Atrial Fibrillation

https://www.kidney.org/kidney-topics/heart-and-kidney-connection

For those who had ablation, can you tell me what type of anesthesia you were under (e.g., general, protocol, conscious sedation) and how long you were actually under anesthesia? Thanks.

@gloaming I have probably seen 4 cardiologists and one well-known EP for my once a year episodes (and my CHADS2DS2-VASc score is 2) and except for the first one (after ONE episode) not a single one has put me on an anti-coagulant. Ditto the ER MD's and hospitalists I have seen. I think this is very individual.

My mother was on Coumadin and a GI doctor took her off for an endoscopy without a bridging med. She had a stroke 5 days later. So it's not like I am cavalier. But I am also not cavalier about the side effects of Coumadin for her, including dementia from micro bleeds in her brain.

Yes, it's very much an individual thing, Windy, including the cardiologist/EP and what they find works for them. The CHA2DS2-VASc calculator and sites I have visited all say that a person at or above 1.5 should be advised to go on a DOAC, and that at 2 and up, the patient will be very strongly advised. A Watchman, as I said earlier, changes things and brings the risk to 0, or would except where other factors, say high blood pressure, might keep the score in the 'danger' zone.

The physician in this video is an EP, and he mentions CHA2DS2-VASc score assignment and what it means somewhat later in the video:

The EP will ask the anesthesiologist for an assessment since it is that person's responsibility to ensure you are suitably sedated. Some patients have had to endure a catheter ablation while conscious, although they would have been offered some sedation if they became agitated or uncomfortable.

I was conscious for my angiography, which involved inserting a catheter through my radial vein. I felt the catheter zip up the vein, to my armpit, but after that there was zero (0) sensation. The surgeon asked if I wanted any sedation after I mentioned that I had felt the catheter move up my arm, but I declined. I was good, and I'm a curious fella who wants to see and to understand as much as possible.

During a standard RF catheter ablation, there is often the requirement, for the patient's safety, to insert a trans-esophageal echocardiogram (TEE). This is something like a sigmoidoscope that is inserted into the anus during a colonoscopy. This one goes down the throat, the esophagus, and it is used to monitor the position of the RF wand to ensure it doesn't get too close to the Vagus nerve, the phrenic nerve, or the esophagus, all of which CAN BE burned by a less-than-careful electrophysiologist. You can understand that, with you flat on your back, head tilted well back so that the esophagus doesn't bend enough to make insertion of the TEE a problem, and then having that 1.5 cm thick probe slid down your throat....yeah, you want to be out for that. So, it's either propofol or something else, with the modern preference being for propofol. Especially for older patients who might require general anesthetic for something else before too long, or who recently had a general, you want as little exposure to general as possible. Hence, a strong preference for propofol.

As for duration, anywhere from 12 minutes to three hours, maybe four in really complicated ablations. I say as little as 12 minutes because some other unforeseen incident, or condition in your heart, or other intrusion makes the continuation of the procedure impractical or dangerous, or unethical. No sense in speculating about which of those might be the case as that would be an extremely rare and unlikely event. My own two ablations lasted about 90 minutes each. I was awake and alert about 30 minutes later.

The nurse looking after you will ensure you lie still, even keeping your head on the pillow and not raising it. This will last for at least three hours, and you'll have a heavy compress or bandage with a weight on the groin incision(s). At about three hours, they'll ask you to drink, and if you can do that, to eat a muffin or whatever, and if you can keep that down, to rise and carefully walk around the ward. This is to ensure your safety and to ensure your blood pressure is high enough to allow you to stand and to move on your own. While you're making your second or third lap, your 'ride' gets texted and told you are going to be released to that person very shortly. You will be legally impaired for 24 hours after your release, not from the time you get wheeled back, unconscious still, into the recovery ward. So, you'll need a taxi at the very least, or a friend/relative to take you down to the vehicle and drop you off at home.

My score of 2 is due to being female and over 65. No other factors like high bp, weight, diabetes etc. And my afib is infrequent. It is indeed very individual. Once I reach 75 it will go up to 3.

Thanks @katiekateny. I did look it up. Without obesity, diabetes and high blood pressure I am less worried. However my kidney disease has caused mild anemia. It is certainly wise to keep an eye on kidney function. And hydrate!

Here is the current situation:

Newest research suggests that there is little to differentiate longevity between those who have paroxysmal or persistent AF and whether they take medication or have an ablation. IOW, the morbidity is about the same across the entire population of AF patients if they are broken up 'randomly' into two groups, one receiving monitoring and drugs, the other getting an ablation.

But...............................................it's the individual patient who matters. Some do well with cardioversions now and then, with DOAC (Daily Oral Anti-Coagulation medicine), and with rhythm and rate control (rivaroxaban/apixaban and metoprolol/bisoprolol/diltiazem respectively), while others do best with the mechanical 'fix' (it isn't a fix, it's just a way of blocking the spurious electrical impulses) in a procedure called ablation. [Sorry, I tend to write complex sentences that may need a re-read...].

Secondly, the patient is the one who is either really bothered by what he/she feels when in arrhythmia, or they are blissfully unaware and don't lose any sleep or feel pressured to deal with the arrhythmia. I was highly symptomatic, so as soon as I read about catheter ablation, I began to push for that form of relief. I finally got the relief, but not until I got a second ablation (my first one failed. F first ablations have a 75% success rate, 85% for a second attempt).

Thirdly, almost all cases of AF are progressive. At first, they are manageable and infrequent. Then, they begin to come more frequently, and they often last longer, even a couple of days. You want to be treated before you enter the 'persistent' phase, and certainly before you are deemed to be 'permanently' in AF. The reason is that the heart begins to 'remodel' its substrate (underlying structure) with chamber thickening and with fibrosis, neither of which is good for the heart. A heart advanced in remodeling is usually headed for heart failure, or what I would wish they'd rather call it 'cardiac insufficiency', because the heart doesn't really 'fail.'

You are strictly in the paroxysmal phase, where your AF comes and goes. That's good. If you ever feel like you're beginning to lose ground to the disorder (that's what it is, an electrically disordered heart), you must get referred to an electrophysiologist as soon as possible and get either improved medication control or get in line for a catheter ablation. You want it dealt with firmly before you become 'persistently' arrhythmic.