Part 1: Epicardial Ablation

On Sunday my wife and I drove down to Boston which was a story in and of itself with massive traffic jams and a flaming car explosion worthy of a box-office hit. We managed to use the GPS to our advantage to avoid the drama and arrived just in time to enjoy a nice Provençal dinner overlooking Boston Commons and the Public Gardens.

Boston Commons

Boston Commons

The stifling heat and humidity of the past week had finally lifted and Boston was calm and quiet as it prepared for the new week. Boston Commons In the morning I was slated for my 4th heart surgery in 8 months but this would (or should) be the penultimate procedure – an Epicardial Ablation.

After a quick check of vitals I was allowed to walk right into the chilly Operating Room and jump onto the table that would serve as my resting place for the next 6 or 7 hours. The atmosphere seemed relaxed as pop songs played in the background with one of the doctors doing a pretty good Rihanna interpretation. Another young male doctor of similar age to myself was austere by comparison and began calculating the exact placement of the conductive stickers on my chest. Shortly after, the anesthesiologist floats into my field of vision from overhead and within seconds the details and commotion of the room melted away under bright lights.

I awoke in a completely different atmosphere where I had difficulty seeing or talking and my body temperature was so high I thought I was going to implode.
Nurse: “How are you feeling?”
Me: “I’m… soo…. hot. I’m… soo… hot,” I slowly mumbled.
I was sweating profusely with an extreme thirst as if I had just completed a 100k ITT in the desert.
The nurse tries to make me a bit more comfortable.
Nurse: “Your wife is here.”
I immediately get a big grin on my face.
At least 3 or 4 nurses and moving around me making adjustments when one nurse pulls a 6×6″ towel out of my gurney/bed.
Nurse: “I don’t know how this got here,” she says to the other nurses as she holds up the towel.
Me: “Yeah,… I was.. doing dish-es,” I manage to say.

Of course I didn’t remember any of this (except for being crazy hot) but my wife told me about the towel incident 5 days later when we finally got home. I laughed for several minutes – clearly a fan of my own humor.

Once I cooled off, I was wheeled into the ICU where I would spend the next 3 days. It was spacious and since the ICU is setup for just one patient, my wife could stay as long as she wanted at any time of day. One of the first things they did once I was in the ICU was to put on some compression socks (which I’ve never tried before) but apparently that wasn’t enough as the nurse then put on a futuristic “boot” that covered my ankles and calves. Each boot was connected to 3 air lines powered by a compressor that would inflate the lower air chamber at the ankle, followed by the mid calf and upper calf. The massaging action took about 20 seconds and then the boot deflated and the same process would begin on the opposite leg. After I started to become more aware of my surroundings I said to to the nurse:
“These boots are awesome!”
“Really? Everyone hates them!” the nurse replied.
“No way. It’s really pleasant. Plus, they are stylish. Can I take them home?” I asked.

Covidien Kendall SCD Sequential Compression System

Covidien Kendall SCD Sequential Compression System

I would wear the storm trooper compression boots for 3 days straight.

Strangely enough, just about everything hurt except for my chest. My upper back and shoulders were in immense pain. The nurse thought that it could have been from the position of my head during surgery, but the pain was so bad I could only imagine that the doctors were playing a sporting match of soccer with my head in between the steps of the procedure. Additionally, my throat felt as though I had been swallowing gravel off the pitch. I was already on morphine but the pain was still hard to handle at times. I usually felt the best about 20 minutes after a fresh injection of morphine but once administered, I couldn’t get any additional pain medicine until in wore off 7-8 hours later. During a period when I was feeling better, I peeled back the covers and had a look at the damage:

Epicardial Ablation Aftermath

Epicardial Ablation Aftermath

Later more leads and ECG stickers would be added but the main area of interest is the coiled up section of tubing. This is basically a drain that allows blood to be removed byway of a pigtail catheter from within the epicardial sac due to the trauma caused by the procedure.

The entire post-operation recovery process would have been largely pain-free were it not for the entourage of technicians that would creep into my room every 4-8 hours to drain any blood using the pigtail catheter. Usually I would be feeling great but as soon as they drained the liquid, the pain would start. Each heartbeat was rough as it rubbed against inflamed areas once the liquid buffer was removed. However, the referred pain proved to be the worst with my back and neck in agony. One group of technicians who snuck in at 1am were determined to fill the 90cc syringe – which they almost did but afterwards each breath caused so much pain that it came with a chorus of moans and groans. DSC_1272The nurse had given me a fresh injection of morphine just 20 minutes prior so it was too late to upgrade to something stronger. It was 1:30am and I’d have to stick it out until the next scheduled pain medicine at 8am. After an hour of groaning, I simply fell asleep due to exhaustion.

A few times, the doctor who performed the operation came to check on me. A man of few words, he said that the procedure was a success in fixing the Ventricular Tachycardia and was glad I was feeling generally well.

By Wednesday afternoon things were looking up. They removed the stitches that held the catheters in place on my right leg (similar to the previous procedures) but this time they had a catheter up both the artery and vein in the right leg and stitched them into place. The left leg also had a catheter at one point but it was removed during the procedure. The trend continued as I slowly began shedding hardware. The pigtail catheter drain was finally ready for removal. I figured this would be painful since apparently there was a wire inside my chest to facilitate the draining and they keep the wire extra long “so we don’t lose it”. Yeah. The EP assured me that it wouldn’t be very painful.

The first step was to take off the large sticker that was covering the coiled wire on my stomach. They use a very strong glue (see the orange colored stain on my stomach in the above photo) to adhere it to the skin but it was almost impossible to remove. He asked the nurse if there was any of the “orange glue remover stuff” that he couldn’t remember the name of.
“Is it like that ‘Goo-Be-Gone’ that you can find at the hardware store?’ I asked.
“Pretty much! It’s orange… has a funny name…” he explained.
We finally tracked it down and removed the sticker.

After removing a few stitches that kept everything grounded it was time to get the wire out.
“Do you guys have any wire cutters?” the Electrophysiologist Technician asked the nurse.
“Clearly we should have stopped by the hardware store first,” I added.
Once we sourced the wire cutters, the fun began as he started to pull the wire out. The wire that he began to pull out appeared to be a 1.2mm stainless-steel (black anodized or DLC) derailleur cable.
Wincing, I ask, “Is that stainless steel?”
“Hmm, I think so,” the EP Tech says as he pauses then continues pulling.
I can feel the cable unraveling and snaking around my chest as it seems to be making a “zip”-ing sound as it grinds along a rib or two. A little over a half-meter of the cable is removed before we literally hit a snag. The pain is tortuous while he’s pulling and the visuals combined with the sensation is making me nauseous. A nurse who isn’t typically assigned to my room gets summoned in from the hallway to help out. After much pulling and prodding around, the meter long cable is finally extracted. I’m shown the cable close up:
“You see the large hook at the end? That helps to keep it in place. But you see the knot here, that caused the problem in getting it out,” he says.

I felt much better once all the hardware was out and by 8pm I finally got out of the ICU and moved to the ‘regular care’ cardiac floor.

By 4pm the following day, I was discharged and drove home with my mother and wife as I felt most comfortable driving in city traffic out of the three of us.

While the operation was a success it was the information we received just prior to being discharged that was the most confusing and difficult part of the entire week. [Read on here for Part 2]

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3 Responses to Part 1: Epicardial Ablation

  1. dpetalas says:

    Horrific, J. Was that ride in France you previously chronicled the first occurrence of V-tach you were aware of, or had this aleays been out there unknown to you? Youve accomplished some amazing endurance climbs / rides in your day. Hope this surgery finally resolves the problem once and for all!

    • thewaywardcyclist says:

      I’m not sure Dan. I don’t think Tourmalet was my first episode, but it definitely was the first big slap in the face that let me know what the problem was. I’m really not sure at the moment, but it’s possible that it can be traced back more than a dozen years ago when I stopped racing, or earlier. One doctor thinks I could have had a viral infection in childhood, but it’s hard to say since he often speaks of textbook possibilities without really referencing or considering my own case.

  2. Emily says:

    I’m so glad I happened to come across your website. I’m 24 years old, and suffer from frequent pvcs (>50,000/day) and runs of tachycardia. I’m scheduled for an endocardial/epicardial ablation next month, and it has been really hard to find a patient perspective of the whole ordeal. This will be my third ablation, but I’m nervous about the recovery from having the epicardial approach. I’ve followed up to your most current posts about ultimately needing an ICD. I’m so sorry to hear that, but I hope it has helped you go back to living your life. I was very involved in fitness prior to all of my issues, and the hardest part has been not being able to exercise. Anyway, I just wanted to say thank you for posting such a detailed and honest account of your surgery. I feel alot better knowing what to expect. Best wishes to you. Take care!

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