another ablation or av node ablation

[loou]

Should I go for the 3rd ablation or just go for the av node ablation..... I just have a feeling this 3rd ablation won't last long either.....

[jeanjeannie50]

After my third and last ablation I felt so much better, than after the first two, and my AF attacks are now a lot milder.

Jean

[loou in reply to jeanjeannie50]

Thank you Jean!

[pottypete1]

It was suggested to me a couple of years ago that I would most likely need an AV Node Ablation sooner rather than later.

It didn’t sit right with me and I rejected this solution.

I since had 2 further ablations and my heart is now behaving itself most of the time.

I can’t say I will never need the procedure but I have avoided it for the time being which pleases me.

I suggest you have a long talk with your EP.

Pete

[loou in reply to pottypete1]

Thanks Pete!

[CDreamer]

I went with the AV node ablation route - had the PM implanted but the LV lead detached and I am still waiting reattachment, however, I feel SO much better since the PM implant I am reconsidering the AV node ablation. I have had one very short AF episode since September which did not really bother me at all although I was aware of it.

It seems that modern PM’s are now being reconsidered for AF. The implant took about 2 hours under local anaesthetic, I arrived at 1.00pm and was home again by 8pm the same day. The recovery time was much quicker than for ablation only restrictions being not able to raise arms above shoulders for 4-6 weeks.

[Hidden in reply to CDreamer]

This is interesting CD.....what rate is your pacemaker set and what sort of rate did you average when you had AF episodes pre implant ?

[CDreamer in reply to Hidden]

Set at 60 was dropping to low 40’s. I still get tachycardia but not at the rates I used to so I think I have had 1 or 2 times it has exceeded 120 since September, 1 episode of AF, whereas 160-200 wasn’t uncommon before.

[Hidden in reply to CDreamer]

Sounds really promising.

[loou in reply to CDreamer]

Good to know! Thank you

[Kingslip in reply to CDreamer]

That’s bad luck regarding the lead detachment. It’s really important not to lift arm above shoulder height for at least three months. I waited six. All went well and haven't looked back. Fourteen months now and OMG can’t believe the difference. It’s like I never had a heart problem in my life. Despite nearly twenty years of arrythmias and eventually 24/7 rates of 148bpm for last two years before AV node ablated. Can’t recommend it enough. Good luck.

[CDreamer in reply to Kingslip]

I am being very careful this time - 2 weeks in and it’s looking good but the evidence was that it was less bad luck, and more poor placement as the LV lead detached before I even left the ward after the 1st procedure - according to the x-ray which was taken a few hours after the procedure. I only found that out recently though. This time it feels much more comfortable, absolutely no twitches and although HR is elevated above normal resting rate, it’s steady and I feel much more confident this time. My HR has dipped on a few occasions a couple of readings in the low 30’s and 40’s and I haven’t even noticed the PM kick in - which I had been doing.

Your experience sounds really promising, pleased it worked for you. I must say I felt my heart have a few bumps in the last few weeks but I had a virus which always triggers my AF and I’m pretty sure I have been in and out of AF this past week but of course my pulse is steady and I am starting to recover now. I am feeling very hopeful.

Thank you for sharing your experience.

[Kingslip in reply to CDreamer]

Glad all seems well and a bit improved. Not sounding like your AV node has been ablated, so you are not completely dependent on the PM. Long may it continue without any problems. The PM obviously copes with any heart rates below 30bpm but what is controlling the fast rates? Are you still relying on drugs to keep the rates lower?

[CDreamer in reply to Kingslip]

Hi - I’ve not had any HR above 120 since last Sept - which coincides with the PM insertion - strange since I used to have HR of 180 in AF. I’ve not been able to take any heart meds other than anti-coagulants since 2014 as they are contraindicated for another condition which was diagnosed then and I feel I am much better without. The problem for me was POTS + AF + Autoimmune and how to balance them all and the more the autoimmune disease came under control, the POTS improved, when the POTS with Hypotension improved the AF improved and the PM just seemed to stabilise the whole lot. My BP is now an almost constant 117/75 whereas I was lucky to maintain 90/60 prior to 2014.

It just highlights how very individual we all are.

Best wishes

[Buffafly]

I'm watching all posts about pacemakers with interest because a pm is a possibility for me sooner or later. I have only had one ablation and don't want a repeat, partly because of problems with first one and also because I don't want to go through months of recovery only to be back where I started again two years on. Not knowing your history and circumstances I couldn't possibly give you advice but I'm interested to know what you decide and how it works out.

[tibetan36]

Hi

I had one Cardioversion and two RF Ablations which all failed. I then had the AV Node Ablation which has given me back my quality of life. I went from daily episodes of AF to just one episode in six months.

I already had the pacemaker for six years previous due to Bradycardia. The Pacemaker records every heartbeat and that information is downloaded when one has a PM check. The PM is adjusted to suit individual needs. Mine is set at 55 bpm.

The actual AVNA procedure takes approximately forty five minutes.....much less than a RF Ablation.

I’m only on Amioderone for meds....all the others failed.

Life is great. It’s worked very well for me.

[HatsOn in reply to tibetan36]

Hi Tibetan36 - it's great to read a positive story especially one which involves a good result from AV Node Ablation. I've had 3 failed ablations and my EP is suggesting AV Node Ablation next. The hook for me would be if I could lower or even get of medication (currently 12.5mg bisop daily). What are your own thoughts on that? I see you are on amiodorone - did your meds reduce after the AV procedure or stay the same? I'm puzzling on how they would be able to reduce my meds if one is still susceptible to the afib, but just feeling it (or not) in a different way. Thanks.

[tibetan36 in reply to HatsOn]

I’ve been on Flecanide, Sotolol and every other AF controlling drug you could ever think of.

The AF became too powerful for those meds to have any effect.

Amioderone is an antiarythmic medication. It’s the only one that works for me, as I’m on no other heart drugs.

[Kingslip]

Hi there. I underwent six ablations, none lasted. Eventually drugs didn’t work any longer and, I was in fast atrial flutter non stop for the last nine months (I wouldn’t recommend it!). I decided the A.V node ablation and pacemaker was my best option. Pacemaker was implanted and four weeks later the node ablated and PM switched on. I can only tell you it has given me back my life. Attending pacemaker checks are nothing in comparison to living with arrythmias! Eventually it’s yearly. Look at all your options and make the decision that will give you the best quality of life and allow you to get on with it.

Keep in touch and good luck

Li.

[HatsOn in reply to Kingslip]

Hi Kingslip - I'm considering AV Node Ablation but interested to know first of all whether you were able to reduce or come off drugs? Thanks.

[Kingslip in reply to HatsOn]

Hi there. I was on 5mg bisoprolol due to symptoms of heart failure. After the node ablation my EP said let’s do an echo. He was amazed at the results which had gone back to normal with no sign of heart failure. I cut down to 2.5mg and intend to continue very slowly to wean off. He said that my atrium could do what it likes in terms of arrythmias from now on, it won’t affect the ventricles which are now synchronised by the PM so don’t need drugs to do it. I am occasionally aware that something may be going on in the atria but nothing that ever bothers me. If drugs didn’t control the atria before the ablation, they are certainly not going to control it now, so no point really. From what I understand from my EP friend, the atrial arrythmias sometimes just run their course and eventually just give up. The whole point is that no matter what is happening in the atria, it is completely disconnected from the ventricles and, never going to have an adverse effect on them and, it’s the ventricles that keep the heart muscles ticking away happily and, preventing heart failure, which should be avoided at all costs!!

I can honestly say that I have never felt like I have had an event since the ablation, just peace and quiet, no chaos any longer.

Hope this helps. Always here.

Li

[HatsOn in reply to Kingslip]

Wow that's great, thanks so much for this encouraging response. Also you made it much more understandable for me!

[Appelonia in reply to Kingslip]

Dear Kingslip -

The AV node ablation & pacemaker have been recently recommended to me, & I found your explanation so understandable & helpful. I was also encouraged by your experience. I think you posted 3 months ago. Would you mind telling me how you're doing now, and also how long your rest & recuperate period was. Thank you.

[Kingslip in reply to Appelonia]

Hi Appelonia. Nice to hear. The AV node ablation is far quicker and easier. Usually the CRTP is inserted about six to eight weeks before so it is ready to be switched on immediately the node is ablated. Once you are switched on you will have regular physiology checks to adapt it to your individual needs according to your daily activities. Gradually as you are comfortable with it the checks will reduce to six monthly and yearly. Recovery from the pacemaker insertion depends on bruising. Usually it resolves quite quickly, you just have to be a bit careful not to lift your arm on the side of the pacemaker above your shoulder height for three months. This allows time for the leads inserted in your ventricles to bed in and the veins to tighten around them. After that movement becomes pretty normal, though I waited six months to be on the safe side. The ablation recovery is very quick. Mine was done fourteen months ago now. I don’t really think about it being there much now. Technology has improved dramatically now and Medtronic, Boston Scientific and St Jude’s are the front runners for CRTP and CRTD. Ask your Consultant which PM they intend to use. I was advised that if the AV node was definitely being ablated there was no point in three leads, plus it allows more room in the vein in the unlikely event you ever need a lead replacing.

Good luck and keep in touch.

[Appelonia in reply to Kingslip]

Thanks so much for your reply. It was most helpful! I think I will do it as nothing else has worked to control my afib and tachycardia. I am moving in next couple of months so i may need to wait until after I make my cross-country move to begin the process. Thanks for the encouragement & offer to stay in touch. I'm 73; may i ask how old you are? Also I'm in the states; where are you located?

[Kingslip in reply to Appelonia]

Hi there. I am just 70 and I am in the U.K. I have lots of relatives in the States plus a daughter and son-in-law. Both ER Docs. Lovely to hear back. Stay in touch.

[Appelonia in reply to Kingslip]

Hi Kingslip. My PM implantation is scheduled for Monday , July 1. My EP has changed his mind and decided to do the AVNA at the same time. Evidently it is frequently done this way in the US. I know you had your procedures done several weeks apart. Do you have any information on the advisability, or not, of having them done at the same time? Thanks.

[Kingslip in reply to Appelonia]

Hi Appelonia. To be honest in some ways it will be nice to get it all done at once. It can be done here in one procedure due to various reasons, but overall the protocol is six to eight weeks after insertion of the device to give the leads a good chance of settling into the ventricles and allowing the veins to tighten up around them to reduce the risk of dislodgement. If you are really careful though, and don’t lift your arm above shoulder height or lift heavy weights etc., it shouldn’t be a problem. It seems there is also a very slight risk of rejection due to sensitivity, in which case the device would need removal and, once the node is ablated it can’t be reversed. It’s a rare reaction though. In these cases I understand a temporary lead can be inserted until things settle and another device can be inserted. If you have any concerns at all, speak to your specialist before going ahead, and you will be able to make an informed decision and, he can reassure you. I don’t think they would do the procedure in this way if there was a high rate of failure and, a reaction is rare.

Will be thinking of you on the 1st and looking forward to hearing that all went well. Will be here for you anytime. You aren’t alone. X

[Appelonia in reply to Kingslip]

Thanks Kingslip. I've had more time to ask questions & feel comfortable now that doing the procedures together is the routine way of getting it done here. The possibility of doing them separately was because of scheduling concerns only. I think I have my head wrapped around it now and feel "good to go" if a little nervous. I was also able to talk to a person locally who had had it & that helped. I'll update you when i can after the procedure. Thanks for your kind thoughts and support!!!

I need all I can get.

[Kingslip in reply to Appelonia]

Will be here any time. Just be prepared for a bit of bruising around the PM site and it takes a little getting used to it. My doc explained it as being like having a new watch, you are aware of it to start with but after a while don’t really notice it. The best part is being able to feel confident that you will have a life where you aren’t constantly wondering what the day will bring in terms of the ticker! Once the physiologists get the programming right to suit your lifestyle it will be a relief. The device is the longer procedure but the AV node ablation is really quick. It will be done before you are barely aware of it. So, Good luck and look forward to hearing all is well.

[HatsOn in reply to Kingslip]

Thanks so much - that's great and I'm glad to hear it worked for you.

[CDreamer]

I don’t know - because of the lead displacement they put everything on minimum, to just kick in when HR fell below 60. I’ll know more at the 6 week check.