A description of undergoing a Cryoablation - ablation #1 for me... (MAY 2020)

Ablation 1

My previous post rather glossed over the whole ablation sage and so I thought I would revisit it.

I only got 48-hour notice of the ablation.  I was scared, but at the same time, very glad and relieved to be seen during the Covid-19 pandemic. In fact, it transpired that I was one of the first ablation patients to be seen since all non-emergency procedures had been stopped due to Covid.  I arrived hours too early and had a nice chat to the Day Ward receptionists before being taken to my skinny day bed in a ward with a total of two other people, although it looked as though it usually would hold about six in ‘normal’ times.  We also had staggered arrival times although nobody wore masks.

There followed the usual rigmarole of height, weight, blood pressure and insertion of the cannula (three attempts! Ended up in the back of my hand!)

I was told I would be going down at about 10 am and was surprised that the Deputy EP didn’t come to see me until 9:50 am.  I was also concerned that I had not yet seen the anaesthetist, but the reason for that soon became apparent.  The original plan had been for me to take no anti-coagulants prior to the procedure and then only for a month afterwards.  This was due to the terrible nosebleeds I had been getting due to my HHT.  I was therefore going to have a TOE under General Anaesthetic followed immediately by the cardiac ablation to treat AFib and Aflutter.  Now I was informed that this plan had been changed as I had been on anti-coagulants since my AFib in March so there was no need for a TOE.  This also meant, to my surprise (read “horror”) I would be awake throughout, just sedated. 

To say I was alarmed was an understatement, but I was taken down within 10 minutes or so and the porters were lovely and told me what good hands I would be in and how lucky I was to be treated at a world-class hospital like Papworth. Porters do such a valuable job and they are always so cheerful and reassuring.  I cannot praise them highly enough.

Once in the Cath Lab I was introduced to all the lovely staff who made me feel very comfortable and reassured.  It was cold in there but I was also shaking with fear! I was injected with something that I was told would make me drowsy, I don’t recall that it did anything of the sort, but the 90 minutes did go very quickly so perhaps it had more affect than I realised!

I had to lie on the narrow-padded bed near the CT scanner and they affixed various ice-cold pads onto my chest and back.  I think I also had ECG pads too.  They then gave me a sedative through the hand which they said would make me feel a bit tipsy, like having a cocktail and lying in the sun.  As I said, I don’t recall it did any such thing though!  Then they injected a painkiller into my right hip crease.  That hurt but soon went numb.  This was followed by a lot of tugging and fiddling about, for what seemded like ages.  I couldn’t see anything as there was a screen across the bed which was a shame as I find this sort of thing interesting!

All of a sudden, they told me they were ready to begin the ablation!  I thought they had been struggling to get the catheter into the vein and now it turned out that they had also manoeuvred it up through the veins, into the heart and through the septum wall (middle of the heart) and so introduced it to the left atrium in that short time.

They warned me I would get “hiccups” at certain points during the procedure!  But these were not really hiccups at all.  These were huge muscular spasms.  The deputy EP would hold me down at abdomen area while it happened!   Then they would immediately do the cryo burn and I would get a feeling of stripes of pain down my face!  I mentioned this to the nurse who was looking after me and he said it was because the nerves of the heart, when we are an embryo, are connected to the nerves of the face.  Therefore, when they irritate the cardiac nerves, you feel it in the face!!!  It was slightly painful, but didn’t last long.  There were maybe 6-8 of these with the accompanying hiccups beforehand.  On one occasion the deputy EP was busy and so couldn’t pin me to the bed when the hiccups started and I was being shaken about like anything!!! The power of a diaphragmatic spasm is just amazing!

I was amazed when they told me it was all over and they were going to stitch the wound!  It was so easy and quick.  About 90 minutes in total.

Dr Begley came to see me later and said that that they had performed a cryoablation with a balloon.  They insert the catheter into the pulmonary vein and inflate the balloon.  This is then frozen and so induces a freeze burn in a perfect circle around each pulmonary vein.  He told me that I had four pulmonary veins.  I asked how many I should have and he replied, in that airy way they have, “Oh, four, but some people have three or five”.  Who knew?

However, mine were “awkward” (trust me!) in the sense that they were wonky so required more than one burn on each.  He explained this is neither good nor bad, it’s just like having different size feet from other people.  I asked about the hiccups and he said they are checking everything is going as it should (Found out later, that they are checking there is no damage to the phrenic nerve which controls the diaphragm, which is where hiccups originate.  Hence the odd sensation – like hiccups on steroids!).  You are also viewed via the CT scan throughout.  Just imagine – they are noodling around inside your heart while not only are you are awake but it is still beating and sloshing blood all around where they are working.  Mind blowing.

I was back in the ward bed by 11:45 am and texting everyone to tell them it was over.  Had to lie flat for an hour because of the groin wound, but by 1:45 pm I was eating although getting out of bed for the toilet made the wound bleed again so I had to do another 30 minutes of lying flat.  The worse bit was having the stitches taken out, but it’s only a few seconds.  I was discharged at 4 pm and felt fine, just a bit shell shocked and tired.  I was told to rest for two days and nothing strenuous for two weeks (although I was told I could run after 48 hours by the EP! Yet another example of TTRMP vs TTRRL – see abbreviations below). 

My plan was to walk for the first month, then cycle for a month and then begin running at the beginning of the third month – easy peasy……

 

Well - Spoiler Alert - that didn’t happen……

To see the incredible technology, they use see this video from Medtronic showing their Arctic Front Cryo ablation gadget.  Simply mind blowing!

https://www.youtube.com/watch?v=ZSlnI6YN7p4

 

Terminology

Atrial fibrillation (AF or AFib) and Atrial flutter (AFl)                                                      two different types of heart arrythmias.

Cryo-                  suffix meaning icy cold or frost.  In this case Cryoablation is where the burns (which form the scars to disrupt the irregular rthythms) are cause by ice

Electrocardiologist (EP)    

A specialist in the electrics of the heart (think

electrician to the normal cardiologist’s plumber!)

Hereditary Haemorrhagic Telangiectasia (HHT)

Inherited disorder which affects blood vessels. Can be anywhere in the body but most commonly see as nose bleeds, which can be severe.

Papworth           Royal Papworth Hospital in Cambridge.  The UK’s premier Heart and Lung facility.

Transoesophageal Echocardiogram (TOE)

Basically a miniature echocardiogram which goes down your food pipe and allows the medics to check for a clot inside the heart from the other side from one down on the chest.     

TTRMP               I made this up!  Time To Recovery Medical Profession 

TTRRL                I made this up too! Time To Recovery Real Life!