Pace and Ablate

[bobbyp28]

would luv to see some discussion on the pros and cons of Bi-Ventricular Pace and Ablate as a follow on solution to 3 Ablations and 7 months of Sotolol….yet still experiencing Para AF and Flutter. many 🙏

[jeanjeannie50]

Type in Pace and Ablate in the Search box on here, this subject is discussed quite a lot.

Jean

[CDreamer]

I went for Pace and Ablate 2018 as in a similar position - but got a RST Pacemaker and that worked so well at stopping AF that I never had the AV node ablation.

As Jean says - lots of previous threads if you do a Search.

[Hidden in reply to CDreamer]

Please tell me what’s an RST pacemaker?

Thanks

[CDreamer in reply to Hidden]

Sorry- Resynchronisation bi ventricular pacemaker. As soon as it was connected AF stopped. Worked SO well that I didn’t go ahead with the AV node - best thing I ever did as immediate improvement in QOL.

[Hidden in reply to CDreamer]

That’s brilliant ….

[CDreamer]

Eg recent post on P&A

healthunlocked.com/afassoci...

Just note that a) recovery takes a while b) you will still feel AF

Having followed a number of P&A posts over the years I would say that most posters report reduced symptoms and increased QOL - but it won’t stop AF, unless like me you are very lucky!

[tomtom222]

There is one thing I don't understand. Why do you feel atrial fibrillation the same way you feel before the pace & ablate? These, in my case, severe symptoms that I have during the fibrillation attacks, like the big "bumms" in the chest and so on, are timing and rhythm identical to the irregular pulse beats, and these come out of the chambers. If the chambers are after the P&A in a clean sinus rhythm, then how can I still have these strong feelings in my chest? Could anyone explain that please?

[Buffafly in reply to tomtom222]

It seems you are unlucky or unusually sensitive. The atria - two top chambers - are the source of the irregular beats in AF. The ‘ablate’ part of ‘pace and ablate’ cuts the connection between the atria and the ventricles -two lower chambers - so the ventricles are controlled by the pacemaker and beat evenly. Most people don’t seem to be very aware of the atrial beats after the procedure but I guess it depends on how forceful those are. It is possible for the ‘ablation’ part not to work completely but if you feel your pulse at the wrist and it’s regular then that’s how it should be. Hope that helps.

[tomtom222 in reply to Buffafly]

Thank you so much for your answer. I don't think that's exactly what I meant. What I meant is that these bad feelings in the chest in there rhythm are indenticaly with the irregular pulses I touch on my wrists. So if P&A Is done, then the pulses would beat regularly. And since the very unpleasant chest feelings were identical with the irregular pulses at the wrists, then the feelings should disappear according to A&P, tells me my logic 🤔

[CDreamer in reply to tomtom222]

No, the sensations will not always disappear because the AF will continue in the atria. This should have been clearly explained to you prior to the procedure.

Despite this, because your ventricles are paced your pulse should be regular - I have to say though my EP strongly advised for the RST biventricular pacemaker and it seems not everyone gets this.

[bobbyp28 in reply to CDreamer]

Curious what the R, the S and the T actually “stand for”

[CDreamer in reply to bobbyp28]

See my reply above - RST = Resynchronisation Therapy.

[reinaway in reply to tomtom222]

Having had Pace and Ablate last year I know that the results can vary in different people. Ablating the sinus node cuts off the connection between it continuing the firing impulse from the atria to the ventricles. The pacemaker takes over this job and regulates it to a nice steady beat instead of them trying to keep up with the wild gyration of the atria. As in most people this is the cause of discomfort felt, myself included, the pain and awful body discomfort is relieved. Yes you still have AF but in most cases the symptoms are removed. I was one of the lucky ones and can now live a normal but quiet life. Hope the same happens for you if you decide to go ahead.

[tomtom222 in reply to reinaway]

"Yes you still have AF but in most cases the symptoms are removed. I was one of the lucky ones and can now live a normal but quiet life. Hope the same happens for you if you decide to go ahead.."

Yes, thanks. That is what I meant and what my logic is actually telling me, and it is my great hope, because the feeling is unbearable to me. . Good luck to you!

[reinaway in reply to tomtom222]

Sorry as CDreamer pointed out I should have said AV node which is the one that spreads the impulse not Sinus node. 🙄

[tomtom222 in reply to reinaway]

It's all good. It was clear to me that you meant the AV Node 😉

[CDreamer in reply to reinaway]

I think you might mean ablation of the AV node?

[reinaway in reply to CDreamer]

Yes sorry got them mixed up! 😉

[Nannysue1]

I had the pace and ablate end of last year. I now no longer feel any AF symptoms at all and feel better than i have in years.

[tomtom222 in reply to Nannysue1]

That sounds good. I'm really happy for you. May I ask what symptoms did you feel before?

[Nannysue1 in reply to tomtom222]

I was pretty symptomatic with it, some people dont even know that they have it. My heart rate would go from low 50's to 150 regularly and also missing beats, actually made me feel like I was going to die ( sounds dramatic I know but that roller coaster feeling in my chest and stomach was awlful). The 1st episode was scary because I had never even heard of AF and was on holiday on Crete. I was rushed into a village hospital, where the language barrier meant that nobody could explain to me what was going on. Put onto a drip which i later found out was flecanide, which didnt make any difference at all. At that stage my husband was watching the monitor and my heart rate was jumping from 30 to 220 bpm. Eventually they changed the drip to amioderone which did the trick.

I stayed in hospital overnight then discharged. They gave me a note with AF on it so I of course Google!! And then had an idea of what it was but it wasnt until i got back to the UK and saw a cardiologist , that I could truly understand what was going on. All pretty scary and it left me for the first time with anxiety.

Anyway, I then took amioderone for the following 6 or so years which for the most part kept me in sinus rythm. When it stopped helping, my ep tried various other drugs, all of which made me feel awful. Fatigued and generally my body not feeling at all well and the AF not fully controlled . Some days, I functioned ok and others, I didnt feel that I could do anything. I didnt know when I was going to have a bad or good day, so didn't feel that I could plan anything. Im also an avid traveller and have been lucky enough to have seen a lot of the world but that too stopped because i felt wary of travelling. Yes I know that lots of people say " just get on with it" but maybe, those people arent as symptomatic? I eventually went into permanent AF after a few cardioversions.

It was a massive decision for me to have the pace and ablate but as I said , for me it has given me back normality.

I hope that helps you with any decision you may have to make. Its definitely not for everyone.

[tomtom222 in reply to Nannysue1]

Thank you so much for the detailed report and I can understand it all very well. I'll have tough decisions to make, but that's life, isn't it? One thing is certain I'm incredibly happy that you're feeling better now. And I wishes you a wonderful life.

[Nannysue1 in reply to tomtom222]

Thats a lovely thing to say, thankyou. Wishing you well too.

[JOY2THEWORLD49]

Hi

There are some very good explaining persons on this forum.

Our Texan lass could help you. We haven't heard from her for a while .. DAWN TX I think.

I understand the ablation shuts down the rhythm and entirely relies on the pacemaker. Big decision.

I guess you have had a n ECHO or mRI to check out any abnormalities to the structure of your heart. Sotalol or ablations should not be given/carried out on an abnormal structural heart.

Caution.

I have known hearts to go low in BP and/or H/R range and a squirt of something (probably adrenaline) needs to be administered.

cheers JOY. 74 (NZ)

[CDreamer in reply to JOY2THEWORLD49]

PM kicks in when HR drops below a set number - in my case 60 so as soon as HR hits 59 - Pacemaker takes over & also controls high HR.