AV Node ablation and Pacemaker

[meadfoot]

Has anyone on the forum had an AV Node ablation and Pacemaker. It was one of the treatments to consider when I met with an EP for the first time last week. (have been previously treated by a cardiac consultant for last 6.5 years for AF). Apparently I have a number of arrhythmia's going on which are quite complex. (I never do anything by halves !). No surprise given the horrendous episodes I have, knew something was badly amiss.

Still on meds, Flecainide and Atenolol, but EP is sending me for an Echo and a Angiogram to check my arteries are ok as Flecainide is not good or particularly safe if I have artery problems.

I had waited 10 weeks for an NHS EP appointment even though I was on the cardiac care ward for 5 days in the early summer and told, every day, that an EP was coming to see me about an ablation but no one came. I paid to see an EP last week and mentioned it to him, he said no one had told them I was there! Not very satisfactory all round.

I was surprised an Ablation was not given higher prominence in the hour long EPconsultation, as I assumed it would be the treatment of choice by EP's. Very balanced consultation I thought with lots to think about. An Ablation procedure in my area has a 1 year waiting list. All the pro's and con's were spelt out to me very clearly.

So I sit and wait (yet again) for nhs hospital to send appointments for the tests. Very unnerving.

Any personal experience of AV Node ablation would be helpful please, I have read the useful AFA pamphlet.

Thanks.

[BobD Volunteer]

There are others better able to tell you about that but what I do know is that pace and ablate a) makes you pacemaker dependent and b) doesn't stop the AF. What it does is to isolate the AV node and therefore the heart's natural pacemaker and use a machine to pace your ventricle. You therefore have a normal pulse so do not suffer the weakness and other sides of the AF but may still be able to feel the atria filbillating in your chest.

Bob

[meadfoot in reply to BobD]

Thanks Bob. Regards Dee.

[Offcut]

My Angiogram went well but they found I was allergic to Iodine after the procedure. I went grey and my BP went to my socks.

My Last Ablation (Third) was to see if that was going to be the route for me. I am seeing my EP next month to see what they are going to do. I keep getting Tachycardia and arrhythmia at the same or different times.

I am on 2 x 80mg Sotalol 1 x 125 digoxin and 12 others for other conditions

[meadfoot in reply to Offcut]

Hi Offcut. Thanks for your response. Good luck with your appointment next month, hope you get some help. Regards Dee.

[Loquitir]

I have had a very long history of AF and arrhythmia but ruled out a pacemaker after seeing the EP consultant. As I understood it there is a risk that you are both dependant on the pacemaker and of course the complications with malfunction.

Sometimes the EP cardiologist needs to take a longer view of treatment so that might mean a number of ablations to remodel the atria to eliminate electrical activity or locations initiating AF.

I started with an expectation that my AF would be cured with an ablation right at the start of RF PVI treatment when it became available but when the cardiologist initially got into the pulmonary veins and the bridge, he found a very complex arrangement and was only really able to deal with one branch of the pulmonary vein and also to eliminate atrial flutter.

Over the following 13 years he undertook another 5 ablations with significant advances in technology and each time there has been incremental improvement and increased quality of life. I don't think it will be cured completely but I can now get on with things which I couldn't do before because of blackouts etc such as going on holiday. The medication I take works very well especially if there is a sudden onset and you take the tablets I find it brings it under control.

So I'm glad I never got the pacemaker because the ablations have delivered an incremental improvement and that's also been managed in combination with dronedarone.

With the huge potential for technological advancement in the area of AF and the more discovery about its genetics, a pacemaker might be an option of last resort.

Your cardiologist would be the best person to advise you how the AF could be improved through ablation and medication vs. pacemaker.