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Pace and Ablate (CRT-D implementation)

I now have my date for my CRT-D implant (15 August).

I'm a little confused as to what to expect on day 1. For example, do they turn on the pacemaker function or do they wait until they ablate the AV Node (sometime in September) ? If they do switch it on wont my heart get confused as it will have two pacemakers giving it a kick (my own and the pacemaker.)

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From what little I know they fit and pace from day one to ensure that it is working properly before they ablate the AV Node. If not you may not have any pace maker! I always thought there was about three months "running in time" before AV node ablation but from what you say maybe not?

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Hi Bob - From what I have gathered the delay in performing the AV Node ablation is down to managing risk. They want to make sure the pacemaker is in, working and infection free before removing the AV Node.

I'll know more after the 15th!

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That was my point. What surprises me is the speed as I thought it several months.



I had my pacemaker several months before I had my avnode ablated. As Far as I know they do it in separate sessions not all together.

They zap the av mode not remove it. In my case if for some reason my pacemaker stops my heart will continue to beat although very slowly, but enough for me to be able to ring an ambulance.


Ogilvie Please will you let us know how you get on? Pace and ablate are distant possibilities for many of us so your experience will be of great interest. I know someone who had the pacemaker fitted and it was so successful that she has never had the AV node ablated. I'm not sure how that works but I do understand that a bit of the node is retained so that you can function temporarily in the event of battery failure.

Very best wishes

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I will certainly report back.

What you might find interesting is my conversation with my EP. I was worried about pacemaker malfunction and he told me that pacemaker reliability is fast approaching 100% and as you say, the AV will still be able to keep the heart going if it has to. My EP felt that the main risk was infection of the wound site, especially after the AV Node has been Ablated (presumably at battery change time).

Watch this space!


Hi Ogilvie,

Some hospitals do the AV node ablation the same day, but as mentioned before, it is more usual to delay the ablation to minimise any risk due to infection or lead displacement. You've probably been told to limit movement of your left arm to try and prevent lead displacement. This is usually only for around the first month to allow the leads to become embedded in the heart.

The CRT-D pacemaker monitors your heart rate and will only pace it if there is a requirement for a higher rate. If it detects your HR is too high it will further increase it and then slowly bring it back to where it should be. That action is called anti-tachicardic pacing. So, during the period between the pm being implanted and the ablation it will only pace the heart if it detects it needs to. After the ablation it will pace the heart all the time.

If the pacemaker fails then the Purkinje fibers have a natural rate between 16 - 40 beats per minute that will keep your heart beating and give you time to get to A & E via the "blues & twos" If you look up Purkinje fibers on Wikipedia it explains it rather well. Apparently the fibers are also responsible for causing the PVC's everyone experiences.

Hope that helps.



I had my 3lead Pacemaker fitted in April 2016 with a node ablation to be performed 6 months later, however in the intervening period I have only had two AF events so have been advised to delay having the AV node ablation. The events I had resolved without any intervention, something that never happened before the Pacemaker was fitted.

Good luck


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