Pace & ablate, the only option?

[Lillesden]

Dear friends

I having been following this site for about a year & have learnt many useful facts about AF.

My first incident was about 4 year's ago after a heavy Christmas meal & drinks. After a terrible night with a wildly erratic heartbeat I went to see the doc sent me straight to Acute Assess Unit where I was successfully converted by receiving Flecanude through a drip.

A year later a similar incident occurred but this time a different doc was reluctant to send me to the hospital. When i eventually did get there the fkecaniude drip failed. I spent 3 days in the Acute Assess unit where the cardio Docs tried to stabilise my condition. Eventually I left with anti coagulant pills, Riveroxiban, increased dosage of bisoprolol & Adizem. I was given a follow up appointment with a cardiologist six month!s later & there it was suggested that I undergo a cardioversion procedure to 'shock' my heart back into synus rhythm. This was unsuccessful. Back to the E C who suggested that I take amiodene in preparation for an ablation. I didn't like the sound of this drug & so declined & made an appointment to see another EC . His opinion was that Pace & Ablate was the only way to go. As I wasn't very symptomatic I asked for time to consider that option.

A year on & feeling unwell & with chest tightness I recently ended up in the hospital again. After an overnight stay drugs have been increased & a 'water ' tablet introduced.

I apologise for the lengthy pos. . The main question I want to ask is, would it be worth trying for ablation without the pace maker before committing myself to the whole deal? Of course I will listen to the opinion of the E C at my next appointment but would also appreciate advice from you people who had had the experience,

Sorry to bore you with such a long past history.

Lillesden

[BobD Volunteer]

The more info the better we can understand so please don't appologise.

It is important to undestand that ablation for AF and Pace and Ablate are two completely different procedures. The former attempts to block the rogue electrical signals (usually coming form the four pulmonary veins ) to prevent AF. A pacemaker will not stop AF BUT once installed and working, ablating the AV node will disconnect the atria form the ventricles allowing the pacemaker to manage the ventricular rate and therefor your heart beat. The left atrium which is fibrillating will therefore not affect your heart beat and many of the synptoms will be removed.

[Lillesden in reply to BobD]

Thank you so much Bob. I obviously need to do more research & no doubt there will be more questions. Your expertise is greatly appreciated.

[Buffafly]

If you search the site for 'Pacemaker' and 'Pace and Ablate' you will find some posts which may be helpful as well.

[Lillesden in reply to Buffafly]

Thank you Butterfly I will certainly do that.

[CDreamer]

Hi Lillesden - I have had 2 ablations but unfortunately the AF came back after a few years so after increasing episodes I decided reluctantly, to go for P&A. Everyone’s AF is different and what works for one, doesn’t work for another so it is very individual

There is a lot to think about, not least which type of PM to consider as ablating the AV node will make you pacemaker dependant which means that your PM will be working 100% of the time. Many PMs inserted only pace one side of the of the lower part of the the heart - the right ventricle - which after an AV node ablation can increase you susceptibility to the 2 sides of the heart going out of sync which increases the risk of cardiomyopathy which can then lead to heart failure.

It took me a year to come to a decision and although the PM was inserted in October, I still haven’t had the AV node ablation as there a few problems with the PM which need to be sorted first.

Having said all of that, I have had only one episode of known AF since insertion and I felt far better during the epsisode than anything prior - in the spring I had episodes every other day. It may be I stick with the PM which is helping me enormously anyway although is currently set to only kick in when my HR drops below 60.

My advice would be to take your time to understand and consider all of the ramifications looking forward and to research, research, research and armed with knowledge question your EP as to what he will do, timings etc.

Best wishes - CD.

[Barb1]

The Pace and Ablate is irreversible and so far my EP has always said I am too young! Now 64. That is why I have had 4 ablations. I should ask why they are not considering ablation.

[Lillesden in reply to Barb1]

Thank you Barb 1. I will certainly ask that question.