Another ablation or perhaps a pacemaker?

[jerseygirl49]

Some might remember my earlier posts on this forum. My husband had his first ablation mid March. He "sailed" through it and didn't have any real side affects just all positive. He very gradually got back into his exercise routine although was never able to run more than 15 minutes on the treadmill whereas after last cardioversion (Oct 2017) and prior to the onset of permanent AF (June 2018), he was running for 30 minutes (twice a week). Still that didn't really bother him and he accepted that it didn't matter; I'm sure he did things just as he should, cut back on alcohol but permanent AF returned 1 August after just over 4 months. Devastated - we both are and his breathing is much worse this time, as is his tiredness. He also says his brain isn't working properly - insufficient oxygen getting to it, making him forgetful and not being able to concentrate. NHS appointment to see consultant not until mid November but I've booked a private appointment to see same consultant so that we can ask some questions and have more than 3 minutes with him. My question is - why an ablation when a pace maker can do the same thing or can it? We were seriously considering paying privately for the first ablation - if we had I think we would be feeling pretty cheated with it only lasting 4 months. Do we pay for the 2nd one and will it last longer than 4 months? The thought of having to wait another 7 months is so depressing. Any comments gratefully received.

[BobD Volunteer]

A pacemaker alone will not stop AF I'm afraid although it may enable drugs to slow it down without the risk of it going too low.

To have any permanent result an AV node ablation to burn out the heart's natural pacemaker would be needed a few weeks after the pm was installed. Even then the left atrium may still decide to fibrillate at will although the PM would control the ventricular rate and should improve symptoms.

Since this is an irreversible step it is generally regaraded as a last resort so a second ablation may well be required. I needed three before my AF was terminated fully 11 years ago BUT I continued to have other arrhythmias for which I have just had a fourth ablation.

[jerseygirl49 in reply to BobD]

Thank you very much for responding to my enquiry so quickly Bob. This is something we will be asking my husband's consultant about. There is so much I have to learn - my husband has always said to me that a pacemaker would be the last resort.

[jerseygirl49 in reply to BobD]

Bob, I've just seen a load of posts on exactly the same subject from 5 years ago. There is a lot to absorb but I hope I can understand it better once I've read the comments a few times and perhaps 5 years on there have been further developments with pacemakers.

[AvrilB]

Hi, After 10 cardio versions and 2 ablations during a period of 22 months, all of which put me back into sinus rhythm, but unfortunately not for very long each time, my EP said he thinks we will have to accept that I am one of the unlucky ones that can’t be kept in sinus and he would not do any more ablations.

He said ‘as a last resort’ he feels the best way forward for me would be to have a two lead CRT-P pacemaker implanted and an AV Node ablation. I was in persistent AF and was very symptomatic.... Medication, and I think I must have tried them all, never once reverted me back into sinus...

I found it an extremely hard, scary decision to have to make, but I agreed and 5 weeks later in March ‘18 at the age of 71, I had the implant, followed immediately with the AV Node ablation.

My EP felt that it would be a waste of time my waiting 6 weeks to have the ablation as I would not feel the benefit of the pacemaker until ablation was done too, so he would be happy to do the 2 procedures together.

It was the best decision I have ever made. It was, however, explained to me that it would mean I would then be in permanent AF, and dependant on the pacemaker, but I would NOT be aware of it. I felt so much better almost immediately :), and I still do. I was taken off all meds except Rivaroxaban (anticoagulant), and Ramipril (for high blood pressure).

I no longer wake up every morning thinking will I be going back into AF today! I now hardly ever even think about the pacemaker, it is wonderful.

I do hope you and your husband are able to sort out the best way forward, for him, and quickly, and the continual worries that AF brings, can be put to the back of your minds.....

I wish him well, and you too. Avril x

I am sorry I have written so much about me, but I just wanted to share my experience of AF with you, hoping it will help in some way. Good luck x

[jerseygirl49 in reply to AvrilB]

Dear AvrilB

Thank you very much for your post which I have just read out to my husband. I am so grateful to you and for everyone on this forum who are all so kind and supportive. I am very pleased that things have/are working out better for you and thank you again for sharing your own experience. I don't log into this site on a regular basis as I'm afraid my character is such that I tend to start becoming somewhat obsessed about things but whenever I do it usually helps and I have certainly always had positive responses to any post I have made.

So thank you all again. Sending my very warmest wishes to AvrilB.