Contemplating ablate and pace

[Franny50]

I've been lurking this forum for some years now. Less so when I'm happily in NSR, but more so, as now, when things go off the rails.

I'm almost 75 and have been fighting AF for about 15+ years. From the first diagnosis, all sorts of toxic and scary meds (Tikosyn in recent years which has actually worked very well) multiple cardioversions, and an ablation that failed b/c of giant left atrium, I think caused by my past long distance bike riding (?).

The trend for several months/years has been AF about every two weeks lasting 2-4 days and then back to NSR Then, around March 2024, all of the sudden out of nowhere, weird AF with wildly variable tachycardia, up to and past 140 BPM, after decades of having slow HR (and low BP).

And then, back to NSR for a couple of days, and then, back to crazy tachycardia/afib.

Had a major emotional hit around the time the crazy tacky stuff began as a close family member was diagnosed with Alzheimers. I have read recently about stress-induced cardiomyopathy, but I don't think any U.S. EP or regular cardiologist would address that as a possible cause.

At any rate, my long-time EP has been pushing pace & ablate, which I must admit, scares the heck out of me.

I searched this site and saw the many enlightening and helpful posts on the subject by CDreamer.

But to be quite honest, I still don't understand why CDreamer never got the AV node ablation. If AF was/is still there, how did the pacemaker override the chaotic signals coming through the AV node to the ventricles, without an AV node ablation? Did the biventricular pacemaker somehow influence the atria to calm down and not fibrillate?

I have re-read the posts, but am still at sea. I mentioned the "pace and NOT ablate" possibility to my EP's PA and just got a response that the pacemaker will regulate a low ventricular rate. But that's not an answer for someone in tachycardia, and does not explain the potential conflict between the still chaotic atria, and paced ventricles, without an AV node ablation.

It is quite possible I have missed some important piece of the puzzle, and if so I heartily apologize. I'm truly seeking answers, guidance and feedback before I jump into this AV node ablation.

Many thanks!

[Jalia]

I admit that I'm not sure about CDreamers pace only procedure so will wait to hear the explanation.

I had my final ablation a few days ago and have been told that if this doesn't hold AF back then it will be Pace/ablate. I've had so much treatment that I will bow to the inevitable. I know it will be a 3 lead.

[BobD Volunteer]

No doubt CD will comment but it is important for you to understand that even a full AV node ablation will not stop AF. Yes the left ventricle and therefore your heart beat will be controlled by the PM but the left atrium will remain unconected and doing the light fantastic whenever it likes and many people who go this route are still able to feel the box of frogs in their chest. The fatigue etc associated with AF will (should) end but sensations may remain.

[Buffafly]

A little while ago there was an admin post leading to a questionnaire about the newest? Medtronic pacemaker which seemed to be able to do everything but turn you into a dance champion. I think the latest pacemakers can influence fast rates and rhythm whereas the basic pacemaker is set to stop the rate going too low and the AV node ablation then stops it going too high. As nobody knows the individual’s cause of AF it seems to sometimes happen that a pacemaker improves QOL eg if their AF is triggered when their HR drops too low then a basic pacemaker is going to be helpful. It seems you are hoping for a pacemaker smart enough to let you avoid the ablate part. I don’t know how the system works in the USA so I don’t know if you can choose your pacemaker and even if you are able to get the smartest one available it may not work for you as CDreamers has for her. It might be helpful if you could find the (mostly) warm recommendations from those who have had the full procedure.

[Franny50 in reply to Buffafly]

Thanks for your response!

It seems more difficult than it need be to find out information about the various pacemakers and their usage for various conditions here in the U.S. I'm guessing that nobody wants to reveal their trade secrets or functionality to their competition. U.S. medicine is now so skewed towards profitability for Wall St. So patients have to figure out what is happening to them treatment-wise and why as best they can. The very best information I have seen yet was from Dr. Sanjay Gupta, who is saintly in his willingness to enlighten us patients, and also some New Zealand and Australian sites.

[Pace1308]

HiI have had the pace and ablation three years ago . It is the best thing I did. If took 3 months to settle after the adjustments but J am do glad I had it. I had tried every medication going and had been using the ambulance service for my emergencies. I needed the av node, the pacemaker was not enough for me. I have a fantastic EP so trust him completely. I also have a dilated cardiomyopathy and wish that could be treated by a pacemaker.

You will feel so much better and have your life back.

Good luck

[Franny50 in reply to Pace1308]

Thank you for relating your good experience with the pace and ablate procedure.

I'm hoping other folks who have had it done will share similar positive results. But I'm guessing it works so well that people are less inclined to visit this forum regularly.

[Ppiman]

There aren't many here who refer to their atrium as "chaotic", but mine is, too, yet without the excessive tachycardia you suffer. That would be awful. I would add to the chaos in my case, the bundle block (LBBB) making it even more of a mess electrically.

I'm looking forward to the replies.

Steve

[Golfing2022]

I had P&A done 2 years ago, 3 lead pacemaker. I was age 71 when this was done with no regrets. It took approx 3 months after abate to see a big improvement but this didn’t change the meds I take, just improved my Q &L. Hope this helps

[Franny50 in reply to Golfing2022]

Thanks for your reply! I understand that after P&A one still needs to be on anticoagulant, but my EP said I will no longer need anti-arrhythmic medicine.

[Moonriver in reply to Golfing2022]

Why could you not change your meds? And how has it improved your quality of life?

[Golfing2022]

when I would go into AF, I could not be converted back with drugs or CV that is why P&A, by this time I was in HF. My EF was down to 22 I have improved to 45 but believe this is why I’m on meds still trying to improve things a little more. Hope this helped & good luck with your choice

[Buffafly]

On my iPad there is a list of posts referring to pace and ablate at the right of the screen. You should see the same somewhere on your screen with a ‘view more posts’ option as well. ‘Got my life back’ is a fairly common conclusion.

CDreamer Could you explain why you haven’t felt the need of the AV node ablation, please?

[Sheepbreeder]

At 77 and 18 months after a P + A procedure using a Medtronic 2 lead device I'm free of any symptoms, very busy on the farm and the only frogs are outside.

[Franny50 in reply to Sheepbreeder]

Thanks for the positive reinforcement!

[Hylda2]

I had pace and ablate at 79. Finally have my life back x

[Franny50]

Very glad to hear such good news!