connections were well fried, the electrophysiologist yanked the ports out and applied pressure.Which, OUCH, because the fentanyl had worn off sometime earlier. I cried.

Straight after that, one of the nurses touched my arm by the port. She got a screech of, ‘What the f*ck are you doing!’ O dear. I never would say that, normally. I know how to use my words. After that they were Very Careful to ask me before they did anything. No, I didn’t want to hold my own pressure on my groin. No, I didn’t want them to clean up the copious amounts of blood that had come out as the ports went in. Yes, I could transfer back onto the bed to go back to the waiting place.

When I got back I got out the ipod and put my earphones on and ignored everyone, trying desperately to get my shit together. I’m pretty sure the earphones made my ear temp spike to just over 38degC. Ears get hot with earphones. I had to have paracetamol to bring my ‘fever’ down.

They elected to keep me in the ward over night, on a heart monitor. My room was handily close to the toilet as I had to pee numerous times due to the fluid they put in through my port during the procedure.

Next morning, after a practically sleepless night, the electrophysiologist came to see me. He informed me I would be taking aspirin for a month. ‘No, I won’t.’ I countered. I had discussed it with two different nurses.

He looked shocked. ‘But you have to,’ he said.

‘I don’t tolerate it: it makes me throw up.’

‘Couldn’t you just try it?’

‘No. Can’t you give me something else?’

‘Uh…’

‘Well, what about Pradaxa?’ (A blood thinner that lasts 12 hours.)

‘Oh,’ (evident relief) ‘That would do. It’s quite hard on the stomach, though.’

‘Well, you could give me omeprazole for the duration. That should help.’

‘Oh, yes. That should work…’

Save Me. What do people do who don’t know enough to suggest alternatives, I wonder?

It was a generally positive experience, though. That last exchange reinforced my belief in the need to be your own (and others’) fierce advocate within the health system, though. Get copies of everything. Read your chart. Ask questions. Check everything. I have great respect for Medical Professionals, but they all work far too much and far too much is expected of them. We need to be the back stop.

I needed quite a bit longer off work that was indicated, as I got a haematoma in my groin. It was localised and not that unexpected, due to the heparin used during the procedure to prevent blood clots, and the Pradaxa afterwards. I couldn’t sit upright and had to wear boyshort knickers and couldn’t tie my shoes for a few days. I had the most glorious bruising.

I am happy to report that I have since been fully discharged from the care of both cardiologists.

I’m thankful that it’s all over.

 

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