After AV node ablation and pacemaker implant.

[cali111]

I have not posted for sometime as I only had this procedure in December 2018. Although considered a success by my EP it is not a complete success by me. I feel as if I have spent three years going in a circle (this I told him) as the breathlessness is not resolved. He is going to cardiovert me with Flecainide on board to see if he can restore sinus rhythm. As I am now in waters that I know nothing about I have to go along with his suggestion but did not think it was possible to do this? The breathlessness is to due with the dynamics of my heart changing due to the ablation of the av node. My heart has no structural defect the only problem has always been the Adfib.

[BobD Volunteer]

Sorry cali but I'm confused here now. If you have had pace and ablate procedure your ventricular rate should now be managed by the pacemaker so cardioversion should not be needed. Yes the atrium can continue to fibillate as we all know and you may well be aware of this but your pulse should be that of the PM.

[cali111 in reply to BobD]

I too am confused. I will wait for his letter because he did comment on an echo that was done at the same time as the ablation part, but as I am very deaf I have trouble following his explanation, but although I feel a lot better and am convinced without the procedure I would not have seen Christmas as I felt so ill I returned to see him to see if I had any options. I will chase him up for further comments. I did not ask yesterday as he was running an hour late and looked very stressed. He is a well respected man in his field and so other bring him their problems. I did not think a cardioversion could be done. Still we live and learn. My ankles swelled and he gave me furosemide to try and correct this problem but it is only had a limited success. I have not been surprised if I have fallen into the small amount of people for who this procedure is not successful as these things happen to me. The last EP did not want to know and my regular cardiologist was the same as I am sensitive to most drugs, and am described as "tricky" so at least this guy is willing to try.

[cali111 in reply to BobD]

I am pulse regulated so I too am confused. I am booked for a TOE next Thursday and a cardioversion if the clot has resolved. I am in unknown territory. Will update as and when.

[Hidden]

Hi cali111

A couple of months back you mentioned your ventricular rhythm was irregular. Is that still the case?

I imagine cardioversion in your situation could (briefly) restore normal sinus node function. Whether that could be called sinus rhythm and whether it would have any diagnostic or lasting clinical benefit after P&A, is a puzzle.

Is there any suggestion that you might have that 3rd lead you previously mentioned?

[cali111 in reply to Hidden]

I did ask my GP to write to the EP regarding having a three lead pacer but as I said he did answer but I did not really hear him. I got the impression that the problem lay differently and was probably due to the thickness of the heart walls being different as I have hypertension for over 30 years. I think that he is hoping to restore sinus rhythm for a couple of months and then ablate my heart from the back if the clot is still there or if it has resolved a ordinary RV ablation. This is if I am substantially better when in sinus rhythm. My GP said that a three lead is used for problems arising from the filling of the ventricles and not the pumping action. So what do I know!

[CDreamer]

Hi Cali - I have been following your posts as I am still pondering the AV node ablation so I am sorry you are not happy with the outcome.

I notice you say several times that you don’t always hear what your doctor’s are telling you so therefore you don’t always understand. Is there anything either your doctors or you could do to rectify this? Is there a LOOP connection in the surgery? Can you take someone with you who can hear and take notes or could the doctor write things down for you. It seems a very basic requirement to ask your doctor to ensure you have heard what they are saying and which may very well save time and repeated visits in the longer term.

[cali111 in reply to CDreamer]

I did consider asking for it to be written but he looked so exhausted I decided to wait for his report which are usually comprehensive. I do have portable loop but as I have a pacemaker you cannot use one of these.

[CDreamer in reply to cali111]

Aah. Life gets complicated with PM’s doesn’t it.

[cali111]

This is why I had my GP write to him regarding a crt 3 lead pacer. Although I have been described as left-sided heart failure it is an umbrella term used to describe any malfunction of the heart. I do not have anyone who can accompany me to the hospital except my son and as he is autistic it didn t work out. Apparently this problem can occur after a AV node ablation. According to NICES guidelines medication has to be seen to fail before a crt is offered but as far as I am aware crt is not suitable for my problem. The heart gets stiff on the left side and this creates problems after the ablation part. He will send his report to my GP with a copy to me so I will be able to take anything I Don, t understand up with him by letter. I was very taken aback when he said that he wanted to do a TOE to see the outcome of the clot and while I was under anethesia cardiovert me and give me flecanide,and see how we go. I was under the impression that pace and ablate was the end of treatment but obviously not. So I will look for his report arriving.

[cali111]

Thanks for that. He said that he would do a pace & ablate first as it was the least risky. So where we go from here will depend on what he finds next Thursday. I feel worse than Teresa May!

[Hidden]

Hi HappyJo

Great post, thank you. Just a bit puzzled by "closed AV node".