Pace and ablate for atrial tachycardia?

[mike1961]

Just wondering.....

The evidence here and elsewhere suggests that pace and ablate comprises a good option for many of those folks in later life who have very symptomatic persistent/permanent AF and for whom cardioversion no longer works.

We also know that one or more ablations, whilst on the face of it preventing AF per se, can result in scar tissue that gives rise to re-entrant atrial tachycardias (and I'm not talking about flutter here) that can be more problematic than AF since it does not respond as well to drugs (both anti-arrhythmic or rate control).

Has anyone here ever had pace and ablate where their problem has been mainly/solely atrial tachycardia rather than AF? And, if so, was the PM 1 lead, 2 lead or 3 lead?

In fact, and opening my question up rather more, has anyone here who has had 2 or more ablations ended up with persistent atrial tachycardia? And, if so, how was this dealt with??

Thanks in advance for any and all responses.

Best to all,

Mike

[BobD Volunteer]

Ten years after three ablations for Atrial Fibrillation I develped atrial tachycardia which was ablated for in 2019. My average HR is now 80-85 but PM fitted due to second degree block 2022.

[mike1961 in reply to BobD]

Thanks Bob,

When you mention that your average HR is now 80-85 presumably you mean after the PM - i.e. the PM is set to 80-85bpm? What rhythm and at what ventricular rate were you in before the PM?? Apols in advance if I'm misunderstanding you here!

[BobD Volunteer in reply to mike1961]

PM set at safety net 60bpm due to heart block occasionally dropping rate to sub that level. Rate before ablation 140 in a tach. NSR ever since but at 80-85 unless HB occurs in which case 60.

[mike1961]

Thanks Bob. How long were you in the 140 tach before it was ablated?

[BobD Volunteer in reply to mike1961]

Paroxysmal but longest time probably 3 weeks when I was abroad at my sister's in France. E mailed my arrhythmia nurse and she arranged DCCV for the week after I returned. Things came to head when after another week or so at a different time my EP arranged for me to have DCCV at local hospital. Unfortunately I went PEA (Pulseless Electical Activity) which meant the ECG looked good but my heart wasn't responding and I had no circulation ie dying! A nice kind doctor spent 4 minutes cracking ribs doing CPR and pumping adrenaline into my heart muscle before it started pumping again so not keen on DCCVs ever again. It is something like 1 in 5 million chance by the way but still not won the lottery. lol 😁

That was Feb 2017. EP decided to do A tach ablation and this performed August 2019 when he found four sites operating and ablated them all.

[mike1961 in reply to BobD]

Thanks for that Bob. That DCCV certainly was a bit of a dance with death for sure! No wonder you don’t fancy another! Interesting that 4 sites were operating and great that your EP found them all. Who was the EP and where? Private or NHS??

[BobD Volunteer in reply to mike1961]

Jonathan Clague at Royal Brompton Hospital NHS. Been with him since 2005. Put my PM in last year.

[Karendeena in reply to BobD]

I do love your analogy Bob, always amuse me and make me feel better 👍

[BobD Volunteer in reply to Karendeena]

Laughter is the best medicine (as Readers Digest used to say).

[dedeottie]

following ablations and having had AF for around 15 years, I went into permenant tachychardia. This was ablated successfully for 11 months. Now back in intermittent tachycardia ( everyday for around 5 hours) . Consultant told me after last ablation that if it came back I would have to have pace and ablate. I’m now waiting to hear back from my arrhythmia nurse as so what happens next. Will keep you posted. X

[mike1961 in reply to dedeottie]

Thank you for your reply - much appreciated. Ending up with persistent or permanent tachycardia is my main fear. I spent the last 10 weeks of last year in and out of it before my second ablation at Bordeaux. During the ablation I went from AF at the start to tachy in the middle and then - after the roof-dependant tachy was ablated - back into NSR by the end. I still get very short runs of the tachy now, once or twice a week maybe 5 to 10 seconds. The tachy feels very much the same as before at around 125 bpm. Last year my tachy used to drop to the low 60s during the evening and night which was good! It was going from 2:1 atrial:ventricular rate daytime to 4:1 nighttime! Yes please do keep me posted and fingers crossed for us both.

[dedeottie in reply to dedeottie]

Said I would keep you posted so here goes… my EP wants me to go on low dose ( 200 or less… not sure if this milligrams) Amiodorone before proceeding to pace and ablate. All the info is being passed on through my arrhythmia nurse which is totally unsatisfactory as any questions have to be passed backwards and forwards. As far as I can make out the longest time zi could be on this is 2 years ( she said that was statutory?) and could be less if it doesn’t work or causes problems. The rationale seems to be that it will put of the pace and ablate off for a while as he says I am young at 66 and Pace and ablate is very final. I do trust this EP but fail to see that it is worth risking the dangers of amiodorone for a mere 2 years delay. I am forced to consider that this is hospital protocol and in effect an unofficial waiting list! I live in South Wales and so am not able to go elsewhere for treatment. I feel I am going to have to accept this in order to eventually be put forward for the pace and ablate. I am scheduling a private appointment with him so that I can ask him questions and begin to understand the logic so that I can mentally accept it all. Talking through the nurse is unsatisfactory.

Anyway, when I have spoken with him zi will update…. If you can bear it. 😝

Don’t mean to hijack your post but it seemed relevant and others may different experiences. X

[mike1961 in reply to dedeottie]

Thanks for the update. Yes it does sound a bit like a two year waiting list in disguise…. If it were me, even at the relatively young age of 66 I think I’d go the P&A as soon as possible rather than have two years of Amio toxicity first - I mean 66 or 68 not a lot of difference there is there. Forgive my ignorance here, but are you limited to South Wales in terms of hospital choice? If so, is the two year ‘wait’ the same throughout South Wales? The private EP consult is I would agree essential at this point.

[dedeottie in reply to mike1961]

Unless I were to go privately I am limited to Wales. I would still have to return to Wales for after care. X

[mike1961 in reply to dedeottie]

Noted - so presumably it is the same situation - i.e. 1 to 2 years 'wait' list for P&A at all hospitals throughout Wales?! If so, then maybe other than going private (and I'm guessing a 3 lead PM is around £15-20K these days on its own so that's not really an option unless one is really quite well off) , maybe it is a case of go on Amio until a slot comes along for the P&A. Makes me wonder what the wait is for P&A here in England these days.... Is Amio the best anti-arrhythmic drug for atrial tachycardia (AT)? Worth checking when you speak to the EP. My understanding is that AT is a lot more difficult to treat than AF is with pretty much all rhythm and rate control drugs, so maybe it's that Amio at the strongest drug out there is the best of the bunch for this reason. Keep me posted once you've spoken to the EP.

[dedeottie in reply to mike1961]

Will do. I am seeing him on 26th of August

[pottypete1]

I developed Atrial Tachycardia after having 6 ablations.

However my EP was of the opinion that one more ablation would deal with the Tachycardia and furthermore Tachycardia in his opinion was easier to deal with than AF.

I had one more ablation, that was in 2017.

I haven’t looked back and gradually AF decreased and now I haven’t had AF since March 2022.

Pete

[mike1961 in reply to pottypete1]

Thanks Pete - much appreciated and good to know. I've already got the money set to one side for a third ablation to deal with the atrial tachycardia if it becomes a problem again.

[Deejay62]

I had persistent atrial tachycardia as they ablated it started in a different spot, and eventually was coming out of my AVnode. I eventually had a 3 leed pacemaker fitted (CRT-P) and then an AVnode ablation.

[mike1961 in reply to Deejay62]

Thanks Deejay - much appreciated. You and I would appear to be of a similar vintage !

How many ablations had you had before you had the AVna and CRT-P? If the AT was coming out of your AV node, was it 'just' going to the atria??

[Deejay62 in reply to mike1961]

Yes we seem to be😀I think it’s 3 then the AVnode. The AVnode I think electrically connects the hearts atria and ventricles to make the top of the heart beat. They told me it’s the hearts natural conductor and once they ablate it I needed a pacemaker fitted beforehand to take its place.

I didn’t get that far to ask all those questions I just wanted it to stop. But it didn’t stop me from getting AFib 3 years ago and other arrhythmias.

[mike1961]

Thanks for the further info 👍

[SophieBella]

Hi, I've had 4 ablations and yes more recent episodes have been Atrial Tachycardia!