I’m at the JR for an assessment prior to treatment.  Although the risks are low, Catheter Ablation does not sound a barrel of laughs.  The nurse tries to put a positive spin on things; “compared with what you’ve been through this will be a walk in the park”.  Ha – heard that one before.

It can be both uncomfortable and time-consuming. Uncomfortable because it involves lying absolutely still for a few hours, while wires are threaded through the body, pushed into placed and used to analyse and then burn (ablate) troublesome heart tissue – all without a general anaesthetic.  And time consuming because before the slash and burn process, a map is made of the heart’s electrical activity – electrical disturbances are deliberately triggered and analysed – and by a process of elimination, those parts of the heart deemed responsible for the disturbance are eventually located.  Then the big gun is manoeuvred into place and the faulty tissue zapped.

That’s a worse case scenario – if they already know what they’re looking for and where, then the procedure might only take an hour or so.  I should be able to go home in the evening but no driving for a week and no strenuous activity for 10 days.  If they completely fry my heart’s electrics and I end up needing a pacemaker, they’ll probably implant one at the same time or the next day.

None of this would particularly concern me if I were fast asleep, dreaming of bones (no – that’s in a previous life when I was a dog).  But a general anaesthetic will interfere with the heart’s rhythm so the entire procedure needs to be done without one.  Some (mild) sedation is possible – so a dozy “why are you sticking that wire up my leg” is entirely possible, as is “ooh that hurts” when they turn up the heat.  As it surely will.

As I read about the process I do marvel at just how preposterous it all seems – like something out of a Science Fiction film (I’m reminded of Fantastic Voyage).  Wires are threaded along veins (usually starting from the top of the leg) until they reach the heart. It requires a lot of skill – push too hard and the heart or lungs can be punctured – too gently and they’ll never arrive.  And once there, each catheter is guided into place with micrometre precision – and for ablation to work the tip of the wire must be in contact with the abnormal tissue.  And this is performed blind – apart from an X-Ray at the end.  So it all seems dead clever stuff.

Not so long ago this process was under threat; in 2006 Ablation therapy at the JR was curtailed for financial reasons – patients, other than extreme high risk, were treated with drugs instead.  So if Tony Blair had turned up at the JR in 2006 he would have been turned away – or so the Press at time would have you believe.  (TB had catheter ablation therapy in 2004; he was a ‘non-urgent case’).  Would I have been turned away as well?  I guess so.  It appears the cost of treatment had been underestimated – so the hospital was making a loss on every CA undertaken. Something clearly changed in the meantime because in 2009 the new Oxford Heart Centre opened at the JR with, amongst other things, increased facilities for CA.  For which I am thankful.

I’m beginning to tire of playing the 18^th C country gentleman/scientist.  Where did they get their patience – and the time?  No Facebook I guess.  Otherwise history might well have shown that Mr G. White of Selborne “Likes” Parson Woodforde.

I’ve amassed 66 nuggets of data – 3 readings a day (early morning, midday and late evening) for 22 days.  I now feel like a real scientist.  Having said that 22 days is a little pathetic by 18^th C standards.  They would probably consider 22 years as just warming up.

Around 80% of the early morning readings show a stable heartbeat – this figure drops to 50% for midday and evening.  I show a table of results to the nurse.  She feigns interest; “we see a lot of these”.

I need a blood test a few days before to confirm my INR; if it’s above 3 the procedure will be cancelled.  It was 1.8 last week so I’m hopeful that it won’t scupper my plans.   As I get up to leave she says, “You’ll need to shave before you come in”.  I feign ignorance; “but I’ve had a beard since I was 18”.  She gives me a look that says she knows that I know what she means.  I guess flippancy is out of place here; cutting myself while shaving around the groin – while on Warfarin – is no joke.