Cardiac ablation: Paying someone to burn my heart from the inside out

After months of waiting, I finally had my cardiac ablation. I won’t keep you in suspense: It went well, and I’m okay. It was, however, an interesting experience, so read on for my reactions and reflections.

I was told to report to the hospital at 6:30 AM. Rather than getting the entire family ready super early so that they could drop me off before the kids had to go to school, I took a Lyft. It was the practical decision. I tend to be a practical person. In this case, I probably should have made a less practical choice.

Shit started getting real when I filled out the intake forms. There was the basic stuff (confirming my address and insurance information, acknowledging the privacy policy), but there was also a page asking whether I had a living will. I do, but I hadn’t brought a copy. I hadn’t thought of bringing a copy of my living will. I hadn’t thought my living will might need to be exercised for what is supposed to be a fairly routine outpatient procedure.

I got called to go to the prep area. I was told they needed a urine sample to ensure I’m not pregnant. This seemed like an easy request, but I had been told not to eat or drink anything, which made this a difficult request. Eventually I was able to provide enough of a sample to be tested.

I was left in a curtained area and told to change into a gown and wait. I could hear nurses and doctors talking to the other patients. And I began to cry.

I had gotten very little sleep and wasn’t allowed any coffee. I was tired and my nerves were rattled, which is probably why I cried. That, and, I had to admit that I was scared. I hadn’t admitted that to myself before then. The decision to go in alone, to not find someone else to take care of the kids so that my husband could be with me began to feel like a mistake. I told myself that soon I’ll be in the procedure room. My husband would just have to sit in the waiting room anyway. It would have been silly to make him sit there. But in that moment I felt very alone.

Then, I got taken to the procedure room. I was surprised by how much technical stuff was there. I was thinking “simple, outpatient procedure.” I had been picturing something like a dentist’s chair. This was far more complicated and high tech. That is, this suddenly seemed like a far bigger deal.

The table that they put me on was encircled with a giant ring attached to which were several sliding white boxes, which I later learned were x-rays. There were eight monitor screens in an array, plus a rolling EKG cart and monitors at stations around the edges of the room. The picture below is something similar that I could find with a creative commons license, but the x-ray machine (apparently called a biplane) went around the table rather than over the head and there were a lot more screens.

Cardiac Electrophysiology Equipment
By Glitzy queen00 – Own work, CC BY-SA 3.0

One of the reasons for all the screens was to monitor the several dozen adhesive electrodes that were stuck to my chest, back, sides, and legs. There were bumpy, round ones and flat, rectangular ones. The flat, rectangular ones were really cold. There were so many of these things stuck to me that a day later I found two more still stuck to me that no one had taken off.

In addition to the electrodes and their many wires I had an oxygen tube under my nose, an IV in my left arm, a monitor on my left index finger, and a blood pressure cuff on my right arm that automatically contracted every 15 minutes.

They also strapped my arms down to keep me from moving them. That wasn’t so bad at first, but having one’s arms strapped to one’s sides for two hours gets really uncomfortable.

I was given a sedative, enough to make me foggy but not fall asleep. A local anesthetic was put on the right side of my groin so that several holes could be cut there and catheters with wires in them could be run in through the vein and up to my heart.

The first part of the procedure was the electrophysiology study (EPS). During that portion the goal is to trigger an arrhythmia to identify what part of the heart is causing the trouble. If they are able to identify the problem area and it is not in a part of the heart where ablation would be dangerous, they then use radiofrequency to destroy the abnormal part of the heart.

There were about six people in the room, but after I was prepped, the nurses stood off the side and talked to each other. During my procedure they discussed a variety of topics including Sonos speaker systems, types of bike racks, soil seepage/garage paint/caulking products, sherbet, and fantasy football.

The main person performing the procedures wasn’t my cardiologist, although he was there. Being a teaching hospital there was a new guy doing the work. I heard him say that he’d only been doing this for two months. I heard him say, “I only made one mistake.” He said this before anything had really started happening. (He had ask for the wrong wire to run into my body during prep.) He had trouble running the bi-plane (which is how I learned what that is called). At one point the new guy told my cardiologist that he was the Jimmy Garoppolo to my cardiologist’s Tom Brady.

Dude, you know I’m awake, don’t you?

Regardless, Dr. “Garoppolo” did the EPS. I watched the monitors. The x-ray images were clear to me. There were my ribs, my heart, and the wires. There were also some ECG/EKG (I still don’t know the difference) displays but with many more lines than usual. It was weird. Because of the sedation I could see on the screen that I was having heart palpitations, but I couldn’t feel it. There was another display that was farthest from me, so I couldn’t distinguish it well without my glasses. I could tell it was some sort of display from the wires inside my heart.

Apparently, they got the information they needed because they told me they would proceed with the ablation. Dr. Trainee did the start of the procedure, then my league MVP cardiologist finished. It was my cardiologist who did the minute long burn on the bad part of my heart. When he did that I could feel the heat in my chest. Was my sedation wearing out? Does sedation not work on hot? Did I just imagine it?

Next they needed to test their work. I was told I would be given something “adrenaline-like” to stimulate my heart. When they did that I could feel my heart pumping hard and intensely. It was uncomfortable. It was intense. It was worse than most of my normal episodes of heart palpitations. But apparently, it was fine. Even when pushed my heart did not fall into arrythmia. The procedure was declared a success, but my discomfort was not over.

Having a couple dozen stickers peeled from my skin was as fun as you would imagine, but that wasn’t the worst part. After my second string doctor pulled the catheters out of my vein he said he had to apply pressure to the area. That made sense, but jeez, dude, do you have to apply that much pressure? My insides felt crushed. I suppose it’s funny that after everything I’d been through having pressure applied to my wound was my least favorite part, but it was.

Oh, and Mr. Second String Doctor, once you finished crushing my hip joint and you applied the dressing to the wound it would have been nice if you had covered up my crotch before you walked away. You left me more exposed than I had been at any point in the actual procedure, and I couldn’t do anything about it because my arms were still bound. Thankfully, one of the nurses covered me up shortly after you left.

Oh, and those bound arms. By the end of the two hours they were really sore. Particularly the left arm, which had the IV in it. Oh, I was so happy to be able to bend my elbows! But bending my elbows was about all I was able to do.

I was on strict bed rest for four hours. I say strict because I wasn’t even allowed to move from the procedure table to my recovering bed on my own. The nurses/orderlies did the thing where they swiftly pulled me on my sheets from one surface to another, which is a disconcerting ride that I had only before seen on TV medical shows. After an hour I was finally able to eat but only with my head up at a max 30 degree angle. Fun fact: it is really hard to eat (or even just drink with a straw) when you are only sitting up at a 30 degree angle.

That food, by the way, was brought by my husband and son (out from school because of an ear infection–it’s been a crazy week). It was very nice to see them. My son had been really worried. I don’t want my children to have to worry about me, but it was very sweet.

After they left I tried to amuse myself in my inert state. I had my Kindle, but I was having trouble focusing on my book. Whether it was the after effects of the sedation or just the after effects of having gotten up at 5:30 am and still not having any coffee, The New Jim Crow proved to be a bit much. I tried to nap, but that was hard since I still had a blood pressure cuff contracting on my arm every 15 minutes. Eventually, I fell into the procedural comfort of an endless stream of Law & Order episodes on Ion TV.

When I was finally cleared to get up, my initial trip to the bathroom was fine, but a walk to the nurse’s station proved too taxing. I got dizzy. I guess they were serious about needing to take it slow and easy.

So, what now? Now, I wait. You see, my doctor (Brady not Garoppolo) said that when the procedure goes as it did for me there is a 95% chance that the condition is completely fixed. That is, I should never get palpitations again (unless I develop a new condition when I’m older). But there is that 5% chance, and this is something that happens to me irregularly. How long will I need to go without an episode before I’m confident this worked? A few weeks? A month? Three months? A year?

For now, I’m just comforted that the procedure went well. (No need to execute that living will! Woo-hoo!) After all the time and expense (20% copay is still a lot), I feel like this was worth it. I feel good. I feel grateful (if still a bit sore).

RELATED POST: I’m perfectly healthy except for this pesky heart condition

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