Pacemaker and AV node ablation

[Golfer60UK]

Have had a pacemaker fitted now waiting for AV node ablation.

Wonder how other people have coped with the same procedure

Dave

[RaySyl]

Hi Dave, I was just about to ask the same question. I am listed for Pace and Ablate at the beginning of August and, like you, would love to hear from people who have had these procedures. I have read good stuff about the outcomes but would like to hear other first hand accounts. How long between the P and the A will it be for you, by the way?

[Golfer60UK in reply to RaySyl]

Hi thanks for your reply. It will be 5 weeks after the pacemaker was fitted. I'm told normally between 4-6 weeks before the AV node ablationBest of luck

Dave

[ETFCfan in reply to RaySyl]

Hello, I couldn’t tag you but you may be interested in my answer below.

[rosyG]

Some people here found pacemaker alone did the trick. I’m sure they’ll advise when they see your post

[Golfer60UK in reply to rosyG]

Thanks RosyG

[CDreamer]

Yes - I had the pacemaker but postponed the AV ablation as PM seemed to work so well for me. Had only 3 AF episodes since impkantbin 2018.

[Golfer60UK in reply to CDreamer]

Thank you, sounds interesting

[ETFCfan]

Hello, I had my pacemaker on Wednesday, I’m in permanent fast AF and it’s still chaotic as my consultant describes it. I have an appointment for my Pacemaker check on August 5th and was told the Ablation will be within two weeks after. Not sure when Ill get the date. Feeling reasonably okay after the Pacemaker and feel and hope Im coming to the end of a journey or more likely the start of a new one. All I’ve heard is good reports of this procedure and my EP thinks it’s the answer. I hope it is for you too.

[Golfer60UK in reply to ETFCfan]

Thank you for your reply, like you I have heard good reports on success of the procedure. I can't say I am over keen on being reliant on a pacemaker for control. Will post on here after all over.In the meantime best wishes

Dave

[ETFCfan in reply to Golfer60UK]

I feel exactly the same, guess it’s normal. Mines in now and trying not to think of being reliant on it too much. I’m finding it good to talk about it.

[Alphakiwi in reply to ETFCfan]

Yeh, seems we all go througj this mindgame will i wont i. Its the nature of the best though. When i come semi right after a few nasty weeks i geel so elated and tjink ive beaten it and then bang it all turns to custard again and i say internally bring it on the sooner the better. Its just the process of facing up to reality.

[Adalaide2020]

Hi. Can I ask how young you are? I'm 65 and going down the same route as you and I wonder if I should go for another ablation rather than P and A. I'm in a dilemma even though I have heard positive things about the procedure. I have had 3 ablations so far, and have P afib about twice a week for 24 hrs approx. It's a difficult decision don't you think and this site is a god send I think. Thank you everyone 🌻

[Golfer60UK in reply to Adalaide2020]

Hi thanks for your reply. I am 76 and I thought I was quite fit. I play golf 3 times per week so I can't complain. I had permanent AF and then Atrial Flutter too, after two ablations my advice was to go down the route of P and ABest wishes

Dave

[Adalaide2020 in reply to Golfer60UK]

Thanks Dave. Appreciate your comments. Happy golfing

[Canada01 in reply to Adalaide2020]

Hi I am 67 and been dithering about P&A for a while but already had 2 ablations and tge percentage success for 3rd not good 60% and i cant take anymore meds so have decided to have PM on 4th Aug and ablate i think 4 week later, I still work (from home) at the moment, and i am hoping to be ok a few days after PM proceedure. I feel i have made the right decision for me. Good Luck with yours x

[Golfer60UK in reply to Canada01]

Hi thanks for your views, bit like mine tooBest of luck

Dave

[Adalaide2020 in reply to Canada01]

Hope all goes well for your procedure in August. Please keep us informed. Good luck 🌻

[Golfer60UK in reply to Adalaide2020]

Hi and good morning, I will post on here after the procedure

Best wishes

Dave

[Adalaide2020 in reply to Golfer60UK]

Wishing you well 🌻

[dedeottie in reply to Canada01]

Hi. I am in same place as you . One partially successful ablation , 1 attempted ablation but abandoned due to rare complication. Various medications were initially successful but now not doing as much good so pace and ablate recommended. I know this is the right decision when I am having 1 or 2 long episodes of fast AF every week but then I have periods when I only have 1 every few weeks…. Then I’m not so sure! I suspect the waiting list in my area will be a long list and I’m hoping by the time it’s my turn , things will be a bit more cut and dry . I’m 65.Good luck everyone. X

[RaySyl in reply to Adalaide2020]

Hi Adalaide,

(Do you get fed up with people calling you Adelaide?)

I have had two lots of ablation - two in my left Atrium and one in my right Atrium - which may count as three, I guess? My EP is of the opinion that there is no point in trying a further ablation because the ablatable areas on the left side have been zapped to buggery! I have been in AF, on and off, since last September and thought that I had run out of options until the Cardiac Guy told me about Pace and Ablate. Since there would appear to be no alternative, for me at least, I will go with the P and A and hope to get something of my old "Oomph" back. I am, by the way, a 77 year old bloke who doesn't look, or act my age, as people never tire of telling me. If you haven't done so do read the long article I shared yesterday - it is VERY reassuring.

[Adalaide2020 in reply to RaySyl]

Good morning. My name is Jan actually. Adelaide was my lovely mum and I love the name😉. You do sound young and upbeat and that attitude will help tremendously I'm sure. I shall look for your long post but I am pretty poor on technology so could be a non starter. At 65 I'm still looking for that magic bullet. But I'm realistic too so I shall follow these posts (as best I can) with great interest. Good luck and healthy outcomes to you all 🌻🌻

[Golfer60UK in reply to Adalaide2020]

Hi and thanks for your reply

Best wishes

Dave

[dedeottie]

Hi. Thank you for the post . I will be following the replies with interest as I am on waiting list for the same. Best wishes all. X

[Golfer60UK in reply to dedeottie]

Best of luck tooDave

[Alphakiwi]

A pace maker for me this wednesday. 5 weeks later will be the AV node ablation. My left atria is severely enlarged.Keep me posted ad im about to experience the same track you have already started on Dave. Im just on 79 and been a lifetime athlete. Noticrd aflutter starting seversl years ago.

[Golfer60UK in reply to Alphakiwi]

Hi, I think once you have made the decision, it's get on with it and 'enjoy'.Some people seem to think that at our age we are 'old', I must admit I still think the same as I did when I was mid twenties, but can't obviously do the same physical things. Golf does play a part in my life too.

I will keep posting to let you know how I get on

Best wishes

Dave

[Adalaide2020 in reply to Alphakiwi]

Hope all goes well for you Alphakiwi. 🌻

[RaySyl]

Hello again, Just happened upon this paper whilst doing my home work n advance of my upcoming Pace and Ablate. The title of the article, which I failed to copy, is "Pace and Ablate: The Ultimate treatment for atrial fibrillation?" See what you think about the answer and let me know.

Atrial fibrillation (AF) has become a major epidemic and is associated with high morbidity and mortality.

Pacemaker treatment combined with atrioventricular (AV) node ablation is an effective treatment in patients with atrial arrhythmias and symptoms due to high ventricular rate refractory to pharmacological treatment.1

Another group that benefits from AV node ablation is patients with heart failure (HF), AF and cardiac resynchronization therapy (CRT) with a low percentage of biventricular pacing. AV node ablation has been shown to increase the percentage of biventricular pacing and thus enhance the therapeutic effects of CRT.2

However, AV node ablation is not without risks. Right ventricular pacing induces left ventricular dyssynchrony, which in turn impairs cardiac function. There is also an increased risk of sudden death after AV node ablation.3 In addition, the long-term performance of pacing devices is not flawless.4 Hence the relevance of long-term results after a pace-and-ablate strategy.

The article by Manuel et al. in this issue of the Journal5 describes the retrospective experience of a Portuguese tertiary center with the longest follow-up ever published after AV node ablation. The authors followed a highly varied population of 123 patients who had undergone AV node ablation for a median of 8.5 years (8.8-11.8). Most of the patients presented uncontrolled supraventricular tachycardia that resulted in HF, tachycardiomyopathy, inappropriate implantable cardioverter-defibrillator (ICD) shocks and other severe symptoms related to tachycardia. Ten (8%) patients were treated due to low biventricular pacing percentage.

The most common arrhythmia was AF (65%). All AV node ablation procedures were successful and there were no major complications. Thirteen (11%) patients had previously implanted devices and all the others were implanted at the time of AV node ablation. The final distribution of devices was 90 pacemakers (82%), seven CRT pacemakers (6%), nine CRT defibrillators (8%) and four ICDs (4%).

Unexpectedly, there were no device-related complications during this long follow-up.

The authors report improvements in HF functional class and fewer hospitalizations and unplanned emergency department visits due to HF. There were no differences in left ventricular ejection fraction (LVEF) or left ventricular end-diastolic diameter before and after the procedure. The authors do not clarify the timeframe of these clinical and echocardiographic changes. For this reason, the magnitude and pattern of benefits cannot be fully elucidated.

At the end of the follow-up mortality was 23%. There is no information regarding causes of death.

Despite these gaps, this article highlights the importance of AV node ablation.

In a meta-analysis of randomized trials comparing pace-and-ablate with drug therapy, overall mortality at one year was 3.5% in the pace-and-ablate group,6 similar to the findings of Manuel et al.5 It should be borne in mind that no robust data support survival benefit after a pace-and-ablate strategy.

Elucidation of the causes of death is of paramount importance. AV node ablation is associated with a small (2-4%) risk of sudden death.7 It is important to note that the vast majority of those who experience sudden cardiac death had a significant number of risk factors, including reduced left ventricular function, advanced HF, and a history of ventricular arrhythmias.

Programming the pacemaker at higher ventricular pacing rates (minimum 90 bpm) for the first 1-2 months following ablation has been a way to mitigate the risk of proarrhythmic bradycardia, which can result in sudden death, but pacemaker dysfunction is another possible cause of sudden death. With this concern in mind, many centers postpone AV node ablation until pacemaker electronics are reassessed. Alternatively, a simultaneous procedure like that of Manuel et al.5 would be less burdensome. The vascular access for the ablation catheter could even be the same as for the pacemaker. By not reporting causes of death, the present article fails to clarify this important issue.

The assessment of symptoms, improvement in ventricular function and reduction in hospitalizations and emergency department visits is a matter of debate. Most studies, including that by Manuel et al., included patients with and without reduced LVEF. Patients with reduced LVEF could be expected to improve due to reversal of tachycardiomyopathy or increased biventricular pacing percentage. On the other hand, patients without reduced LVEF could worsen because of pacing-induced dyssynchrony. Some patients could improve by one mechanism and worsen by the other and the final outcome would be difficult to predict.

In general, several retrospective studies, randomized controlled trials, and meta-analyses have reported positive evidence that pace-and-ablate is a valuable palliative therapy for highly symptomatic, drug-refractory AF patients. Many retrospective studies have documented significant acute and long-term improvement in left ventricular function, symptoms, cardiac performance, exercise tolerance, clinical outcomes, and quality of life.

There have been several randomized controlled trials comparing a pace-and-ablate strategy with medical therapy. Pace-and-ablate was effective in controlling symptoms and improving quality of life but showed no benefit regarding death or left ventricular function.

Some meta-analyses have reported improvements in patients with symptomatic, drug-refractory AF. Wood et al.8 found that exercise duration, LVEF, quality of life, symptoms, and hospital admissions improved significantly. Chatterjee et al.9 found in their meta-analysis that in the therapeutic management of refractory AF, AV node ablation was associated with improvement in symptoms and quality of life. In addition, patients with reduced LVEF demonstrated an improved echocardiographic outcome compared to medical therapy alone. However, there was no survival advantage.

For the subgroup of patients with CRT and low pacing percentage the benefit is beyond doubt.10

The debate on the effects of AV node ablation on left ventricular function and clinical outcomes of HF is ongoing and reports of these effects are not consistent.

Meanwhile, in order to avoid the deleterious effects of long-term right ventricular pacing on left ventricular function, biventricular pacing has been proposed as an alternative to right ventricular pacing. CRT significantly reduces hospitalizations for HF and significantly improves functional capacity and left ventricular function, volumes and diameter in comparison with right ventricular pacing.11 The PAVE study12 randomized 184 patients with a mean LVEF of 46% to biventricular pacing or right ventricular pacing following AV node ablation. Both groups showed an improvement in 6-min walk distance compared with baseline. Of interest, the two pacing modalities did not differ until six months after the procedure, when a slight deterioration in the right ventricular pacing group resulted in a significant difference between the two groups. The right ventricular pacing group showed a significant fall in LVEF within six weeks which persisted at six months. On the other hand, LVEF in the biventricular pacing group did not change from baseline values. Patients with impaired LVEF at baseline who underwent biventricular pacing showed the greatest improvement. Furthermore, patients with New York Heart Association class II or III heart failure who received biventricular pacing improved significantly more than those who received right ventricular pacing.

The current guidelines give CRT a class IIa recommendation, level of evidence B, for patients with AF and left ventricular dysfunction who are candidates for AV node ablation.13

Huang et al.14 demonstrated that permanent His bundle pacing is safe and stable in HF patients with AF who had narrow QRS and underwent AV node ablation. They observed a significant improvement in functional class and echocardiographic LVEF and reduced use of diuretics in HF therapeutic management. Current results make His bundle pacing an attractive pacing modality before AV node ablation, preserving ventricular synchrony.

Patients with AV node ablation become chronotropically incompetent. This condition may be corrected by rate-adaptive pacing. While rate-responsive pacing can help these patients to adapt during exercise, it can also elicit an excessive increase in heart rate with possible deleterious effects. Device programming should be meticulous.

A less radical alternative to AV node ablation is AV node modulation. Although the results are less predictable, it avoids the need for a pacemaker and can be thought of as a step between drugs and AV node ablation.15

Ablate-and-pace is a useful and easy therapy but should be regarded as a last resort. It makes patients pacemaker-dependent and thereafter prone to pacing-induced dyssynchrony, pacemaker dysfunction and infection. Although the markers for a worse prognosis after ablate-and-pace are not completely elucidated, care must be taken when choosing the pacing device, particularly in patients with impaired systolic function and HF. For these patients a more physiological pacing modality, like biventricular pacing or His bundle pacing, should be considered.

Conflicts of interest

The author has no conflicts of interest to declare.

REFERENCES

[1]

G.N. Kay, K.A. Ellenbogen, M. Giudici, et al.

The Ablate and Pace Trial: a prospective study of catheter ablation of the AV conduction system and permanent pacemaker implantation for treatment of atrial fibrillation.

J Interv Card Electrophysiol, (1998),

dx.doi.org/10.1023/A:100979...

[2]

A.M. Ferreira, P. Adragão, D.M. Cavaco, et al.

Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation.

Europace, 10 (2008), pp. 809-815

dx.doi.org/10.1093/europace... | Medline

[3]

C. Ozcan, A. Jahangir, P.A. Friedman, et al.

Sudden death after radiofrequency ablation of the atrioventricular node in patients with atrial fibrillation.

J Am Coll Cardiol, (2002),

dx.doi.org/10.1016/S0735-10... | Medline

[4]

R.E. Kirkfeldt, J.B. Johansen, E.A. Nohr, et al.

Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark.

Eur Heart J, (2014), pp. 1186-1194

dx.doi.org/10.1093/eurheart... | Medline

[5]

A.M. Manuel, J.F.P. Almeida, P. Fonseca, et al.

Long-term outcomes after radiofrequency catheter ablation of the atrioventricular node: the experience of a Portuguese tertiary center.

Rev Port Cardiol, 40 (2021), pp. 95-103

[6]

D.J. Bradley, W.K. Shen.

Atrioventricular junction ablation combined with either right ventricular pacing or cardiac resynchronization therapy for atrial fibrillation: the need for large-scale randomized trials.

Heart Rhythm, (2007),

dx.doi.org/10.1016/j.hrthm....

[7]

R.X. Wang, H.C. Lee, J.P. Li, et al.

Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation.

Clin Cardiol, (2017),

dx.doi.org/10.1002/clc.22600 | Medline

[8]

M.A. Wood, C. Brown-Mahoney, G.N. Kay, et al.

Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis.

Circulation, (2000),

dx.doi.org/10.1161/01.CIR.1... | Medline

[9]

N.A. Chatterjee, G.A. Upadhyay, K.A. Ellenbogen, et al.

Atrioventricular nodal ablation in atrial fibrillation a meta-analysis and systematic review.

Circ Arrhythmia Electrophysiol, (2012),

dx.doi.org/10.1161/CIRCEP.1...

[10]

A.M. Ferreira, P. Carmo, P. Adragão.

Cardiac resynchronization therapy in patients with atrial fibrillation - worth the effort?.

J Atr Fibrillation, (2012),

dx.doi.org/10.4022/jafib.435

[11]

S. Stavrakis, P. Garabelli, D.W. Reynolds.

Cardiac resynchronization therapy after atrioventricular junction ablation for symptomatic atrial fibrillation: a meta-analysis.

Europace, (2012),

dx.doi.org/10.1093/europace...

[12]

R.N. Doshi, E.G. Daoud, C. Fellows, et al.

Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (The PAVE study).

J Cardiovasc Electrophysiol, (2005),

dx.doi.org/10.1111/j.1540-8...

[13]

M. Brignole, A. Auricchio, G. Baron-Esquivias, European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA), et al.

2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).

Europace, (2013),

dx.doi.org/10.1093/europace...

[14]

W. Huang, L. Su, S. Wu, et al.

Benefits of permanent his bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction.

J Am Heart Assoc, (2017),

dx.doi.org/10.1161/JAHA.116...

[15]

J. Tebbenjohanns, B. Schumacher, T. Korte, et al.

Bimodal RR interval distribution in chronic atrial fibrillation: Impact of dual atrioventricular nodal physiology on long-term rate control after catheter ablation of the posterior atrionodal input.

J Cardiovasc Electrophysiol, (2000),

dx.doi.org/10.1111/j.1540-8...

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[Golfer60UK in reply to RaySyl]

Hello and good morning. Thanks for your very detailed message, I have been through, looked up that I can't understand, and my conclusion is:

1 Don't frighten one's self

2 Life is better after the procedure than before for most people

3 It's a yes from me to go ahead

Once again many thanks for the information

Best wishes

Dave

[playcards in reply to Golfer60UK]

Usual disclaimer - this was my personal experience only BUT after my node ablation, within an hour, I felt like a normal person again for the first time in two years (and have stayed that way.) They tried not giving me a sedative for the actual procedure bur I grumbled so much that after a while they did (relief!). My heart was totally unreliable and just going bananas, so I have no qualms about relying totally on a nice reliable pacemaker instead!

My one complaint is that although I have rate response on the pacemaker, it comes with the basic factory settings so might be restricting me. The pacemaker clinic keep offering to tweak it but then they bottle out at the last minute. There is a research project going on somewhere specifically to address the issue of personalizing response rates etc. Does anyone know anything about this??

[Diddyd]

Hi Dave

I am literally 3 weeks out the other side. I know when I was looking for people to share their experiences, they were few and far between. It was suggested that they improve so much that they no longer use the forums. 🤞🏻 I am hoping that is the case.

I am 51 and it took a great deal of agonising after many hospitalisations in the last 9 months to go with pace and Ablate. It all started by having to stop fleccainide as it caused my heart to go to 30bpm. Then I went into AF big time and continue to be in it. This led me to have heart failure symptoms with a drop in LVEF to 30% (normally about 55% ) and realistically I was in a corner about decisions. Drugs did not work either. It has been a long and hard journey for me and you will probably see from my previous posts.

I have a 3 lead CRT-P pacemaker fitted for biventricular pacing. It was fitted in March but not switched on. As it was a 3 lead it took about 2 hours under a local anaesthetic only (you can also have sedation).

I was supposed to be high priority with no more than a 4 week wait for the ablation. It ended up being 12 weeks due to Covid back logs etc and I coped as best as I could with my symptoms.

The node ablation was again local anaesthetic but was not as straightforward as they had hoped so then gave me sedation which knocked me out completely for a very short time and I came to with the procedure completed and the PM switched on.

On return to the ward and getting hooked up to heart monitor, my heart had gone back into AF at a high HR. Now this is extremely unusual! The success rate of a node ablation is way above 90% so most people only go through it once. After the procedure you lie flat for 4-6 hours with someone checking the puncture site in the groin. Then if all is well you will be able to get up but probably stay in hospital overnight.

As I was in AF, they set the PM to 50 bpm in the day and 40 bpm at night to see the AF breakthrough. I was discharged the next day and told I would be listed urgently for a repeat node ablation. Unfortunately, I collapsed at home 10 days later and had to be blue lighted to hospital and had the procedure as an emergency.

They found that my heart was physiologically different in position and shape which had made everything technically challenging and that they had to also perform a transeptal puncture. Something that is unusual in a node ablation so the cardiologist told me. This is more common in AF ablation (see the info sheets available on this).

This time required a stitch in the puncture site and again lying flat for 4-6 hours before it was removed. Then 45 mins still laid flat before being allowed up. Then an overnight stay in hospital before being discharged.

The ablation itself, you can feel when they are burning the sites. It is a strange sensation that can feel like a tightening and discomfort. Sometimes with sensations into your neck, throat and roof of your mouth. This is short lived though so is manageable. I experienced this with no sedation; slight sedation but still conscious and total sedation where I was knocked out. I would recommend sedation.

Recovery at home- I have been quite poorly due to the transept puncture this time. The first time, I felt tired with some aching in the heart but all was fine and I went back to work after a week.

Second time round, I have stayed in bed 2.5 weeks and just got up for food. First week, I did feel awful but paracetamol kept on top of the pain. Weird kaleidoscope vision etc but this is all due to the puncture which most people do not have with a node ablation.

I had my check up yesterday and I am very relieved for them to confirm my node is totally zapped now. So it has been a success.! 😊 The PM was set at 90 bpm in day and 50 bpm at night after the second ablation and now it has been dropped to 75 bpm in day. I go back in 4 weeks to have it dropped again.

Currently the PM is in non responsive mode so going upstairs means it stays at 75bpm and does not go higher. When I have recovered more and am ready to be more active, it will be switched to responsive mode so it can give a variable HR just like your normal heart would do when walking up hill.

Immediately after the second ablation, I stopped all medication except apixaban and have lost nearly 2.5 stone in fluid.

I cannot feel the AF and am having glimmers of how life used to be. My LVEF is back up to 56%!! 😊😊😊This gives me hope and confirms that I did not make the wrong decision.

The highly experienced EP told me that he has not had one patient who has regretted the procedure. Even a 34 year old who he was uncertain about recommending the procedure to, came back at a review appointment with enough improvements in quality of life for it all to have been worthwhile.

Would I choose this pathway again..... yes, I think so.

I hope this helps you and others in this thread who find themselves in this position.

Please feel free to ask me any questions that you may have and I will do my best to answer.

Best wishes to all.

[Golfer60UK in reply to Diddyd]

Hi and many thanks for your message. You have obviously been through an awful lot but hopefully now you seem to be experiencing better quality . I can only say you have been very brave throughout and a huge benefit to others who need to follow a similar path

Best wishes

Dave

[Diddyd in reply to Golfer60UK]

Thanks, Dave. As I said before, anything that suddenly pops into your head to ask, just get in touch. Be well x

[Adalaide2020 in reply to Diddyd]

Hi. I wouldn't want anyone to go through what you have especially at 51, but that does give me great hope. Thank you for your post and may you continue to be well 🌻

[Diddyd in reply to Adalaide2020]

You are welcome. Not a path I would have chosen for myself but you roll with what life throws at you x

[Eastwick]

I think we are all worried before we go to this procedure but I am sure we have all had pretty bad experiences along the way to get here. I had the pace and ablate 6 years ago and have never looked back. Quality of life is amazing compared to how it was. My heart rate is set to 60bpm but is variable as is normal after the procedure. Yes, it does feel a bit odd at first to be dependent on a small metal sphere. First time I hit a golf ball off the tee I was convinced I would pull the wires out! I have never regretted having the procedure

[Golfer60UK in reply to Eastwick]

Hello and good morning, fantastic the only thing I could possibly ask is:

Did the ball go straight ?

Seriously a superb experience, hope mine goes as well as yours

Bye the way I am 76 and play golf 3 times per week

Dave

[playcards in reply to Golfer60UK]

Sorry, one important thing to add to my earlier post - good luck and all best wishes. I am sure everyone will be wishing the best for you.

[barbharris1937]

I had a pacemaker fitted early February and had an av node ablation 2 weeks ago at James Cook hospital Middlesbrough. My pacemaker was set at 90BPM but tomorrow I get it set at 80BPM then another 2 weeks it will be set at 70BPM. The procedure was fine but I had awful withdrawal symptoms from stopping the Bisoprolol . I am now weaning myself off them slowly. I hope all goes well for you.

[Golfer60UK in reply to barbharris1937]

Hi and yes Bisoprolol is difficult, and to slowly move away is the best route

Best wishes

Dave

[barbharris1937 in reply to Golfer60UK]

Thank you.