Post Alcohol Ablation Questions

[MartinKennedy]

:wink: I am scheduled for my ablation at MGH for October 21. Dr. Fifer has done 55 so far with extremely good results. His center only has a 20% rate of pacemakers needing to be implanted compared to studies that indicate closer to 33%. I am working at preparing for surgery as well as having questions about follow-up. Do folks stay on beta blockers after the surgery? Has anyone been through this who is also dealing with recovery from alcoholism? While not a drop-down drunk I was drinking a fair amount and it had become a problem so I stopped over ten months ago. I am a little worried about the morphine for pain as well as the alcohol. I am told the ethanol evaporates and does not get into my system and should not be a problem for me. I have never had morphine before and just worry it will have a longer term impact on me.

All in all I feel good about my decision. I can always have a myectomy if this is not successful. I just cannot adjust to thinking about open heart surgery, having thought I would never need this kind of intervention.

Marty Kennedy

[Sarah]

Dear Martin,

I know what you mean about getting your mind around the situation. But it gets better with time and you will come to terms with it. Try to focus on the here and now and feeling good as much as possible. And taking the best care of yourself. AA has a lot to say about being in the moment and it all applies to dealing with HCM, too, in terms of taking it as it comes, not to worry about the finish, just the here and now.

RE: morphine. AA probably has some wisdom about that too. Perhaps a family member can be in charge of dispensing the painkillers when you get home so you don't have to worry about. You will need some pain killers, see if over-the-counter works first if you feel the need to avoid morphine. The ablation just puts a small hole in your groin, so you probably aren't going to need the big guns.

take care,

S

[MartinKennedy]

:o my recovery process is really quite an adventure and actually taught me that I can do something that is difficult. Honestly, the pain and misery in my life for the past few years seems to have prepared me for this next adventure...one more step along the way towards a fuller spiritual life. After what I have been through (aa is just one of several things) this procedure seems relatively straight forward and it is all about healing. So many of my friends and family have suffered from incurable illnesses that I feel profoundly grateful to have this opportunity. I feel very much that my Higher Power is at work here and that this force in my life wants me around longer...

Marty

[Reenie]

Marty,

I had a different type of ablation done in April. They used radio waves to burn an electrical pathway in my heart. I can tell you about my experience with my ablation and pain. For me they put 3 catheters in, 2 through the groin and one through my upper right chest. After the procedure I stayed overnight for a night, don't know how long for Alcohol ablation, though. The only pain medicine I took was when I had to lie flat on my back for a few hours. My back got stiff. After I was able to sit up I didn't need pain killers. Again, I'm not sure how much of my experience correlates with Alcohol Ablation, but thought I would share. I also have to add that I don't have HCM, my husband does.

Reenie

[Lisa Salberg]

Pain meds will only be needed for a short time, I would not worry about getting hooked on the meds. You will likely not even know you had the meds as you are on medications to calm you and let you "feel no pain" during the procedure.

Re the % of pacer implant - 33% were the first numbers published. Most centers with ample expereince are at about 10-15% pacer implant - You have some indicator to know if you may need a pacer. They are:
Right Bundle branch Block - most will get a pacer
Left bundle branch block - some will get a pacer

If you have no pre exsisting heart block then the odds are very low that you will need a pacer.
HOWEVER - I am seeing a growing trend at ICD implants post procedure -I do not know all the reasons yet...but it is happening more often then Pacers??

RE the Meds - you will likley stay on the meds but may lower the dose.

Lisa

[swinand]

Lisa, are you saying that after myectomy or ablation a good number of patinents end up with an ICD? I have read that these operations MAY disrupt electrical impuses and cause fibrulation requiring pacer or ICD. Do you have any updated statistics reflecting what you are seeing lately?

Steve

[TammyC]

Ok, that scared me!
Nobody told me that you may need an ICD after an ablation! I just had an angiogram to see if I qualify for the ablation and the doctor said that there's a good chance. I ended up having a hemotoma after the test and am still quite sore. Needless to say I'm very scared of the ablation because I had complications......
What's the difference between an ablation and myectomy?

[Sarah]

Tammy,

an ablation is when they run a catheter up your artery into the heart and inject pure alcohol (ethanol?) into the obstruction which kills that piece of heart muscle and it melts away.

a myectomy is when the surgeon goes in and cuts that bit out.

s

[Reenie]

Tammy, this is a post from Lisa the other day.

Based on data I heard at AHA - I would not be looking forward to an ablation at this point. Surgury is still the gold standard and with good cause. The infarct created with the ablation leaves tissue that can cause problems down the road - myectomy has a 40+ yr history of no adverse reactions post procedure. Ablations appear to have a high rate of ICD's with appropriate discharges post procedure (about 7% of those implanted). This is a HIGH number.

You are young - I would seek the opinions of either center and I truly feel you are in great hands either way.


http://www.4hcm.org/phpBB2/viewtopic.php?t=2470&highlight=ablation+icd

Reenie

[TammyC]

Thanks Reenie
I'm really confused now....Dr. Woo, here in Toronto spoke very highly of the procedure. She said that the only reason why people were hesitant was becuase it was new and didn't have a lot of data to support it's benefits but was confident with the patients she had that it was much easier than the myectomy. Apparently a patient was coming up to her 5 year post alcohol ablation and was medicine free, feeling great....I guess I have a lot of thinking to do.....I appreciate the info....

[Sarah]

tammy

this is why anecdotal info is not really helpful. some individuals have an ablation and are great altogether. others can have two and still have problems. this is why aggregate data is so important -so we can see what happens to _most_ people.

ablations are so new that the aggregate numbers are still small. however, they are increasing rapidly and the major centers are looking at the results very closely.

i would certainly pay close attention to what is being reported for groups over individual results.

s

[TammyC]

Thanks Sarah
I don't know what I'm going to do! :roll:

[Sarah]

age 50 is what most specialists consider the breakpoint. if you are under 50, then you are probably healthy and strong enough for surgery and you will not have to worry about any long term issues that may be present with an ablation. it is major surgery, so you should get two doctor's opinions on your worthiness for the procedure. if you are over 50, then the long term stuff is less than an issue.

however, be prepared for all the possible complications of either. long recovery time or icd or icd/pacer etc. think about your life and what is important to you and consider those elements when weighing it out.

take care,

s