Why do some people develop HF after av node ablation and pacemaker and some don't. They say about 40% do.

[Possiemae]

Hi, I am new. I had an av node ablation and pacemaker two months ago and feel really good. I was not informed of the possibility of developing AF at the time or about the biventricular pacemaker which I did not get. What determines why some people get it and some do not. How does the EP determine who needs the biventricular and who doesn't.

[Buffafly]

You could also ask this question on the British Heart Foundation forum as most people who have ‘ablate and pace’ here already have AF. BHF have a PDF leaflet on pacemakers too.

[Possiemae in reply to Buffafly]

I have afib, but was wondering about the development of heart failure. Is there a common thread that links people who develop it after the implant.

[CDreamer in reply to Possiemae]

Please see my answer below.

Some people with AF do develop HF because of an enlarged atria but not everyone, I don’t know the numbers but my understanding is there is a link. If the AF and HR is controlled then the HF may resolve. My husband developed Aortic Stenosis and heart failure after a few years of persistent, thought to be permanent AF as cardioversion failed. He was converted to NSR with Amiodarone and remains on a maintenance dose and HF and Aortic Stenosis have resolved.

It has been shown that about 40% of those who have an 2 lead PM implanted go on to develop HF which is why my EP insisted on prevention rather than wait and have to do a revision once I developed HF - but he really had to fight for it for me as it is not NICE approved as evidently you need to wait until you have HF to get the re-sync PM.

HF can be caused by AF but HF may be present prior to AF and so may also cause AF - case of which came first?

[Possiemae in reply to CDreamer]

Thanks for your reply. How would I know if I am developing HF?

[CDreamer in reply to Possiemae]

Symptoms - constant fatigue, breathlessness on slightest exertion and then diagnosis would come through echocardiogram and various other tests, an EF measurement of 35% or less is an indicator.

[CDreamer]

My EP was adamant that a bi-ventricular be fitted in preparation for AV node ablation because in his experience there was a ‘high probability’ of HF within a few years without - caused by only one ventricle being paced - the ventricles go ‘out of sync’.

As it happened the fitting of the re-synchronisation pacemaker worked on it’s own for me and I haven’t had the AV node ablation AND only 2 very minor episodes of AF since implantation - June 2018.

[Possiemae in reply to CDreamer]

Really wish my EP would have done the same. Thanks for your reply.