AF Association
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pace and ablate

feeling a little lost and confused, saw my EP yesterday after having two previous ablations for paf and tachycardia, my alivcor shows that I am in af most days with a hr of 117.my EP has given me two options to think about one is a further ablation but to be done under general anesthetic (they had problems with sedation on the last one) or to have pace and ablate, he seems to prefer the pace and ablate option as it should mean that I can come off some of the medication, Bisoprolol and Dronedarone. But to me the pace and ablate seems so final to be left totally dependant on a pacemaker, has anyone on here recently been given this decision to make? please would love to hear from you.

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Sorry I don't know much about it but if you type in pace and ablate in the search box top right of page something should come up .

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Popular subject it seems several posts about P an A recently.

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I saw an EP privately recently. He has advised me of both options. I have never had an ablation and he has some concern as to its success or effectiveness in my case because an MRI scan has thrown up a past myocardial infarction,about which I have no knowledge or recollection. ''''Tis a mystery. He has not ruled out a pace and ablate, but like you I am not keen on the implied dependency on a machine.

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I've had the AV Node Ablation after having two RF Ablations which only lasted twelve months each. One Cardioversion. The AF became too powerful for the meds so the last resort was the AVNA.

It was the best thing ever for me to happen. I have my life back, I can breathe and exercise again. No Antiarythmic drugs with side effects.

I had the pacemaker 4 years before the Ablation so that was no big deal.

I can only say for me that was the best thing ever to happen in this journey with AF.

Cheers

Barry

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I haven't had pace and ablate but for other reasons have a pacemaker. Meds and it have given me a new lease of life gym5/6 days a week five mile walk today.

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I am considering it also and have just taken advice from several people and for me it does look like a good long term and viable option - drugs are not an option for me long term - ablation is a risk with uncertain outcomes so I intend to research a lot further and would advise you to do likewise.

I think it is becoming a more viable alternative to multiple ablations or long term drug therapy but I think we need to be well informed before taking that irreversible very big step.

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If/when I go back into AF then P and A wold be the option for me after 4 ablations. My EP would not consider it before as I am too young ( 64!)

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Pace & ablate has been discussed for me.

In my case I have similar reservations to others because of the total reliance on a mechanical device. In addition, in my case, I am scared to have an implant due to my preponderance to allergic reactions following procedures for my heart.

A doctor has told me that sometimes they can implant a pacemaker to resolve AF without ablating the AV Node.

I also understand that they can implant the pacemaker and do the AV node ablation about 6 weeks later once they are satisfied that the pacemaker is effective.

Pete

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Can a pacemaker resolve AF? Previous postings here have said not. All mine does is speed my heart rate up when it goes under 60bpm and stop the pauses..

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I too am going down this route. Pacemaker fitted 18 months ago and so far only 1 AF event since the 3 lead Pacemaker fitted so have delayed the node ablation until I have further problems . My only concern is QOL afterwards not the reliance on the PM my natural PM is pretty shot anyway!!

Good luck and stay well.

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I too am in this position of pace and ablate being the only option for me too as have had all the Meds and none work well enough and 3 ablations the longest lasting was 5 months. I am sitting on the fence too at the moment as afraid they will find a cure as soon as I have had it done and it is irreversible. I am also reluctant to rely on an electrical device to keep me alive. Although I am in persistent AF at the moment with rhythm changing hourly from slow AF to tachycardia up to 130 I am trying to train my mind to ignore it, not doing great but getting on with my life at the moment. Read all you can, some sites are impossible because of terminology but there are loads out there, read, read and read some more. Good luck.

Brenda🐝

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Brenda

You echo my feelings exactly.

It is all getting very scary.

Pete

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Hi Brenda. I️ have been looking for so long to find anyone faced with the decision of pace and ablate. Am being told no drugs out there that will control my A fib and A flutter. Currently doing 144 all day and evening and sometimes getting some respite during the night on 5mg Bisoprolol daily. Went in for my fourth ablation back in May and my aorta was punctured. Arrested, rescussitated, major Open heart surgery to repair and placed on life support. Much worse since. What was your decision in the end or are you still agonising?? Whatever is going on for you at the moment, I so hope you are managing ok.

Take care xx

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Sorry Lee I know this is a bit late in the day but I have only just seen your reply as it was on another thread. What an awful time you had, would love to know how you are now. After lots of ups and downs I suddenly went into sinus rhythm at the end of July last year get lots of ventricular and atrial ectopics and shorts runs of tachycardia but fingers crossed am managing ok at the moment but still anxious about it returning. Not the fittest person in the world but jogging along, well not jogging 😂

Brenda🐝

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Hi Brenda. Thanks for reply. I struggled on doing 145bpm permanently since November last year, being told it wasn’t doing any harm. I finally made the decision to try another ablation. I was in the lab doing 145 but when they pushed the needle through from the right to left atrium the shock put me in sinus rythmn. Sadly it only lasted three days and been doing 145 again since March, so no more attempts for me. They did an echo and it showed left ventricular systolic dysfunction and it appears I am in left systolic heart failure. So, don’t anyone out there think they are safe from developing heart failure from 65 years onwards if they have an arrythmia! I now have no choice but to have a CRT pacemaker device implanted and then have the AV node ablated. It’s the only way to protect the left and right ventricles now and keep them pumping adequately to circulate blood effectively.

If I were you, I would ask your Doc or the hospital you are under to do regular echocardiograms and as soon as the ejection fraction starts to reduce (it shouldn’t fall below 50%) have the pace and ablate asap.

I have now been told that doing consistently fast rates will result in ventricular dysfunction and the older you get the more at risk you are of sudden cardiac death and that heart failure should be avoided at almost any cost! The earlier the device is implanted the better chance of an extended life expectancy. The pacemakers are much more advanced now and even after AV ablation there is still enough left to allow 40bpm and time to get to a medical facility. In reality I think we can safely say there isn’t going to be any miracle cures any time soon. It’s a much better option to get one before heart failure sets in, if like me, no drugs are helpful. Finally you could ask about a three lead CRT I understand that way they don’t ablate the node in case correction is decided on at a later date. For me it wouldn’t work as there is no longer any prospect of an Ablation working anyway. The ticker is too scarred now.

Will keep you updated so check that thread!

Take good care. Lee 🤷‍♀️🌈🌈🙏🙏

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Thanks for all your kind replies and words of advice, it's nice to know that others in the same situation have some doubts as to which route to go down, have a little more time before I have to make a decision so will do a bit more research on the options. Thankyou

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Hello Brenda

Lee-J has sent a response to your email 8 months ago but it came to me as he replied immediately below my reply.

Hope you are well Pete

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Just saw this Pete, a little late but I have replied to Lee now. Thanks. I am doing ok still lots of ectopics but trying to tune them out of my mind. Hope you are doing ok.

Brenda🐝

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Hello Brenda

Glad you are doing OK now.

For me yes much better run of NSR but like you I still do get a lot of ectopics.

Pete

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Hi Lee-jay. I also had an aortic puncture during my last ablation. You are the only other person I know, to have this happen. In my case, it seems it was more of a scratch than a puncture but enough to scare my EP and I was kept in hospital for observation until they were sure all was well. They wont do another ablation that involves piercing the septum so if my AF returns it will be pace and ablate for me too.

It sounds as though you had a much worse experience than me. I hope you are recovered from the shock. X

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Also, I have to say that it was one possible complication they didnt warn me about when signing the consent form!!

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Hi Dottie. My goodness someone else, thank goodness you didn’t end up with major surgery. I was,told I had only four minutes to live as my lungs filled immediately with blood, thank goodness there was an excellent surgeon in the lab who put chest drains in immediately to drain off enough blood until they got me to theatre. It’s been a long road and still not there yet, but, call me nuts, but I had another attempted ablation two weeks ago but the needle going through from right to left atrium was a shock to the heart and put me in sinus so it was abandoned. After an echo it seems to long period of time I have now been doing 145bpm since last November has caused left ventricular systolic dysfunction, so I have no choice but pace and ablate now. At least I can say I tried everything drugwise and procedures, so I won’t have to look back and wonder if it could have been avoided. The only ablation I wish I had avoided was one five years ago when the EP ablated away with ineffective mapping. After that my drugs were just constantly increased and even 240mg sotalol wasn’t doing it! Can’t go back though so onwards and upwards!!

Please stay in touch. I hope your sinus lasts and lasts, it’s horrible though isn’t it living under that cloud of threat all the time. Hopefully that’s something that may change with the device. They are more sophisticated and MRI safe now, quite small and the node will still allow 40bpm should there ever be a rate failure of some sort, so time to get help.

Take good care. Lee

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My goodness you have certainly been through the mill. The only consolation is that you now have no choice other than pace and ablate so there is no decision to make.

When I get to the stage of uncontrolled AF I will have no qualms about having pace and ablate myself. The only other option is to stay in fast AF and damage my heart. I have done all the research so that if that time comes I will be mentally ready.

I hope all goes well for you and I will be following your progress with great interest. You certainly deserve a break. X

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I've just posted exactly the same question. Having the same decision. Did you have it done, did you get any answers?

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