Defibrillated!

Above is the latest physical manifestation of my condition: the welty burn mark of a defibrillator paddle on my right pectoral.

The backstory: Monday May 19th I was carted off to the cardiac cath lab at U Penn for a follow up electrophysiology study (EP) to determine if the first round of radio-frequency ablation had been a success. Briefly, an EP study is a standard cardiac catheter procedure, in my case the catheter is threaded into a vein through an entrypoint in my groin, it snakes up into the heart and from there it gathers information about the state of things.

For my condition the electrophysiologist "paces" the heart, trying to induce ventricular tachycardia, first with electricity, then with drugs, then with a combination of the two. The hope is that I am un-inducable and then I get to go home with a clean bill of health and start my life again -more or less. That did not happen.

First I produced unsustained V-tach, minor things lasting a few seconds. Next were a few longer runs of sustained V-tach, and finally a seemingly endless run. The last run I was in VT for about 30 seconds when Dr. Marchlinski starting fretting, and ordered the defibrillator prepped. First he waited a bit to see if I would come out of it on my own. As anyone who's watched a made-for-TV medical drama you know there is a specific order of commands before defibrillation. In my case the technician pulled the trigger on the wrong command. I suspect I got hit at the moment I was starting to come out of V-tach naturally. I've been in V-Tach a few times and never had to be defibrillated. Furthermore normally when they defibrilate a conscious person they hit you with sedation right before they defibrillate. My nurse was in the process of injecting my IV when I got shocked, so I felt the full voltage with zero medication. It was pretty bad, the equipment around me had not been pulled away so I was slammed into a monitoring unit about six inches above my head and chest. When it was over the first thing I asked was if I still had all my teeth. I can't say its like anything I've ever felt. Apparently the technician was new, when it was over Marchlinski gave him a serious dressing-down.
So the upshot of this EP study: All the remaining origin sites of the VT were on the outside of the heart, so no ablation was done. Dr. Marchlinski wants to go in from the outside, performing an epicardial ablation, a proceedure that has only been done since 2000. It requires going in under the sternum, and is a full day of surgery with full anesthesia. Dr. Marchlinski is confident about the location of the site, it is far away from areas of the heart that might be damaged by epicardial ablation, and he thinks it will be successful. He claims a 100% success rate for all epicardial ablations he himself has performed (the national average I looked up is 84%)
After that he is definitely recommending the ICD, as with all V-tach patients there is no guarantee that there won't be a relapse. One thing we learned with the accidental defibrillation is that I won't go into the continuous loop of shock-V-tach-shock that Dr Marchlinski was worried about before.
So my return visit is now scheduled for the week of the 2nd of June. With both the surgery and ICD it will be 4 to 5 days in the
hospital, and wil likely require more recovery than my past visits. The ICD limits activity for the 6 weeks post-implantation in
order to allow the leads to "bed-in" to the heart.