Ablation vs Pacemaker

I am waiting for my 3rd ablation and have been advised that if this is not successful this will be the end of the road for my treatment by ablation. I asked what would be the next step and was told that it would be ablation of my natural pacemaker and the insertion of a mechanical pacemaker. I have read up on pacemakers therefore and find that thousands are implanted each year very successfully. My query is why we go through ablations (those of us with intractable AF!) when a pacemaker would be a quicker solution. I feel I am missing something which is probably more complicated! Can anyone please help me with the benefit or their knowledge or experience. I would be very grateful.

15 Replies

  • I am also faced with the possibility of having 'pace and ablate.' if my recent pvi (ablation) is not successful so the answers to your question will be of great interest to me too. It seems to me that a lot of the implanted pacemakers are just defibrillators but with 'pace and ablate' you are 100% dependant on the battery. That's scary. Now that I know that I've got an AV node I've become very fond of it!

    There is a new pacemaker which is like an AAA battery and is injected into the heart. That sounds interesting and is an example of new innovation.

    One thing that I need to know - if you are dying, how does the battery react?

  • Thanks Jenny for your reply. I feared that what my last resort would be was a battery operated affair!! I think you have the situation just right otherwise there would be no point in the 6 -hour + ablations. Scary!!!! Anne

  • Ooh. I forgot to mention. I read an article about a man who was on the Liverpool Care Plan and everyone had expected him to have passed away sooner. It seemed he had one of these special pacemakers which was keeping him going. The problem was there was no one in the hospital who knew how to stop the pacemaker. Presumably one could carry this information on a medic alert chain or something similar?

  • There is not simple answer but in general one must understand that a pacemaker will not stop the AF which happens in the left atria, Most pacemakers operate on the left ventricle so while it would stop the fatigue and the allied symptoms, the fibrillation in the atria would still continue and you would be able to feel it. You would also be reliant on the machine as the AV node is ablated a few months after the pacemaker has been implanted. Pace and ablate is a last resort which can restore quality of life but it wont stop AF. I know people who have had this procedure and still feel their heart flapping about even though they can live a more normal life.

    Hope that helps.

    Oh and maybe soon pacemakers may be able to perform more intricate control but don't hold your breath.


  • Bob and Anne, thank you both. I had an ablation because my quality of life had deteriorated so much and I couldn't see an alternative. If things again deteriorate then I am going to have to go with my EP's advice.

  • You and I seem to be in the same bed Jenny. I had an ablation for Atrial Flutter in 2005 and was doing quite well until May 2013 when I was admitted to my local hospital by my Gp who was puzzled by my ecg. The cardiologist at that hospital made a clinical error (for which I have received an apology) which plunged me into severe AF (250 bpm) which no one there seemed in a hurry to sort out. Luckily my own cardiologist rescued me at the Specialist hospital I have attended for 27 years and since August 2013 I have had 2 ablations and 2 cardioversions and am waiting for the 3rd ablation. Like many people who live in my neck of the woods I will have to be in a coma before I go back to my local hospital!!!! Rant over!!

  • This prompted me to look up Implantable cardioverter defibrillators which I remember being mentioned when my heart problems first showed up and I wonder if it would not be preferable to ablations except for the battery problem....wonder why not?

  • Because you really would not want one ! Trust me. ICDs monitor your heart and when it stops they deliver a DC cardioversion. If you happen to be concious when that happens it makes your eyes water I'm told. People who I have met who have them seem to be terrified of it going off and spend their lives in fear. Remember that ICDs work on the left ventricle to stop ventricular fibrillation NOT AF and couldn't do that any way.

    Any case ablation is no big deal from my experience once you have got past the fear of the unknown.


  • Encountered your old response to a post "ablation is no big deal." Have to tease you a little here. Now 3 wks post-ablation-still struggling with 2 femoral pseudo-aneurysms and 1 AV fistula-left leg quite painful and disabled. Poor stomach motility--losing weight living on applesauce, white rice, etc. Anti-coagulant and other meds not digesting well so INR is out of range. MD staff says this may last months. :)

  • There is always one isn't there! lol Seriously you are unusual or should I say it is very rare to have such complications. One must also remember that it is often only those with problems who come here and the straight forward cases seldom bother.

    Sure we all get multi coloured groins and I had a fairly interesting bleed with ,my first but none of it was problematic or put me off the next two I had.


  • I was due a Pace and Ablate but they have found my lung disease is worse than first thought so it was cancelled. I asked what happen if the battery fails and I was told that it would not be a fact I would drop down dead, but would not be that functional and should have plenty of time to have it sorted out?

    Be Well

  • Phew..thanks offcut for this information. I am so sorry to hear of your difficulties re pace and ablate and your lung problems. Is there a Plan B that your EP specialist can offer? How are you doing at the moment?

  • I am waiting for a test that is done by specialist that can read images from my heart? But I am still waiting?

    My lung specialist has been very honest and said that she is sorry but they do not have a magic pill for me yet! But with my present rate of deterioration, providing I do not have a major infection again I am looking at 6 to 9 years?

    Going back to the pacemaker though an ablation may work and you may never need another but a pacemaker has to be changed every 5/7 years because it has a battery. so the younger you are the more pockets they have to make.

    Be Well

  • I had 2 ablations many amiodoryn and electrical cardioversions, although my condition improved for a short while but did not stop the Af I started collapsing last year without warning, I was offered another ablation or a pacemaker although was told the PM would not stop the af, I opted for a pace and ablate, the pacemaker was fitted with the intention of ablate in 6-12 weeks later, 12 weeks later I had not had Af,so consultant decided to see whether the Af came back. I was fitted with three lead pacemaker. I have been Af free for 14 months and a couple of weeks ago I visited my consultant, my heart 6 years ago was severely impaired, my heart now is almost normal and have still not had final ablation. The pacemaker has made a vast difference to me and has improved my quality of life 100%. If I knew in 2008 what was ahead of me, I was extremely symptomatic and had numerous hosp stays I would have opted for a pacemaker. A pacemaker can cost 15000 a 20000 so I suspect it is offered when nothing else works.

  • Thanks for sharing your very positive feedback. It really has cheered me. Thank you.....

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