Hi,So I have had pace n ablate, pacemaker dependent also have HF.
Does anyone know if you can still be in AF after AV node ablation and pacemaker dependent?
I was informed by a doctor after a recent visit to A&E that due to AV node ablation and being dependent on a pacemaker that AF shouldn't occur (ecg didn't record any AF) at the time of visiting A&E, however ECG's taken by my HF nurse and when I've recently visited the pacing clinic have both stated I'm in AF and I also have medical letters since my procedure 2 yrs ago stating I have AF.
My concern is I definitely feel the AF and the potential of making Heart Failure worse with additional risks and although Iam in meds for HF I haven't been prescribed any blood thinning medication.
Has anyone else gone into AF after Pace and Ablate?
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Nomis21
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I cannot believe that a doctor told you AF doesn’t occur after AV node ablation! Very ill informed.
What AV node ablation does is sever the electrical connection between the top (atria) chamber of the heart and the bottom (ventricle). That means your heart is pacemaker dependent on making the bottom chamber contract BUT the atria continues to do its own thing and if it wants to go into AF - it does and you will feel it. The difference is that your pulse will be steady and regular and not have the irregular beat of someone who hasn’t had the AV node severed.
The reason you would have been recommended to have AV node ablation is to help stop worsening of HF however, unless both lower chamber are paced, the ventricles can go out of sync which can sometimes worsen symptoms so if you have increase in symptoms, do go see your doctor immediately.
I have a pacemaker (Resynchronisation Therapy) which has both ventricles paced and keeps them in sync and it also seems to have eliminated most of my AF so I have now only occasional episodes and very few symptoms. Because this was so successful in stopping the AF, I opted out of the AV node ablation, although I’m ready to go if the AF worsens again! Often your pacemaker will be replaced with CRT (cardiac resynchronisation therapy) type pacemaker if your HF symptoms do worsen. It is the ventricles going out of syn which is more concerning than the AF in the top chamber.
I think that HF has many levels and it really depends upon your symptoms and what has actually caused the HF because AF & HF can be a chicken and egg situation as to which came first - did the HF cause the AF or AF cause the HF?
Hi,Thanks for this response, relates exactly to my situation.
Pacemaker technician stated last week I would need a CRT it's also been mentioned by the HF nurse as a requirement due to ventricular chambers not being in sync, which I understand is a contributing risk to HF along with the AF that I suffer from.
Drained most of the time, feel tired, breathless and when I try to do anything like going upstairs it can send me breathless and make AF worse, daily activities are a chore now and I struggle.
Had issues with my pacemaker recently, noticed my HR was around the 70bpm mark even trying to do anything under exertion, pacemaker clinic made adjustments so it would be more responsive, HR did increase under exertion but made the AF worse so had to go back to PM clinic for the previous settings could be applied.
Feel that the adjustments at PM clinic has kick-started something and now I feel an increase of AF and I feel worse over the last week with the symptoms being more noticable.
HF was diagnosed after my pace n ablate which was carried out nearly two years ago after suffering from Wolff parkinson white syndrome all my life which caused extreme episodes of palpations.
The extra electrical pathway causing WPW episodes was next to me AV node so there was high risk of AV node ablation, both the extra pathway and AV node were ablated hence pacemaker dependent.
Struggled ever since and now on HF meds suffer from AF and health isn't brilliant.
Just read yr post again, I'm just trying to understand this:
The difference is that your pulse will be steady and regular and not have the irregular beat of someone who hasn’t had the AV node severed.
So would I be right in thinking AF starts in the atria and would transmit into the ventricles and be noticeable by a pulse for those who haven't had AV node ablation but those that have AV node ablation the AF stays in the atrium due to the severed AV and not able to travel the the ventricles so an irregular pulse wouldn't be noticed?
What would be the method of identifying AF for those with AV ablation & pacemaker? Guessing it can't be detected from a home device such as a kardia, smartwatch or a blood pressure device.
Sorry, I missed you post - your understanding is correct.
Your pacemaker will pick up AF and usually when you go for or have a consult with the Cardiac Physiologists who monitor and programme your pacemaker, ask what your AF is doing. They will normally tell you - your AF burden is. **%. Mine at the moment is 2%, if you are in persistent AF it would be 100%. \
Kardia will pick up AF however there is a disclaimer that shouldn’t be used with PM. There is a good reason for this as because your PM is working you may get a strange looking RST wave but all I can say is I and my husband use it and it will show AF. Mine also shows up on my smart watch.
HiJust an update, went to see my GP, although i have cardiology appointment in 4 weeks time which I have already waited for months for.
Really had enough of feeling exhausted, weak, out of breath and what I can only describe as possible symptoms of AF, which feels like my heart is working harder causes pressure in my head weakness in my lower half, difficulty walking, cough and breathing difficulties.
Anyhow taken on board the excellent comments from CDreamer above I went and seen my gp as I'm concerned that anticoagulation has not been offered.
Bearing in mind before my pace n ablate I was told I was 5x more of risk of stroke of blood clot and was given anticoagulation.
Since my procedure I am now in permanent AF, have heart failure with meds, have left ventricular systolic dysfunction and been informed I need a 3rd wire upgrade to sync both ventricles by HF nurse and pacing clinic.
My health has suffered and I feel more at risk now than pre surgery 2 yrs ago.
Gp did say he was sorry for the way things have turned out (obviously no fault of his) but when I asked about antigogulation he was apprehensive it making a decision and said it would be up to me to decide ?? And if I decided that it would reduce the risk he was happy to prescribe.
I challenged this saying based on the risk the decision should come from a health professional and given to me as an option not for me to decide unknowing what the risk levels are, I was just raising the concern being in what I've been told permanent AF.
Thing is from what I understand I can't even measure my pulse at home for irregularities at my pacemaker is set at 70bpm, I've been asked the question recently from health professionals if I have a smart watch to track HR but from the previous comments given having av ablation and pacemaker it wouldn't pick up any irregular heart rates even though Iam in af ?
Your 3rd lead will enable the Pacemaker to resynchronise the ventricles which in turn should greatly help the functioning of the heart. When only one ventricle is paced the ventricles can go out of sync, causing heart failure. You will need a very experienced cardiologist to place the 3rd lead as it is not attached internally through the veins but to the outside of the heart so can sometimes detach. When both ventricles are paced at the same time, you should see some improvement in symptoms.
This was explained to me by my EP prior to my implant and is exactly why it was suggested I have this type of Pacemaker - CRT =cardiac resyncrhronisation therapy.
Any home device will track your heart rate, probably a smart watch is better as it will track you through the day and give your doctors good information. No it won’t pick up an irregular heart rate unless you have the ECG function and that will not track consistently.
I agree that the health professional should advise on anticoagulant having been through the CHADSVASC scoring algorithm - which you can do for yourself AND the HASBLED algorithm which assesses your risk of bleeding. One risk needs to be balanced against the other. Both are easily accessible on line for you to do yourself on mdcalc.com - and on other sites. The AFA used to have a link also.
All I can say is some doctors are just unable or unwilling to give advice and whereas I believe in joint decision making between doctor and patient, we can only make these difficult decision and do so with data.
PS - what I would be concerned about is lack of anticoagulation with AF and pacemaker. Any reason given as to why not? It could be that your CHADS risk score is low is very low, however, I would have thought the pacemaker would indicate use? Something you need to ask your specialist I think.
Great answer from CDreamer, easy to understand. I went into perm.A/F unbeknown to me! Symptoms were dizzy/breathlessness and a cough, took them about a year of faffing about to finally realise it was a heart problem, knowing full well I was a heart patient for over 20 odd years and wore a pacemaker, so told me I was in heart failure and upped all meds. I also had an ablation in 2015 which was unsuccessful hence the pacemaker. Today, the increase in meds seems to be working, and to date I have not been called back for reassessment of the heart failure etc., nor have I had P/A/F so just getting on with life and to me it feels weird that I can go into a perm. state of A/F without my knowing but if I get any symptoms I shall return to my GP as I don't want the heart failure to worsen if I can help it lol. Good luck x
10mg Bisoporal daily; 150mg Propafenone twice daily; Pradaxa anticoags 110mg twice daily and 20mg Furosemide daily for fluid overload. Prior to this I had tried to wean myself off heart meds, not altogether but to reduce dosage, this the Professionals said had caused my problems........actually I had taken a fall whilst playing table tennis, ended up in hospital with full hip replacement and this, in my opinion together with the trauma, was the start of my problems, that was 2 years ago!!! I have had P/A/F since I was 54, it caused a stroke before I was prescribed anticoags so I believe that all diagnosed with this should be anticoagulated, but on the positive side I have just celebrated my 80th birthday so am still here!!!!! Sadly, no more table tennis lol
I have AFib since 2009 (or at least it is when it was diagnosed), recently I got the new diagnosis of HF, whole combo, well now a I take so many pills a day it is unbeliveable, although I feel well, HF does not give me symptons, it was caught in a Doppler Echocardiogram. I stopped having regular coffee since I was diagnosed Afib, I drank decaf or herbal teas (I love regular tea but it has caffeine), well I just read that have REGULAR coffee, up to 4/5 cups a days is good for both Afib and HF. Has anyone learned about it?
hi. I had one just a little over a year ago now. It was explained to me that I will feel flutter. I will no longer feel palpitations. That is why you have the node ablation. What it does is stop those things from damaging your heart but they do continue and you will feel them not all the time. If you had triggers you still have triggers. For me it’s ice cream lol I’m not a drinker or that might set it off. We all have our own thing, so we really can’t tell you what will trigger. Stress definitely triggers mine. I have heart failure just so you know, since my pace and blade, my ejection rate has improved. It was around 40 or 50 it’s now 70 so you can get better you don’t get cured , I just had my annual with my EP because of what I have for a pacemaker. He has a chart that ran from last June until the day. I saw him a few weeks ago. It shows all my numbers pretty much perfect 90% of the time, absolutely no sign of flutter, etc. , that means my pacemaker doesn’t get overused which helps the battery. That gives her heart a chance to heal. I am living proof it can happen.
nothing is perfect, but I will tell you I feel almost normal in fact except for not having stamina like I used to. I do feel normal. One thing that I discovered that my EP helped me with was getting out of my head about my a fib, etc. I had been so paranoid with my pacemaker, anything I felt even if I had a splinter I was blaming on my heart. My doctor reminded me how many parts we have inside not everything is Hart related and he is so right. my blood pressure is perfect as is my heart rate. I am set for 16 now. I stay in that range usually because I still cannot be that active. I am going to be needing back surgery hopefully soon. The pain in my legs and lack of energy and activity is because of my back pain, I had it before I ever got a fib. I was supposed to have surgery two years ago on my back but a fib came back ugly after behaving for a year and a half so I had no cardiac clearance. When they’re not sure what’s going on they will pull that on you right now I have it again and see the neurosurgeon the middle of the next month.
L O L I will tell you a silly thing the way that iview my a fib/flutters I have a little jail made of concrete that is from the ablation. A fib and flutter are in there all by themselves making noise trying to make me miserable, but I can’t hear them. My heart ignores them. My heart is in charge of how it beats because of, my pacemaker if you’ve ever seen the Mucinex commercial for coughing? Flutter and a fib are the little Mucinex men who try to make people sick, but they took Mucinex so they can’t feel or hear him. That’s what the ablation did for me. yes I know I sound crazy , but you have to psych yourself. You have had a lot of changes and things to go through just like me and we have to move on. I won’t be superwoman or swinging around cirque de Soleil but I can take my dog out who recently became paralyzed from the waist down. It’s my turn to step up and be a warrior like him. You should see him come up the front steps I can do every day things I could not do until I got the pacemaker. My second cardioversion failed and they actually had quite a few issues with me on the table so card is off the table. My doctor told me not to worry he’s got me and I’m not going anywhere. He did it for me. I am here. My primary said he did not think I was going to make it. There was no pacemaker for me. My doctor got in there and thought outside the box at what he was looking at and had planned beforehand also. if you don’t realize they are not only doctors they are software engineers they do everything look at all the equipment. They have to know how to use. I had the first of what I have for the pacemaker and procedure. I have three lines there is a special app on my phone and they monitor me 24 seven that’s where the chart with my numbers came from. I also have one tech that is with me at the doctors or hospital. It is the same one all the time thank heavens she is brilliant. Last July I had a scare with my battery. My doctor brought me right in the same day they got the engineer on the phone. My tech was with us . The engineer straightened us out. I saw some thing I should not have on the app. They didn’t know I was that nosy. The engineer knew right away what it was. No one else should’ve been seeing it. Anyway, I am treated like a princess or a queen, my doctor is also a teacher /professor I think it is and he treats me with respect and has been teaching me what I’m dealing with. I’m not an idiot so the majority of it I truly understand. It demystifies. I am no longer afraid of my pacemaker, possibly stopping in killing me because it doesn’t work that way even the back ups have back ups. My doctor told me there is no way it’s just gonna stop and I will die.
another thing you need to be aware of if they didn’t tell you is don’t ignore everything because you can still have a heart attack. It’s a whole different thing. You can have a stroke unless you are doing the smart thing taking anticoagulant there are things that can still happen, but I’m not afraid anymore. Valentine’s Day was my new heart having a birthday. Best of luck sorry. for the novel.
by the way, the big miracle of mine is the wiring called HIS pace bundling don’t ask me to explain that one lol but to show you what my doctor is like. He presented my case in Dallas at something he was attending and they invited him requested him to return to teach his procedure to the EPs there and hopes of saving other people like he did me
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