Trans-septal ablation

[Protimenow]

My electrocardiologist told me that I'm having SVCs (supra-ventricular contractions) about 7% of the time. He said that it's time to get a trans-septal ablation.

This is riskier than the other ablations because the probe/ablation device has to go through a hole that they make in the septum (the tissue that separates the two sides of my heart), then curve down to the area under my mechanical valve, to ablate the nodes that are causing the arrhythmias.

If you've had this type of ablation, I'd like to learn about your experience with it.

If you've got any insights or advice, I'd certainly like to see it.

I'd like to stop thinking as much about my heart (basically getting my head out of my chest)

 

[pellicle]

I hope that the procedure goes well and you can get back some peace.

Best Wishes

 

[Protimenow]

Thanks.

It'll probably be a few weeks from now - if the insurance company approves it.

Peace would be nice...

 

[dornole]

I have not had this specific procedure but they did do a trans-septal puncture when they did the valvuloplasty on my mitral valve. Dunno what to say about it except that I survived. : ) wishing you a good result!

 

[rich01]

My electrocardiologist told me that I'm having SVCs (supra-ventricular contractions) about 7% of the time. He said that it's time to get a trans-septal ablation.

This is riskier than the other ablations because the probe/ablation device has to go through a hole that they make in the septum (the tissue that separates the two sides of my heart), then curve down to the area under my mechanical valve, to ablate the nodes that are causing the arrhythmias.

If you've had this type of ablation, I'd like to learn about your experience with it.

If you've got any insights or advice, I'd certainly like to see it.

I'd like to stop thinking as much about my heart (basically getting my head out of my chest)

It could be worse. I had the text size set too small and I thought the title was trans-rectal ablation. I clicked on it because I wondered how they were going to get to your heart from there.

 

[vitdoc]

Most ablations are trans septal since the ablations are primarily in the Left Atrium. The Right Atrium is accessed via the jugular but there is no direct venous connection to the Left A. So using a venous approach they pop through the septum into the Left. There are a range of different ablative patterns that are used for different issues. A. Fib is a common reason for ablation and the area around the pulmonary veins which enter into the Left Atrium is often treated. For other issues the electrophysiologists try to find the inciting region causing the problem and ablate that area.
Having had three ablations for A. Fib and having no side effects I can say that generally the procedure is not a big deal from the patient's prospective. There are some risks such as aggressive ablation which can cause a fistula to the esophagus. The electrophysiologists are aware of this and take precautions that this doesn't happen. It is bad if it does. Mine worked for a while but I ultimately reverted to A. Fib.. Contemplating a fourth procedure which will be done a different way. Waiting for Covid to quiet down. Or not.

 

[SiestaKeyJimmy]

Hey guys, while I have no specific knowledge concerning “SVCs”, I monitor this site because I’ve had open heart surgery and suffer from occasional “Afib” episodes. Since I’m afraid that they may get worse, I’ve researched the subject and am trying to learn all I can about it.

I’m looking for you guys that have experience or knowledge in this area to give me some feedback. Here’s what I THINK I know on the subject. (Please correct my misunderstandings or expand on my opinions)...

(.1.) Afib treatment starts with drugs, but if they cannot control it…

(.2.) They try “Ablation” (access is through your arteries/veins). This scarring procedure all takes place inside the heart. This is often only 50% (or less) successful and it is very common to have 2,3 or more ablations.

(.3.) If none of that works, a surgery procedure called “Maze” can be tried. A key difference is that the “scarring” they do is on the outside of the heart. (Therefore there must be some type of “open chest” surgery involved to get to the outside. At first (and maybe “still”) this operation involved stopping the heart, using a (heart/Lung Machine).

(.4.) Now some surgeons are performing a so-called “Mini Maze”, access is through the ribs and the heart is not stopped. It is claimed that this surgery has the very best chance to fix Afib problems when all else has failed?

Thanks for your comments.

 

[Woodcutter]

Protimenow: I have had this and concur with vitdoc's summary. I had an ablation for afib years before I received mechanical mitral valve. It was trans-septal because, as explained afib is in the left atrium and that is how you get there. I had another ablation last year (well after the mechanical valve) for what was thought to be a return of afib. The plan was to go into the left atrium the same way and I will say that the EP was right up front about needing to be careful in the vicinity of the valve. As it turns out, what appeared to be afib was actually a collection of flutters which had formed primarily around the mitral surgery scars . . . so the ablation stayed in the right atrium.

My summary thoughts are simply: 1. ablation is (for the patient) so much easier compared to open heart surgery that it's (comparatively!) a nothing 2. a skilled and careful EP/surgeon who knows of any items like valves in the area will be very careful to stay adequately clear

 

[Woodcutter]

Hey guys, while I have no specific knowledge concerning “SVCs”, I monitor this site because I’ve had open heart surgery and suffer from occasional “Afib” episodes. Since I’m afraid that they may get worse, I’ve researched the subject and am trying to learn all I can about it.

I’m looking for you guys that have experience or knowledge in this area to give me some feedback. Here’s what I THINK I know on the subject. (Please correct my misunderstandings or expand on my opinions)...

(.1.) Afib treatment starts with drugs, but if they cannot control it…

(.2.) They try “Ablation” (access is through your arteries/veins). This scarring procedure all takes place inside the heart. This is often only 50% (or less) successful and it is very common to have 2,3 or more ablations.

(.3.) If none of that works, a surgery procedure called “Maze” can be tried. A key difference is that the “scarring” they do is on the outside of the heart. (Therefore there must be some type of “open chest” surgery involved to get to the outside. At first (and maybe “still”) this operation involved stopping the heart, using a (heart/Lung Machine).

(.4.) Now some surgeons are performing a so-called “Mini Maze”, access is through the ribs and the heart is not stopped. It is claimed that this surgery has the very best chance to fix Afib problems when all else has failed?

Thanks for your comments.

I'll add that cardioversion (electrical restarting of the heart) is a very common initial treatment. Might be done before trying various drugs, after drugs, or in concert with a new drug. If I recall correctly, I had a total of eleven of them in 3 or 4 sessions when I came down with AFIB. For me, the AFIB turned on and nothing corrected it until an ablation. For many a cardioversion works; however for a substantial subset it is temporary. Hence what can be successful is the cardioversion to restart/reset with a drug that works for that individual.

 

[Protimenow]

Thanks to all who commented.

Now my electrophysiologist says that they're PVCs, and between 7 and 12% of my heartbeats are PVCs.

Because I have a mechanical aortic valve, they can't go through the valve to access my bothersome node.

I'll probably have this done in the next few weeks.

I had to promise my wife that she'll go before I do -- I just have to make sure that I can keep that promise.