Abdominal surgey after AV node ablation/pacemaker dependancy

[Snowyowl01]

Hi I need my gall badder removed. But after AV node ablation last year and being pacemaker dependant now the surgeon said it would be tricky.Has anyone had similar, I would be grateful for any reasurring replies please

Thank u x

[SeanJax]

For surgery they will do laparoscopy removal and usually they need to turn off the pacemaker since they use electric cautery and diathermy to cut and coagulate. And all of these instruments will interfere with your pacemaker. Also they need to use curares drugs among other drugs for GA. With the pacemaker off, they cannot do GA. It is the reason the surgeon said it is tricky . Don’t forget you are 100% dependent on the pacemaker. Without pacemaker your heart rate may be in the 30 or 40 bpm and we cannot do GA on you. In the States Pace and Ablate is called nuclear option. We use it as last resort for afibers.

For people who have pacemakers but not ablation of the sinus node then when we just turn the pacemaker off during the surgery, it is not a big deal we can use all the drugs we need to put people to sleep and wake them up. And we turn it on once they are awake.

So your next question why not keeping the pacemaker on during the GA. We cannot given the instruments used during laparoscopy. Your pacemaker will not work correctly and the anesthesiologist cannot accept these risks. Another option is to ask the surgeon to use instruments which do not interfere with your pacemaker and I don’t know if they can. Just ask him or her. I am not expert in laparoscopy surgery.

Hope I convey correctly the consequences of P and A.

[dedeottie in reply to SeanJax]

does this mean that after pace and ablate you can not have a general anaesthetic? Surely the EP would have to make us aware of this before offering the procedure as it would likely significantly affect the decision made. X

[Snowyowl01 in reply to dedeottie]

I dont remember being told this either x

[SeanJax in reply to dedeottie]

pm goes along well with AG as I said turn it on on and off. But the ablation of the sinus node does interfere with AG. I am not sure your ep understands or is aware of it. How a surgeon can operate on a patient with heart rate of 20 to 40 bpm. During AG, blood pressure is critical and it is regulated by the heart rate among other factors. They will find a way to do AG but as the surgeon said, it is tricky.

[Snowyowl01 in reply to SeanJax]

Thank you SeanJax for your detailed info, I have been given an appointment for 2 weeks time for a pre op assesssment which the surgeons and anethetists will be part of so hopefully something safe can be arranged for safe surgery I will let you know. x

[SeanJax in reply to Snowyowl01]

you need to inform the pm team as well as the ep too. It is a multidisciplinary team here.

[Snowyowl01 in reply to SeanJax]

yes the surgical team are arranging for all concerned to be involved in the pre op assessment

[SeanJax in reply to Snowyowl01]

They might use the harmonic scalpel using ultrasound to cut and coagulate. The pm team needs to set the mode before and reset it after the surgery and check everything is working fine after your surgery. I don’t know your pm mode and how many leads so I cannot advise here. Be aware surgical diathermy can damage the pm and causing thermal damage to the heart thru the wires since the surgical site is closed to the heart. Just to inform you and allow you to discuss with them and make an informed decision. I hate to be the messenger here. No intention to scare you whatsoever.

[Snowyowl01 in reply to SeanJax]

Thank you

[secondtry]

I had my gall bladder removed pre-AF diagnosis but I expect the stress pushed me further towards AF breakthrough.

If your removal is not urgent, if I was you I would be consulting popular and hopefully reliable YouTube channels like Dr Berg and experienced Alternative Practitioners in your area to see if some of their suggestions help, provided of course there are no side effects as it is very much trial and error and you don't want to make matters worse.

[Snowyowl01 in reply to secondtry]

all a bit scary

[Barb1]

This is serious news, if you cannot have a GA! No one mentioned that to me before my P&A

[Snowyowl01 in reply to Barb1]

I know I wasnt aware of that either but didnt expect to need surgery either I will let you know what happens at the pre op x

[Barb1 in reply to Snowyowl01]

Thank you

[reinaway in reply to Snowyowl01]

Very disturbed to read this as nobody mentioned this to me and I didn't read it anywhere even though I read almost every bit of literature I could find and this was not found. I consented to the P&A so too late now.

[Snowyowl01 in reply to reinaway]

My surgeons have arrange a pre op assessment they have not said ot cant be done yet just needs careful planning

[GrannySmithgs5]

My husband has had two hernia ops and his appendix removed , all with pacemaker in situ . Never been an issue .

[Snowyowl01 in reply to GrannySmithgs5]

Is your Husband pm dependant ?

[GrannySmithgs5]

Yes he is xx

[Snowyowl01 in reply to GrannySmithgs5]

Thank u GrannySmithgs5 that is very reasurring X

[reinaway in reply to GrannySmithgs5]

That's a comfort to know to me. Thank you Granny.