My Inappropriate Sinus Tachycardia Procedures – Part 1

My Inappropriate Sinus Tachycardia Procedures – Part 1

My First Inappropriate Sinus Tachycardia Ablation

The same day I met my electrophysiologist, I scheduled my first ablation. At this point, we thought I just had an SVT emanating from the right side of my heart (atrial). So he was just going to go in laparoscopically (through my femoral veins) and spend some time starting my tachycardia to find the problem spot.

Two weeks later was the big day. We were hopeful, nervous, and excited all at once. Could this be the procedure that relieves me of all my symptoms? I was so anxious. But me being the nerdy geek that I am, when I was rolled into the operating room I was in awe at how futuristic and “cool” it was. Large monitors were all over, lots of awesome technology. It was fascinating.

As I had a mask placed on my face and told to relax, I drifted off to sleep. I was awoken 3 separate times so that my tachycardia could be triggered (for this procedure it was believed I needed to be brought from under anesthesia to trigger my tachycardia).

Fast forwarding to the recovery room. I woke up with a lot of discomfort and pain. I had laid on my back during the procedure for about 8 hours. Now I had 5 hours of continuing to lie on my back completely still to look forward to. This is done to keep clots from forming in the femoral veins after the procedure.

It was torturous. This was my experience and others may have a different experience with this procedure. The pain meds I was given were very short lived. I really just wanted to not be laying flat on my back anymore.

My electrophysiologist visited me and said he ablated an arrhythmia. That he thinks my PVC’s may be on the left side of my heart and didn’t have time to look. But that hopefully what he was able to do will bring me some relief.

My First Inappropriate Sinus Tachycardia Ablation Outcome

I was released the same day. Can you believe something so invasive is done as outpatient?! I will never understand the logic. Anyhow, I made it home with instructions to rest and take it easy for 48 hours. No lifting anything over 10 pounds for those 48 hours.

I had taken two weeks off of work thankfully. Because I was barely walking upright after 48 hours. I had horrible bruising and soreness in my crotch area at my incision sites. I know the importance of paying attention to my body. I knew 48 hours was not going to be long enough. Even after going back to work I was still not 100% for another 3-4 weeks.

It was pretty clear in those first 3-4 weeks after surgery that my symptoms had not gone away. I emailed my electrophysiologist to update him on my progress. He took some time to relook at my EKG’s and with my input and his knowledge and experience, he figured out that his initial diagnosis of SVT was more complicated. That my tachycardia was coming from my SA node. Thus, diagnosing me with IST (Inappropriate Sinus Tachycardia).

My Second Inappropriate Sinus Tachycardia Ablation

Within 3 months I was back in surgery having my first ablation to my SA node. My EP’s plan was to be conservative and ablate the SA node a little at a time over a series of procedures to try to stave off getting a pacemaker (because I am so young).

I’m not at all a conservative person, so I was tentative about this approach. I had been living my life at 50-60% because of my symptoms. At this point, I was exhausted, in pain, frustrated, and just wanted to feel better.

I went into this second procedure hopeful and trusting that there would be some improvement. It turns out during the procedure an arrhythmia popped up that had to be ablated and I went into afib and had to be defibrillated.

Mind you, one of my symptoms (not necessarily caused by my IST) is a drastic drop in heart rate. This particular symptom hasn’t even been looked into yet. One thing at a time. My heart rate usually normalizes after a few minutes. I guess it didn’t happen quick enough during the procedure.

Outside of those couple issues, surgery was fine. It lasted about 8 hours.

My Second IST Ablation Outcome

Again, after a couple months, it became evident that no progress in the relief of my symptoms had been ascertained. At this point my EP had me try a medication Corlanor. I will further explain this medication in a future article.

My symptoms were not better, plus I was dealing with severe side effects from the meds. I was starting to feel hopeless. I was on the meds about 6-9 months and then had a third ablation scheduled. We determined at this point it was going to be a better plan for us to handle the ablation of the SA node more aggressively.

At every appointment, my EP explained to me the risks. Outside of me wanting him to be more aggressive, I had to trust his judgment and the process. Above all else, he wanted to be sure of my diagnosis and my safety. “First do no harm” and all.

My Third IST Ablation

I was even more hopeful going into the third ablation. This was going to be the one! The one to relieve me of my symptoms and change our lives.

It turned out to be a very short-lived hopefulness. He was able to ablate the remaining SA node internally, but there was SA tissue external to my heart.

No problem there, except, the phrenic nerve is wrapped around the exterior right side of my heart. It was going to need to be moved in order to get to the remaining SA node tissue.

This required a whole other procedure. So, after just two hours of surgery, I was woken up to learn that not only was there not much done, but I would require further surgery; a more invasive and complicated procedure.

My immediate reaction upon hearing this news was intense depression and frustration. For about an hour I didn’t even want my wife to try to console me. I felt hopeless. This was partially because anesthesia blocks logical thinking. I wasn’t processing things how I normally would.

After about an hour I realized what I was being told was not that nothing else could be done, but that there is more that can be done, but he stopped because we had not had conversation about the combination of other procedures that would need to be done to ablate the rest of the SA node.

What now?!

The necessary surgery would include not only going in laparoscopically through my femoral veins but also through an incision made at the bottom of my rib cage to go in under my breastbone laparoscopically.

A balloon would then be inflated between my heart and the phrenic nerve to make room to give access to external SA tissue. Then, it could be ablated.

What’s the big deal with the phrenic nerve? Well, it innervates the lungs. If were to even sustain a small nick, my lungs would no longer work (well, at least one side of my lungs).

I completely understand why he wanted to stop the procedure and talk to me about what was going to need to be done. It also would have added many more hours to the surgery. Hours my EP had not planned or prepared for.

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