Star Trek

I went to theatre a few days ago to see an Atrial Fibrillation ablation. Hells bells - it was amazing, like something off tomorrow's world.

Ablations are done when drugs and cardioversion have failed to convert the heart back to sinus rhythm. It's a long procedure, done under local (This continues to shock me - imagine lying fully awake for five hours whilst someone burns your heart) and the patient tolerated it really well. They start by pushing tubes up through each femoral vein and then they push a round ended tip into the right atrium. Things get a bit scary (For me anyway - everyone else seemed quite blase!) at this point because they have to then push the tip of the catheter through the wall of the atria, through what would have been the foramen ovale when the patient was in the womb. Creating a hole in the heart seemed worrying to me, but apparently it heals and is fine.

It got really exciting then - they push another catheter into the heart and start to build a 3D image of the patients heart. It's hard to explain, but every time the catheter tip touches the atria, the software recognises it and maps like a geometrical image. It was unbelievable - it takes about an hour and then they have a model that looks a bit like the one at the top of this page, only much clearer. Once this is done, they start the ablation which basically means making lots of small burns on the atria with the aim of interfering with the electrical signals and hopefully prompt the heart to flip into sinus rhythm.

I went to speak to the patient the next day to see what he had thought of it all - he was bright as a button and only remembered small bits of what had happened (A little bit of midalozam seemed to have helped)

Then, today I got a bit upset in clinic. I think of myself as quite a tough nut as far as people go - I am useless with animals but I tend to be fine with people and not much upsets me.

An old chap came in with his daughter. His heart had been going a bit slowly and so it was recommended that he had a pacemaker. Unfortunately he was deaf and did not speak much English. He had also lost his wife a few months ago and was understandably very down. As he left the room, after not speaking all through the consultation, he came up to me and and said that it is important to love one person for all of your life and that when you have loved someone all your life and then they die, you want to die and go with them. Sounds a bit naff when I am writing it, but it made me fill up. Crying in front of the consultant is not a good look!