Atrioventricular Nodal Reentrant Tachycardia Catheter Ablation at Papworth Everard Hospital – England
After Jessica’s previous appointments with Dr Sergio Bara at Papworth, he decided to proceed with an Ablation. Jessica suffered a cardiac arrest in the ED department at Ipswich Hospital 3rd August 2015. She had visited the ED department 13 days after giving birth to her son Lewin. She became unwell with pulsating neck vein, persistent cough and was breathless. Her heart rate was 160 beats per minute.
Jessica was in a coma after her cardiac arrest, she suffered multiple organ failure and Sepsis. During her time in Hospital, she also suffered a Hypoxic Brain Injury. This is her story, a journey through the NHS. This post is about her (AVNRT) Atrioventricular Nodal Reentrant Tachycardia and her Catheter Ablation for that Arrhythmia.
The History – My letter to Papworth Hospital Cardiology Department confirming Jessica’s agreement.
“I am writing on behalf of Jessica who we have discussed the treatment options with from your letter 13th April 2016. We have explained that the doctors at Papworth believe the best way forward would be to perform an electrophysiological study. This would be to try and see whether there are any inducible arrhythmias which she understands.”
“She also understands, should you find any inducible arrhythmias then your plan would be to perform an ablation on the day to try and prevent them from recurring. I previously sent you our own medical review which the family commissioned. I thought it useful for you to understand Jessica did not have 15 days of worsening palpitations before admission. She did not present peri-arrest at Ipswich Hospital. She had started to experience symptoms on postnatal day 13. At first, manifesting as the onset of exertional dyspnoea at around 10m of walking on flat, and a reduced exercise tolerance of 1 flight of stairs. On Sunday 2nd August 2015 she additionally noted the loss of appetite and a persistent dry cough.”
“By the evening she was pale and clammy and we were sufficiently concerned to seek medical advice. After a call to 111 we were advised to attend our local Ipswich hospital. Doing so at 23:49 2nd August 2015. Jessica’s cardiac arrest was 04:43 am 3rd August 2015, exactly five hours later.”
“The precise timeline and clinical picture of the events leading up to her deterioration are still not clear but you will have noted she had a variety of drug treatment shortly before her PEA cardiac arrest. Please accept this letter as confirmation we are in agreement with your proposed strategy. Having discussed it with Jessica, it is understood and Jessica can confirm she is in agreement on the day if you wish to discuss it with her directly.”
1. The Appointment Jessica’s procedure was booked 5th August 2016 at Papworth Hospital. She arrived at the Varrier Jones Ward, Papworth Hospital reception two hours before her appointment and was booked in. Once she was gowned up and in bed, two nurses discussed her history and asked her about any allergies. Then they discussed the process during her ablation.
2. Pre-op Discussion Dr Sergio Bara came and spoke to Jessica about the procedure and soon after she was wheeled down to the cardiology clinic with her family following. Before Jessica went in, we all offered her words of comfort and support and I must admit, I was more nervous than her. She remained determined to get this done. She was then wheeled off down the corridor while we waited outside.
3. The Procedure Jessica was gone 50 minutes during her Ablation and then a nurse came out of the clinic and advised the family it had all gone well. Jessica appeared ten minutes later and looked relieved and happy. She explained she was positioned flat on a bed. Doctors and nurses with multiple computer screens were around her. She said they put some tiny wires on my leg and explained what they were doing.
“I didn’t feel much or have any pain. I do remember someone was saying “stop stop stop” and then they carried on again. This was later explained by the Doctor as him instructing the other clinicians to stop the radio-frequency treatment while he repositioned the catheter.”
He later came to Jessicas’s bed and confirmed he had been able to induce an arrhythmia, it was indeed AVNRT. He then went on to explain the treatment area for the ablation was very close to the AV Node in her heart. Therefore it required very careful positioning of the catheter and application of radio-frequency treatment.
4. After the ablation, Jessica was resting in her bed and she was offered some food. To date July 2017 Jessica has not had any recurrence of an arrhythmia and is continuing with her rehabilitation for her brain injury. I took her back to Papworth Hospital in November 2016 and she underwent an echocardiogram which demonstrated an Ejection Fraction (EF) of 67% which was described as normal heart function. EF is described by the cardiologists as the heart muscle function. Pumping function.
Jessica has over the last year continued with her rehabilitation at the IcanHo Centre and is hoping to be able to care for her son Lewin who is now two years old. Unfortunately for Jessica, she has lost her regular employment in a building society and her relationship with her partner has finished.
She now lives at home with her parents and is hopeful over time she will regain some of her cognitive skills which have been affected by her brain injury.
This story and record of a patient receiving catheter ablation is a success story I would like to share with all those who may be considering the procedure for whatever reason and I am in no way am an expert. However, with the experience and discussions I have been involved in over the last two years, I do feel I have gained some insight into the procedure and outcome of those involved in catheter ablation. It is apparent from my discussions with cardiology experts that those suffering from intermittent or sustained arrhythmias do face the dilemma or pharmaceutical or electrical ablation.
5. Outcome In plain English do I take prescribed drugs for many years? or do I opt for radiofrequency catheter ablation? All can say is, in my daughter’s experience who was only 24 years old is that it was successful. I also know other people who have had successful catheter ablation. Those who have contacted me since Jessica’s treatment have never experienced persistent arrhythmias, so I can only say in my view it worked for Jessica. The doctor stopped all Jessica’s medication after her Ablation. She was taking Amiodarone, Bisoprolol, Ramipril and Warfarin. On her leg, Jessica had six tiny holes where the catheter had been inserted. She kept a plaster on for a few days.
Atrioventricular Nodal Reentrant Tachycardia (AVNRT) does seem to be the most common type of reentrant supraventricular tachycardia (SVT). Figures vary, but I have read online 75% of cases occur in females. So please always seek professional cardiology advice but I hope by sharing my daughter’s experience it helps someone to decide their treatment pathway.
If you would like to listen and watch the view of a medical expert who performs these procedures, please watch this video. It’s from the British Heart Foundation.