Pacemaker when ablations fail

For some of us who have had ablations, and although effective for a time, have not proved to give lasting relief, it seems the only remaining course of action is for an AV ablation and a pacemaker. However, the af can still continue. In which case is one put onto medication for that, which is a little concerning as the whole reason for an ablation is because medication has failed. It looks as though I am heading in that direction - any comments would be appreciated. Thank you.

28 Replies

  • Difficult question. No a pace and ablate will not stop the fibrillation but it will stop it affecting your life. By pacing the ventricle you will have a regular ventricular rate and steady supply of blood around your body but you may still be aware of the left atrium playing games. How much or little this impinges on your QOL is debatable and highly variable.

  • Hello Annaelizabeth, I haven't had an ablation, I didn't know what that was until I read about it on here. I was diagnosed with AF in June 2015 after having heart palpitations on and off for about 20 years. I was prescribed Bisoprolol 1.25mg and the dosage was increased over time to 7.5mg. In February 2016 I had a pacemaker fitted , and was told the tablets would bring my heart rate down while the PM would keep it at a steady beat and prevent it slowing down too much. I don't want to tempt fate but this has worked well for me, as apart from the odd flutter, I don't get full blown AF now. Reading the posts on here makes you realise how different we all are, what works for one , doesn't work for another, and of course you have to take into account other health issues that people may have. I hope it works out well for you.

  • I am sure your post isn't going to tempt fate - thank you so much for your reply - we are all different you are right, but obviously you made the right decision and that will help me with mine.

  • I've had the AV Node ablated. I have a pacemaker and do not need any drugs other than Apixaban!

    No antiarythmic drugs needed.



  • Thank you for your reply. Can you remember what drugs you had been put on to try to control the af before you had the pacemaker?

  • I already had the Pacemaker for four years because of Bradycardia, so I had on only the AV Node Ablation .

    These are some of the drugs I was on, . Flecanide, Amioderone, digoxin, Sotolol, Metropolo, Plavix and Brilinta tried to kill me.

    Can't think of any others.



  • Tibetan36 - My mother has a PM for bradycardia too, and now suffers from tachycardia. Her cardio wanted to put her on Amiodarone, because he took her off Tikosyn and digoxin after 5 yrs of being on both. But she refused. So now she has tachycardia along with her afibs. She does take metoprolol - 100 mgs 2 x a day, but he was hesitant then to increase her dosage for that in part because it would cause her b/p to go too low. While I am hesitant to see her on Amiodarone, I'm not sure if it is the right choice NOT to put her in it. There is no other options at this point and she has refused an ablation too.

  • Hi, I was put on Amiodarone after my cardioversion failed. I also take Entresto, Zaralto and metoprolol. This combo seems to be working for me so far. I go back to my cardiologist tomorrow but so far more or less so good. Best of luck.

  • Gosh, your mum sounds stubborn lol!

    My AF simply consumed the meds then spat them out lol. I cannot see Flecanide on your list? I guess the only answer is to why mum is refusing the Ablation which for me was a piece of cake!

  • Tibetan - my mother is on metoprolol - 100 mgs 2x a day. She was on digoxin for over 5 yrs and Tikosyn, but the doctor took her off these meds as he felt they were not helping her anymore. She is in losartan, synthroid, Lipitor and Lasix. He wants to put her in Amiodarone or do an ablation, but she wants no part of either of them. I am working on her taking the 20 mgs of lasix as I feel I will have more input with that - just to make her more comfortable and less bloated. She can't exert herself without breathing heavy. She used to exercise on the treadmill, but I don't see how she does that now and this worries me because I don't want her to become a fall risk with weak leg muscles. She is already vision impaired and the afib makes her dizzy at times.

  • 🤔 I'm not a doctor so I cannot advise which way to go. All I can say is the AV Node ablation took away the shortness of breath and has given me a new lease on life. I told the doc they should have done this in the first place. Perhaps your mum needs to talk to a professional to allay any fears about an ablation? It's actually a procedure not an operation. Very non invasive.

  • Did you have to do any p/t afterwards? Was there any down time after the ablation? She is worried about anesthesia also. Don't forget, she is almost 91 yrs old. I guess the less invasive procedures for her now - the better. She does know what's involved with an ablation. The doctor explained it very clearly.

  • Also - she has 3 valve problems. 2 are stretched out and one is very tight (stenosis). So blood is leaking back or not getting through very well.

  • Down time after the ablation is simply resting for about two weeks to give oneselftime to heal.

    At your mums age I guess she won't be exerting herselftoo much. It's sad to hear about a 91 year old with this condition.

    What did you mean by P/T?

  • Physical Therapy. P/t. It is a shame she has this going on. She had afib for 25 yrs, but it hasn't been a real problem until this past year. She's always been so healthy. This is tricky stuff she's dealing with now. It's slowing her down right before my eyes.

  • No physical therapy was needed for me.

    I can feel the frustration with your mum in your words.

    I guess you just have to accept that mum is not going to conform. Such a sad situation to be a part of.

    Do you think mum is tired of everything and just wants to move on in her way?

    I used to work in the field of human behaviour, some dear old folk just become exhausted from the stress and just want to check out. Has your mum had a good life?

  • Tibetan36 - We were just talking about her life the other day! She has had a wonderful life and she said she is so happy she did so many things before, because now she is limited. But she is accepting of her limitations and is happy to listen to her books on tape and her tv shows and our get-togethers with friends etc. Life has changed for her - big time. She always wanted to live to be 100! But that was living at the same pace as she once lived. Not sure if she is still as gun-ho! She is feeling the stresses of her 91 year old heart lately. My daughter hasn't seen her in over a year, and will be coming up soon to visit. She is in the medical field and she is going to see a big difference in her I think.

  • My suggestion would be to accept mum as she is as from what you're saying she is just happy to be who she is as she is at the moment. When there is resistance to get medical help some folks like I said just want to enjoy there life with family and friends around them. I can feel that your a very caring person. Your mum is very fortunate to have you.

  • Tibetan - She has agreed to take the 20 mgs everyday now! We did an impromptu errand today and she did great, so I think she has confidence now that she won't be so limited. I phoned her doctor and let him know. Not sure if we need to monitor her potassium now, but I am just thrilled. A big weight has been lifted. She is very uncomfortable with all her excess fluids. I think she will comply now, as she got pretty scared when she couldn't breath last week. TY for your help! Much appreciated.

  • Quite enough, a real shopping list, thank you for your reply.

  • Hey Anna, this is Sarah, your ablation day twin!

    Really sorry to hear that things may not be so good for you. Do please get in touch as would be very happy to have a chat. You have still not experienced a doughnut on the pier yet!

    Apologies for not "private messaging " but It does not seem to work for me?My ablation did certainly not improve my IT skills!

    With love


  • Hi! This happened to me about 2 years ago. A fifth cardioversion seemed a bit of a waste of time so I had the av ablation and a pacemaker fitted. I must say that I have had no problems with it apart from being denied a very lengthy operation to skin graft a couple of obstinate and painful ulcers on my right ankle. A pacemaker does not enhance one's chances when faced with a 6-hour operation under a general anaesthetic. However, I am still searching out alternative "cures" for the ulcers - the latest being a "dry wound healing spray" (at considerable expense, but worth it if it works). Apart from that blip, I have no complaints and completely forget that I have said pacemaker. Yes, the af is still there, but the pm keeps the heart pumping regularly and any vestiges of the old symptoms are hidden. I still take Warfarin every night but that is a small price to pay. And I swim and cycle and walk long distances without any problems.


  • Thank you for your encouraging reply, so difficult making decisions that are irreversible, really need to have as much information as one can gather, both good and bad, to help make the right one, although of course sometimes it is just Hobsons choice! The best of luck with your stubborn ulcers, I hope the spray finishes them off.

  • I had 2 ablations/was on meds and still had horrible constant AF palpitations that were making life unbearable. After wearing a Holter monitor that was showing my heart was stopping for up to ten beats during palpitations- I was scheduled for a pacemaker immediately the next morning. That was July 2014. I still take Flecanaide, Metoporol and Xeralto but I never feel AF anymore - tests show I have about 2 every few months or so, lasting about only about 5 seconds and that's it. I feel unbelievably different- wonderful! It's like night and day. Good luck!

  • Thank you for taking the time to reply, it is so interesting to read your experience, it seems that although ablations are the way forward for so many, they are still not, in a lot of cases the answer, in the final analyses it appears the pacemaker is, some with a combination of meds, and some not.

  • I've had 2 ablations. The second one worked for about 18 months. In late May, early June 2016 I began having episodes of afib again. Since then the afib has become more frequent, about in afib for 24-36 hours and out of afib for about 24 hours. This is constant. My EP has tried a multitude of meds, I'm currently on Multaq, Xaralto, and Diltiazem. He wants to begin amiodarone or soltalol. Both of those I don't want to take as they are not long term fixes and pretty horrible meds. So my question to those of you with a pacemaker, are you happier now? And is the pacemaker surgery hard? My EP mentioned a pacemaker possibility back in the summer but he wanted to try meds first. He is not for me having a third ablation since they suspect I threw a clot in June 2016 that went to my spleen and that's when he started me on xarelto previously I was on one adult aspirin. I do have a second opinion appointment for May with the EP that did my ablations but I'm wondering if I should wait that long as the afib episodes are nearly every day now. So just looking or opinions on pacemakers. Thanks! I'm 61 years old and have afib since 2010.

  • This is the dilemma that I am now facing. I was told by my EP that there is now significant discussion as to whether patients should be subjected to long term medication, when ablating the AV node and using a pacemaker would give a better quality of life.

  • Hi Annaelizabeth. Have numerous health issues, & cant get blood pressure down so light really fed up with it all, had a pacemaker in Dec.2016. & changed my breathing instantly & it was local anaesthetic used to fit it ,no pain just be careful using arm for a few weeks its fitted Good 😊 luck keep us informed.

    Peggy ❤️

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