What Works for Me

(continued)

Polio Survivor/Ventilator User's Experience with Surgery (continued)

RF Cardiac Ablation

Several things finally accumulated to change the risk-benefit calculation, however. For one thing, my medication became increasingly ineffective, recently forcing me to visit the ER five times in a seven-month period.

For another thing RF cardiac ablations became standard fare in large medical centers like the one in which my cardiologist practices. Assisted my one of his partners, he does about 120 of them each year, and there are about 15,000 per year done in the US. The success rate is very high: 90% to 95%. The rate of serious complications is under 3% nationally, but over the last few years my own cardiologist's complication rate has been under 1%. In part that is because he is quite risk averse. He would rather "fail" than increase the risk. In my case, we talked about the fact that two of the possible complications would saddle me with another major disability, and we were clear that he would back out rather than proceed if he saw the risk of one of those complications start to rise.

Finally, and probably decisively in my case, the length of the procedure has been dramatically shortened. It is now routinely 2 to 3 hours, and sometimes even less. In unusual cases it can still last much longer than 3 hours, depending on how difficult it is to find the source of the problem in the electrical wiring of the heart muscle.

In my case we got lucky. The whole procedure took only 2-1/2 hours, including a 30 minute testing session after the ablation itself. Still, time on the table is significant, and that is one important reason to have a good anesthesiologist. During parts of the process there is apparently no need for much sedation at all. In fact, the cardiologist said that I "didn't have much onboard," even during the part where they were burning through heart tissue. But I don't remember that part, and suspect they were also using an amnestic.

The rest of the details are unimportant here, except to reiterate that the procedure is done in a minimally invasive way, by the use of tiny instruments inserted through catheters into the heart from femoral veins and arteries. As I indicated, it is done under varying levels of sedation, so I do remember fragments of the process. But mostly I slept soundly on my BiPAP. The anesthesiologist timed things so that I was wide awake just as the nurses removed the instruments, and so I was able to breathe on my own for the trip back to my room. Although the procedure is technically an outpatient one, it does require up to 8 hours of closely supervised bed rest in the hospital afterward. Mine didn't get started until 3 pm, so I stayed overnight.

Happily I can report that it not only went smoothly but was completely successful. Recovery time was trivial (I went back to my office on Friday, after surgery on Wednesday), and there were no complications.

Lessons

Does this experience generalize to things other than SVT? I think so, for post-polios. In particular, I think it generalizes to many diagnostic procedures that use sedation, and to surgery done with a combination of regional or local anesthetic plus sedation. I'm certainly not going to go looking for such opportunities, but I no longer regard them with as much apprehension.

One general caution: The sedation for these procedures in my regional medical center is typically handled by specially trained nurses. So it took some persistence, and flexibility on the part of my cardiologist, to get what he wanted in the way of an anesthesiologist. Further, we didn't actually get our consultation with the anesthesiologist until half an hour before the procedure. I had gone in for pre-surgical blood work and history the day prior to the ablation, and an anesthesia consultation had been arranged for that time, but it didn't happen. Nor did it happen early the next day, when I came back. These may have been entirely local problems. I hope so. But the lesson to learn is persistence.

And humility. The anesthesiologist who was eventually assigned to my case was extraordinarily good - not only technically proficient but kind, attentive and wise. The most important thing I learned in my conversation with him was the necessity for him to be prepared to do more for me than my BiPAP could do, in the event that unexpected things happened. He described exactly how he would want to proceed short of a full intubation. Further, he had read the records of my emergency gallbladder surgery, and was prepared to replicate relevant parts of that if he needed to. All of this was quite reasonable. I had been so focused on insisting on noninvasive techniques that I had not thought about backup procedures - even though I knew very well that one of the rare complications of cardiac ablations yields a pretty colorful emergency.

In sum, though, I'm very glad I chose to have the ablation. The best thing, of course, is being free of the episodes of SVT. But the next best thing is being free of the side effects of a calcium channel blocker. I had not fully realized, until I came off the medication, how much it was compromising my limited reserves. I feel 10 years younger, breathing is easier, my balance is somewhat better, and I have more energy.

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