My Heart Transplant Journey: #21 – Cardiac Ablation (Pre-Transpant)

By Phil Liaboe

At the depths of my advanced heart failure, prior to my heart transplant, I was very unstable. I was being shocked by my implanted defibrillator and these events were becoming more frequent. My heart was going into sustained ventricular tachycardia (SVT) on a regular basis and it was decided that a cardiac ablation would potentially help reduce or stop this abnormal heart arrhythmia. I could hardly walk from point A to any point B without stopping to rest. I needed to take a break after tying my left shoe, before I could embark on tying my right.

My team in the EP department at Tufts Medical Center recommended a cardiac ablation as the best option to help reduce or stop the arrhythmia. My EP specialist was a doctor we really liked and respected. He asked probing questions and listened intently to our answers, never interrupting. He wore thick glasses and the eyes behind them crackled with intelligence.

The alternaitve was a procedure called a Ganglian Block. Breifly, a ganglion block is a minimally invasive procedure where nerves in the lower neck are injected with a local anesthetic. These nerves are active in controlling heart beat activity. The intent is to deaden the nerves to a degree to reduce the sudden escalation of the heart rate and reduce or stop my defibrillation events. He patiently explained to us that it has varying degrees of effectiveness toward our goal and may need to repeated over time. It’s not a permanent fix. It is a band-aid type of solution. Given the risks and unknown reward, Lauren and I agreed that the recommended cardiac ablation was the better route. Plus I didn’t like the name “ganglion block”.

CARDIAC ABLATION

A cardiac ablation is accomplished in the following basic steps:

STEP 1: While under sedation one or more thin, flexible catheters are inserted into a large vein, usually in the groin, and guided into the heart.

STEP 2: The heart’s electrical system is mapped to identify the specific area that is causing the abnormal heart rhythm (arrhythmia).

STEP 3: Once the source of the arrhythmia is located, energy is delivered through the catheter to ablate (destroy) a small area of heart tissue. This prevents the abnormal electrical signals from disrupting the heart’s normal rhythm.

To map the area responsible for the arrhythmia, doctors often need to induce the abnormal rhythm during the procedure. In the case of ventricular tachycardia (VT), they may intentionally trigger VT in a carefully controlled setting so they can identify exactly where it originates. Once the source has been identified, the abnormal tissue is ablated using either heat (radiofrequency energy) or extreme cold (cryoablation), depending on which technique is most appropriate.

PERSONAL EXPERIENCE

This was a long procedure for me. More than 8 hours. I was under anesthesia and unaware of any of it. The good news is, it worked! That said there were a couple of aspects of this that were a little rough for me.

Waking up in a room where I had not fallen asleep was not yet something I was accustomed to quite yet. When I woke up in recovery after being heavily sedated for such a lengthy procedure my back teeth were floating. Big time. It reminded me of an incident when I was 10 years old and stuck in a school bus with my lively classmates. We were retuning home to our school in Edina from a day long field trip to the Minnesota Planetarium. I had been horsing around instead of using the restroom as instructed and was late to the bus. That was a very close call. Had I wet my pants as a 5th grader that day it would have been armageddon. Our family might have had to move to Wisconsin.

I was lying on my back and the lighting in the room was subdued. Was that in consideration of people coming out of sedation? Or was it nighttime? I had no idea. I was told not to move. I was, it seemed, in an open area with other patients that were also in various stages of recovery and lying next to a nurse station. I was not in my own room or a closed space per se.

After this kind of procedure, where a large vein in the groin is used to access the heart, the biggest concern is making sure that incision or hole in the groin has begun to heal before the patient can move. I had to pee. Like immediately.

I could hear nurses talking. They were going on about the men in their lives and it was not positive. Since I was told not to lift my head or move I was trying to get the lay of the land by moving only my eyeballs, tracking medical staff going this way and that. It took some effort to get their attention. They kept telling me not to move when I tried to signal or tell them about my plight. Finally one of them handed me a hand-held plastic urinal and said that I could use it as long I did not put any pressure on my abs by lifting my shoulders. If I did that, it could potentially open the plug in my groin that was holding in my blood.

I was covered in a blanket, lying flat on my back surrounded by chattering nurses trying to position this plastic container using only my hands. I was staring at the square ceiling tiles as I fumbled to get key elements situated. Gravity being what it is, the urinal needs to be below the urine exit point or else it will be “clean up at nurse station number 4!”. In addition, the bottom of the urinal needs to remain lower than the top throughout every step of the workflow. I would not say I have a shy bladder, but it took some intense concentration and careful manual dexterity to accomplish this mission successfully. When the jet stream hit the plastic it made a sound not unlike a power washer on New England clapboard.

After some time and with great relief I unvielded from beneath my blanket the nearly half full urinal and handed it off to the pre-occupied nurse. I don’t even recall her looking at me. She just took it as she passed by while continuing to regale her collegues with tales of her horrible live-in boyfriend. I was expecting at least some recognition. There was no spillage.

This is not a complaint. I cannot think of anything else the folks at Tufts Medical Center could have done differently. I guess I could have had a catheter for my urine inserted during the procedure, but I personally don’t think that is a better alternative because what goes in must come out. I suppose a nurse could have helped but how would that even work? Could I actually “walk the dog” with a nurse holding everything in position? So, it’s just one of those little difficulties that ride along with this deal. It is what it is. Gotta just roll with it.

The second aspect to this that surpised me was some fairly significant pain in my shoulders afterward. I remember when I came out of my anesthesia thinking they must have decided to operate on my shoulders. As I became more aware I surmised that the doctors doing the work must have positioned my arms or even strapped them down in such a way that had I been awake would have been uncomfortable. My arm were probably lashed down over my head to keep them out of the way. In any case, my shoulders were very sore for awhile. Weeks.

As I indicated earlier, this procedure worked as advertised. After recovery and life resumed, I was still obsessively checking my heart rate on my Apple watch afraid of it sailing off into VT. Only now once it reached 140 BPM or so, that heart rate climb would just fizzle out on its own. No Valsalva maneuver. No shocks. My heart just came back to a normal rate over time on it’s own. I was still in advanced heart failure and the scarring from the sarcoidosis was catastrophic, but the sustained VT episodes stopped. I was never shocked by my defibrillator after the cardiac ablation. I was stabilized. It was exactly what I needed and it was a godsend.

I have no real comprehension or clue about how any of this was actually done. Even today after all I have been through I still can’t grasp how people can posses the skill and knowledge to execute the complexities of what was done to me. For anyone going through this or considering procedures of this kind it behooves us to be mindful that we are the first generations to have this technology. Cardiac ablation started as something pretty crude in the 1970s and it has evolved through constant improvements over the decades and difficult trial and error. On patients like you and me.

I am so thankful that this was here for me. While I ended up with a heart transplant and my old ablated heart went off to the pathology lab, the last year and a half of advanced heart failure quality of life was vastly improved. And who knows, without it I could have gone into cardiac arrest and would not be writing this today. Just one more in a long list of examples of God’s amazing grace through dedicated people that have made my extended life possible. I am deeply grateful.

For the next post I am going to shift gears a bit and provide a collection of assorted topics that don’t deserve their own post, but are important and might of interest to folks who have read this far.

© 2026 Phil Liaboe. All rights reserved.