Pulmonary Vein Isolation Ablation

The anaesthetist said to me while I lay flat on my back: 'there are a lot of things that could go wrong, but you could also get hit by a Mac truck. We don't have any Mac trucks around here so you should be OK'. I woke up after 5 hours of surgery and was looking for the Mac truck that had hit me. Remembering that one of my primary motivators in chronicling this illness and subsequent treatment options is to benefit others who might suffer the same affliction, I will not sugar coat my experience. I wrote this soon after getting home and have had time to since reflect on it all.

Simply put it was pretty horrible. Of course I know nothing of what went on while I was under. And all the staff who attended me, from the meals lady to my cleaner to the many nurses and all the way through to my surgeon and his assistant I could not fault my treatment or care. But the pain and discomfort was not fun. In retrospect I should have asked for pain relief on the first night. And some anaesthesia for the lady sharing my room who ensured that any chance I had of sleeping was totally gone. Her hourly trips to the toilet shuffling noisily past my bed, slamming the door into my curtain rail, endlessly dropping her bed remote-control and swearing at the top of her voice, the unbelievable flatulence (both in episodes and loudness), the spontaneous loud groaning and cursing that scared the life out of me in the dead of night, flicking lights and the TV on and off and the list goes on and didn't stop until 5am. I forgave her the constant raking, chest-rattling cough as she was denied access to cigarettes and that clearly irritated her airways. Mind you every time she startled me with an outburst or loud noise either organic or mechanical I would flinch. This flinching would set off pain receptors in multiple sites which to do justice I need to cite: my chest (incredibly sore from the actual ablation kind of like a horse had kicked me), my throat (incredibly sore from the probe/scope and airway that had been down there), my abdominal muscles (painful from the clexane injection directly into my tummy), my elbow (where the cannula remained in case needed and was digging into me mercilessly), my groin (very sore from the puncture site and subsequent pushing and pulling through the small hole and now with a full body clamp squeezing into it to stop the persistent leaking), my back, buttocks and my heels (I had been lying flat on my back in the same position for many, many hours to stop the bleeding and I had pressure pain like never before), the end of my penis (majorly inflamed from the catheter that had been pushed up there to drain my bladder during the procedure) and a headache. I maybe could have managed all of this if I was able to just relax and go to sleep. No chance with my neighbours antics going on. Of course I was also on hourly observations so if my room-mate didn't jerk me out of any hint of sleep the obs would. Mind you the obs were a welcome interval punctuating the long night and reminding me that another hour had passed and I was closer to daylight.

I couldn't help trying to imagine what the poor bugger who had gone in the same time as me for open heart surgery was feeling. I got off lightly by comparison. Like I always say: there is always someone worse off.

Needless to say I slept most the next day. But so did my room mate. I encouraged any medical or meal staff to wake her up. I wanted her tired so she would sleep the next night.

The saving grace was my surgeon came to see me mid morning after the surgery. He said they had some difficulty because the tissue was very thick and fibrous around the root of each vein. So they isolated each one by burning around them. Then they stimulated my heart into AF type behaviour and unfortunately the pulses jumped over the burnt tissue. So they repeated the burn and on the second testing there were no transmitted pulses. He said he expects me to see significant improvement. I was very happy with that prediction. Of course we really won't know until it has all healed up in a few months time but it is definitely promising.

The next step was to get me in some sort of condition to send home. Unfortunately the post-procedure pill-cam had demonstrated 2 haematomas in my oesophagus (explaining one of my pains and why eating hurt like hell) that could potentially bleed given the blood thinning medication I was now on. So I was kept in for a third night. They stopped the clexane injections into my tummy in case it caused my throat to haemorrhage. But the warfarin was continued as that takes a couple of days to take affect and I needed protection from having a stroke.

I went home early on the fourth day. I had to report for a blood test early every morning for the next week and ring for the results that afternoon to determine my daily dose of warfarin. My left arm is covered by a massive bruise from my elbow to my wrist (there was a catheter in my wrist during the surgery to test the blood gases continually to make sure that I was getting enough oxygen despite the breath suspension technique used to stop things moving). It is also swollen because of this and still keeps erupting into an itchy rash. So I have been getting all the blood tests on my right arm and it is starting to look a little worse for wear. My groin developed a massive purple bruise with a hard lump at the entry site. But no pain there after a few days.

Over a week later and I have had several bad episodes of AF. Still. They warned me that could happen but after a week I hoped I would be seeing less of it. It is hard not to be disappointed when it happens. I am still on the flecainide to suppress my heart and that is making me feel like crap. Mind you I felt really crap and was really tired for a week after the surgery. We won't know for a month or so until I ween off the medication how effective it has really been. I am prepared psychologically to go through it all again if need be. I was warned that was very likely. I would rather not, especially now that I know what I am in for. But if it means improvement I will go through it. No question. I just hope to avoid that Mac truck next time.