AV node ablation

[mastiff22]

Does anyone know if the recovery rate from an AV node ablation six weeks after a pacemaker implant, takes the same time as other ablations. I wondered as it’s more straightforward and takes much less time, it might not take so long to recover.

[Teignfisher]

Hi

I started back to work after about a month

2 years down the line it’s proven to have been a good decision.

Good luck

[CDreamer]

Good question - will be following the answers.

I am 4 weeks post LV lead revision and still recovering. I think anything that pokes into your heart will cause a reaction and as I age I am finding it is taking me much longer to recover from everything! I have chronic fatigue at the moment which I am pretty sure is caused by inflammatory reaction to the surgery.

[jossikins]

I had an AV node ablation almost four years ago and it has made an immeasurable difference in my life. I am now pacemaker dependent and, although it records occasional episodes of AF, I am not aware of them. Best decision I ever made as well.

[mastiff22]

How reassuring. Thank you so much for your replies.

[JonathanPittsCrick]

I have undertaken many complete AV-node ablations since 1990 and I think this procedure is seriously underrated. It is a simple operation and has a better than 95% success rate long-term with almost no complications. The issue of being pacing-dependent is really not an issue as, once a pacemaker has been implanted for 6 weeks, a sudden failure is almost unheard of. If I had AF, I would definitely go for pace-and-ablate rather than the uncertainty of a complex PV-isolation ablation with its significant complication and failure rate even short-term, and progressively high recurrence rate long-term.

The recovery is generally no more than a few days. The main factor in getting a good symptomatic result is the adjustment of the rate-responsive behaviour of the pacemaker – if this is not optimised for you individually it can leave you quite fatigued or breathless on exertion. It is very important to get this right even if it means several visits to the pacing clinic.

[Teignfisher in reply to JonathanPittsCrick]

I agree with your statement on pace and ablate. Dr Ed Duncan is my electrophysiologist and he supervised my procedure about 2 years ago and I am so grateful I have had it done. I can occasionally feel some bumps at the top of my stomach particularly after breakfast however the relief from not getting severe bouts of AF is fantastic.

Yours sincerely

Mr Mel Capon

[Hardjuice in reply to JonathanPittsCrick]

I’m considering this procedure as the drugs don’t agree with me and I think the timing may be right to have it done

How is the ablation carried out

Thanks in advance

[JonathanPittsCrick in reply to Hardjuice]

Sorry I missed your message – maybe you have already had this done...

The first step is implanting a pacemaker: it is important to choose the right type. If you have been in AF for years and there are no causative factors that can be improved you only need a ventricular pacemaker but if your AF is intermittent or there is significant doubt about it being permanent you should have a dual (atrial + ventricular) pacemaker. Also, if your left ventricular function is seriously impaired (I would say even moderately impaired but this is still controversial) you should have a biventricular (CRT) pacemaker, requiring an extra lead to stimulate the left (as well as the right) ventricle and keep them optimally synchronised.

The pacemaker leads can occasionally jump out of place in the first week or two so I would not proceed to the AV-node ablation until at least month after PM inplantation. It is a relatively simple process requiring usually only a one or two catheters inserted via the vein in your groin (which is about as big as your little finger so there is plenty of room for the catheters – and several more if needed) and no puncture of your atrial septum (which is required for the more complex AF ablation, creating a "hole in the heart", though only a small one). It may take a while hunting for the AV-node (which is invisible on X-ray) but it has a very high success rate first go.

Please also see my reply to CornPoppy , below.

It is very important to keep taking anticoagulant long-term even though your pulse rate will generally feel regular.

[Shepheart in reply to JonathanPittsCrick]

Hi Doc, it took 2 tries to get a successful av node block. I’m feeling better now that I’m off the rate control meds. I have PAF as part of my SSS. The Pacemaker Clinic has me set up to use the atrial sensing as much as possible. How will I know if I need a third lead to prevent the ventricles getting out of synch? How common is heart failure after an AV node ablation? Thanks.

[JonathanPittsCrick in reply to Shepheart]

Sorry I didn't see this. The third lead (for what is called CRT-pacing) is only needed if your left ventricular (LV) function is seriously impaired. This is checked by echocardiogram: if the ejection fraction (EF) drops to less than 35% or you have symptoms of heart failure, especially being breathless on even slow walking, you should consider upgrading. Most patients who have normal LV function before ablation do not develop heart failure or require upgrade but if it is already impaired, it may get worse with a simple pacemaker – so it should be checked.

Sometimes people with long-term AF require diuretic treatment to prevent fluid overload and this can (mistakenly) be called "heart failure", or (more correctly) "diastolic dysfunction" but upgrade is not needed in these cases.

[Shepheart in reply to JonathanPittsCrick]

Thanks so much for your reply, I really appreciate it.

[CornPoppy in reply to JonathanPittsCrick]

Thank you that is very helpful. I have had my AV ablate and don't feel too good yet hoping it will improve.

[JonathanPittsCrick in reply to CornPoppy]

After AV node ablation it is necessary to program the pacemaker to a faster rate for a month or two to stabilise the ventricular electrical response, but after that the pacemaker can be adjusted to the rate you find most comfortable. As I mentioned, it is then very important to get it to speed up the right amount (for you, individually) to allow you to exercise easily. But then you have to actually do the exercise to build up your fitness again after having been debilitated for some time by the AF.

[DawnTX]

I was told it could be up to a year before I am completely healed from that and the pacemaker fitting at Cetera I think when I had about four months, I started feeling better but I’m not 100% yet. I have atypical flutter along with heart failure, and other things as you know, we are all different, but from day one the doctor said, be prepared for about a year of healing