AV Node Ablation

[Caratacus]

80 years old in Sept and still plagued by afib. Pacemaker fitted in May 2021 and awaiting next step which I’m sure will be AV node ablation – last stop saloon! But is this the only option? The last ablation in 2013 lasted 5 years and possibly longer if severe Mitral regurgitation hadn’t triggered it. AV Node ablation, shortest, easiest and cheapest to keep you out of Hosp! (fire and forget!!) But are there other options? Standard ablation (I’ve only had one in 2013) – AV node ablation – Epicardial ablation – FIRM ablation – Radio frequency ablation – Ventricular Tachycardia ablation or Junctional (Hybrid) ablation. I could always ask them to replace my Mitral Valve and Maze procedure at the same time but that’s about as much chance as England winning the FIFA world cup.

[CDreamer]

Hi Caratacus - my husband, now 87, had similar dilemma and was in persistent AF about 2 years ago.

He has similar problems to yourself but at that time - also Aortic Stenosis. Cardioversion failed so he was told that ablation was unlikely to help.

The bigger problem for him was the Aortic Stenosis causing Heart Failure worsened by AF so the choice was TAVI - Aortic Valve replacement but they wanted to see if NSR could be maintained prior to TAVI therefore the only option was Amiodarone - which worked for him. It took something like 2 months for Amiodarone to have an affect but NSR has been maintained since June 2019 after 2 years of persistent AF.

Myself - I chose Pace and Ablate but the ReSynchronisation Pacing Therapy worked so well for be I didn’t go ahead with the AV node ablate.

I wouldn’t give up hope and I would explore all your options. I think we have this perception that nothing will be available but I have recently had excellent, very rapid care for something else entirely but with hardly any waiting time. It will depend upon where you live and the capability of the medical care available in your area, unless you are prepared to research, seek out the best and be prepared to travel and possibly pay?

Sometimes we need to be proactive.

[Lee-J]

I had AV node ablation three years ago after long history of a fib, flutter and finally 148bpm for two years non stop! Heart was failing, EF was 35%. Medtronic CRTP inserted. Post ablation it was like resurrection. My baseline is 80bpm and with activity up to 130bpm. Immediately post ablation my EF was 55%. Two years later EF was 70%. It’s been three years now. For me no drugs would work. Nothing would slow my HR down. My atrium can do what it wants now, the ventricles are protected and that’s the vital thing. Hope this helps , for me it was a no brainer. Just have yearly physiology check. Good luck and best wishes!!

[Caratacus in reply to Lee-J]

Thanks Lee-J. That's an uplifting reply and eases some of my concerns. Have to be realistic at 80!

[Jetcat in reply to Lee-J]

Nice to know you’re doing a lot better Lee-J👍