Epicardial ablation

Can anyone tell me about their experience? I can find nothing but bad stuff about this procedure. I am 23 and I have been suffering from tachy-Brady for 3 years now. In July I was in junction rhythm for days so we agreed to kill my sinus node and pace me. That didn't go as planned, was in surgery for 7 hours and my heart rate wouldn't go below 100 so they put a monitor inside of me. Over that pasttwo months it showed the my resting rate was 140 and alot higher when I was up and moving. Went in Tuesday for a tweaking and nothing. He said he was extremely aggressive and was getting aggravated that nothing was happening, he had to stop himself because he was scared of doing too much and puncturing the heart. So here I am in the 120s laying down and they think the next step is the epi and I would like to know everything!

8 Comments

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by jessimay - 2011-09-22 01:09:15

Meredith,although it sounds horrible what you had to go through it seems it at least payed off. And if that's what I have to do to feel great I am all in. What ended up happening with the svcs

Inga, it has nothing to do with the SVC. doctors will always choose and endo ablation first. It like what meredith said, it has to do with the cells on the outside. They came to this conclusion with me because I no longer have a sinus node inside my heart, it was all burnt away and my heart rate won't go below 100. They did a mapping to make sure there was nothing else going on and there wasn't.

From what I was reading online I got scared because there seems to be a lot of damage that can be accidentally done.

about SVCS

by mereiriz - 2011-09-22 01:09:24

Hi Inga!

I don't think that they're doing epicardial ablations precisely to avoid SVCS, as you can develop it also if you compress or in any way damage the vena cava from the outside, which can happen with any heart procedure. Most people with the syndrome have it because of some kind of tumor compressing the vein. I had what the doctors called "SVC-like syndrome" after my epicardial ablation, because I had the symptoms but they were not sure of their cause. I had a lot of problems with edema (my face was really puffy, my arms and neck seemed like they were about to explode), and had breathing issues also. In my case, they said they were doing it epicardially because they thought that the cells that were producing the tachycardias were placed more superficially and were not as easily reached from inside the heart. I don't know about other reasons there might be.

Regarding the surgery, it was done under general anesthesia and I spent a few days at intensive care afterwards, and then some more at the cardiology floor. Recovery was really slow and painful. I was hooked to the morphine pump and wanted to take it home LOL. I'm a med student and I had to wait more than a month to go back to school. Bad experience!

hi jess

by Hot Heart - 2011-09-22 10:09:41

met an old guy walking his dogs up my local woods last week, 2 days after having this procedure! he was fine and cheerful and said it all went totally fine, was amazed he was out of hosp let alone walking 2 dogs. Good luck I hope it goes well!

HH

Epicardial SA node ablation

by golden_snitch - 2011-09-22 12:09:18

Hi!

Just wondering, are they doing epicardial SA node ablations now, because doing it the "normal" way can cause so much scar tissue at the junction of the superior vena cava and the right atrium that patients develop superior vena cava syndrome? I have three SA node modifications and one complete SA node ablation (plus other ablations to treat AVNRT, ectopic atrial tachycardia and atrial flutter), and developed this syndrome. Needed open heart surgery to reconstruct my superior vena cava. Know others who have had this complication. So, I'm thinking that the advantage of doing it epicardially could be that the scar tissue cannot block a vein as it's outside of the heart. So, if you need another SA node ablation, I'd probably go for the epicardial because there is no risk of developing SVCS.

A friend of mine had epicardial ablation for ventricular tachycardia and they needed only a small incision, I think, below the breastbone to do it. After all, they only need to put in catheters, it's nothing like an open-heart.

@ Meredith: Were you awake for your epicardial ablation? Sounds aweful what you experienced.

I have had two surgeries with incisions between my ribs on the right side (superior vena cava reconstruction, open-heart with bypass) and left (epicardial pacer lead placement), but I'd say those were much more invasive surgeries than an epicardial ablation. So, yes, I was in lots of pain afterwards, but that's probably not at all comparable to an epicardial ablation.

Best wishes
Inga

that depends

by mereiriz - 2011-09-22 12:09:18

There are different ways to perform an epicardial ablation. It can be done as a catheter-based procedure or through open heart surgery. Usually, they use catheters to go under your breastbone and kill the SA node, but sometimes that's not possible. I'm 28 and I've had 7 ablations to date. Some were accessory pathways ablations, some SA node modifications, SA node complete ablations, and the last one was complete AV node ablation. My case was pretty complicated, so the docs decided to do the SA node complete ablation through an open chest. I had a thoracotomy, in which they went between my 4th and 5th ribs on the right side, deflated the lung, moved my phrenic nerve to avoid respiratory complications, and did the procedure. It was long, painful and very hard for me, and ultimately it didn't work. Right after that I needed the AV node ablation because my tachycardias came back quickly. Now I'm 100% paced and feel great! If you have any specific question about the procedure, feel free to mail me. I'll be glad to help.

Best wishes,
Meredith

good luck

by mereiriz - 2011-09-23 01:09:03

Which hospital are you visiting? I live in Puerto Rico and tried different hospitals here, in Tampa and Miami, Florida and ended up in Cleveland Clinic. That was definitely the best decision! I highly recommend it!

Good luck with whatever you decide.

I'm going to do it

by jessimay - 2011-09-23 01:09:25

I literally have no sinus node inside of my heart and I still have a very strong and fast sinus rhythm. So for me I feel like there is no let's get in there and see. I obviously have something taking over as a sinus node on the outside. I'm only 3 days post op and my hr is already spiking and staying around 135. As far as the av node, they won't touch it, it does it's job and it's doing a great one. I found more research and to me it seems like complications are minimal when a highly experienced doctor is doing it. I either take the chances with that or continue to press my luck when passing out.

Thank you so much for your insight! I have to wait at least 6 weeks to do it and I will definitely message you if I have any worries!

I know how you feel

by mereiriz - 2011-09-23 12:09:22

I know perfectly well how you're feeling right now, because that's exactly what I felt. I used to get mad at doctors telling me: you're too young for this procedure, we don't want you to end up dependent on a pacemaker, let's wait and see if it solves on its own, etc. I always thought that if the ablation and a PM could make my life better, I wanted to try it! But I believe that what worked for me was the combination of SA node/AV node ablation. You should ask your doctor about it!

I'm not sure what they did about the SVCS, but I believe they gave me steroids and it got better in a few days. It wasn't so bad as what Inga experienced.

Keep me informed of what you decide to do.

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