AV node ablation . What does success mean?

[dedeottie]

I have been following recent posts on AV node ablation. I am interested because I am a worst case scenario person and I like to know what may be at the end of the road for me. As I am unable to have any more ablations this may be an ultimate option for me if the good old flecanide stops doing its job.

E.Ps always quote a very high success rate (98%) but rightly see it as a last resort as it is irreversible. However, it seems from very honest posts on here that that high success rate may be on the very optimistic side.

What is success?

It maybe depends on your expectations.

I suspect that my PVI ablation may be on hospital statistics as a success because I now dont have any breakthrough events on the same 300mg dose of flecanide that I was previously on and having breakthroughs. However, i do not in any way count this as success. Maybe I would if I had been able to reduce my dose.

So what would a successful AV node ablation have to look like for me? I know I would still feel the A.F. in my atrium. Fluttering away just like before. I would however hope that my pulse would be regular and under 100 bpm and therefore I wouldnt be breathless or dizzy or agitated . Also because the pacemaker would control the beats to the ventricles they would stay healthier for longer. That would be success for me but is that realistic or not?

There is probably no answer but because of the high success rate claim, I would be interested to know your thoughts. I hope this post makes sense! X

[jennydog]

Hi Dedeottie, I will be interested in any responses to your post as I too face a pacemaker and AV node ablation if my AF becomes unmanageable.

Once I realized that I had an AV node I became fond of it and started to worry about how I would manage without it. What if the pacemaker failed? I read somewhere that they leave a bit so that in the event of pacemaker problems it will still manage to keep you going until you get help.

I understand that they fit the pacemaker first. I know a lady who had the pacemaker fitted and is so well that she has retained her AV node.

Best wishes.

[BobD Volunteer]

OK I'll be honest here in that I'm on the edge of my knowledge but here goes.

Success depends as you suggest on what you expect from it. Ablating the AV node cuts the link to the ventricles which do the main pumping operation. Left = body and right= lungs. Both have a residual pumping response so you won't drop dead if the battery in the PM goes flat although your heart rate may fall very low leaving you very ill.

Ablating the AV node is a success. What you may not be prepared for is that you could still be aware of the atrium fibrillating away to itself and if you feel this then you may not think it a success. I do not think there is any way round this to be honest. I mentioned recently that I know one lady who has had two additional ablations since her Pace and Ablate yet is still troubled by the small furring animals playing tag in her chest. OK your ventricle will be paced and you should not have such feelings of fatigue, fainting etc so that may be what you are looking for.

So in conclusion technically the AV node ablation is a success in that it disconnects the two chambers of the heart allowing the PM to take over running the important bit. Will you thereafter be symptom free? Most likely not but you should feel healthier.

[Maryjcox in reply to BobD]

I am having av node ablation augs29 I already have a pacemaker but I am scared to death.

[Hidden]

Hi, I sympathise with your dilemma. I had a CRT-D for 8 years and flutter ablation with PAF. This degenerated to 100% AF and I began to experience breakthrough resulting in a shock. AF ablation was not an option and I had held out for some years against AV node ablation as its irreversible, means I'm dependent on the pacemaker and prevents me from benefitting from future advances in treatment, if any. Given the choice of this versus increasing likelihood of more shocks with disruption to normal life, I finally went for it. Told of a high if not total success rate and assured that my residual beat would be enough to keep me going if the pacemaker failed, it turns out now some 4 months after the op, which required three attempts to complete ablation but otherwise was a straightforward operation, the advice about residual heart beat is not strictly accurate and my symptoms continue unabated. Would I have AV node ablation again? I guess it's all about prevention than cure/relief, so yes I would. Everyone responds differently according to morphology so, after a long frank discussion with a sympathetic consultant to discuss pros and cons honestly, the final decision is probably best left to your instinct. Good luck.

[dedeottie]

Thanks for your honest reply. Do you have a regular pulse? I would expect to still feel fluttering but would hope that my pulse taken in neck or wrist, would be regular. You are so right, everything about dealing with A.F. is a dilema since nothing is 100% successful. It makes decision making so hard. X

[Hidden]

Hi again, I'm afraid my pulse remains as irregular and chaotic as ever - double ectopics, heavy thumps, fluttering interspersed with periods of steady rhythm and rates varying from 72 to 100 bpm. I had expected my re-synchronisation pacemaker, free of interference from the AF, to do its job and control rhythm and beats to a pre set 62 bpm rate, but sadly not in my case. It makes me suspect that either the AV node ablation was not complete or, as I begin to think more likely, the heart's electrics have found a way around the scar area. But this is all so individual and dependent on pre existing factors that it's impossible to transfer experience to another patient. As I say, a long frank discussion with your consultant is needed before deciding.

[donnajak in reply to Hidden]

I also have had the av node ablation. I can still feel the afib flutter but that is minor. I have unrelenting ectopics, as many as 17 to 20 per minute. The result of these seems to be the same shortness of breath, dizzyness with walking or any activity, and constant tired feeling. Cardio doc adjusted my bp meds thinking that might reduce the thumping. Didn't work. Go back for pacemaker adjustment but not until Oct 12. Haven't been able to convince Dr that this is more than just an occasional thump. Just received my new pacemaker monitor. Hoping this device will show the extent of the problem as it transmits it's daily report. Time will tell.

[dedeottie]

Ok thank you. How frustrating for you. Maybe something else could be done to help? It really helps to have real life experience on this. Yes, if the time comes , long discussions with the E.P. will be happening. Once again , thanks.x