Went very smoothly. Doc did the a/v node ablation through the pacemaker chest opening instead of through the groin. So there is only a single wound that needs to heal. They used some sort of new-fangled surgical glue, so I don't even have obvious external stitches or bandages and could take a shower within 24 hours of procedure. Almost no pain at all. I am not supposed to raise my left arm above my head for a few more days or lift heavy objects for a few weeks.
They kept me overnight in hospital hooked up to some monitor that looked like an ECG, but wasn't called an ECG.
My understanding is that the left bundle branch pacing is even better than the biventricular CRT method. I'm still trying to learn as much as I can.
My base heart rate was set to 80 initially, but can be adjusted downward in a month or so. 80 bpm seems a bit high to me, but they have their medical reasons for starting out high. Most of my adult life my HR has been in the 55-65 range.
I'm posting this hoping it provides information that is helpful to people who will be undergoing pace and ablate. This is the type of information I sought out when I was researching P&A on this site and others.
I struggled with afib for 15+ years and multiple antiarrythmic drugs, one of which almost killed me, multiple failed cardioversions, TEE's, and one failed ablation, due to my enormous left atrium; and most recently in the past year, very unstable tachycardia. So the P&A was the only option left to deal with the afib that has been a constant plague and disruption.
So far I feel much better, but think the 80 bpm HR is just a tad high. The pacemaker lab will get that fixed I hope. I'm aiming to get it set at 60 or 70 bmp. I am back on apixaban anticoagulant this morning, after being off it for a week, from two days before the procedure.
It really was an amazingly easy and painless procedure for me. I'm aware that another recent poster had a problem with a small pneumothorax resulting from P&A. I hope that she was able to get her issues resolved.
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Thank you Franny for posting and good to hear how things went. This will be my next step if AF decides to return properly.....its just had a brief visit 😔
so pleased all went well for you, the LBB pacing sounds very interesting. I look forward to hearing more as you recover. I think many people fear these procedures not realising just how much technology and skills of doctors has improved.
Thanks! You were one of my main sources of practical and helpful information/experience and I greatly appreciate your postings!
I didn't find out about the chest entry for A/V node ablation until I was on the table getting ready for anesthesia. They had already shaved me downstairs for groin entry but the EP and Fellow announced the chest entry for A/V node ablation. Perhaps the LBBP makes it feasible. I'm still on a steep learning curve!
Thank you for posting. I'm on the waiting list for an AV node ablation. I already have a pacemaker as I have LBBB and my HR was dropping too low on the beta blockers I needed for atrial flutter. Keep us posted but so pleased you are feeling positive about the procedure.
Yes, I am really surprised it was so smooth and painless. I had been dreading it for months, and actually asked to have it postponed three months so I could research the procedure to my satisfaction. But as of this moment, I am very satisfied that I got a good outcome. I am 75 and have been fighting afib on and off since my late 50's.
Hi Franny50. Thank you so much for your post. So happy that all went well.
After fretting about that procedure, I have decided to have the pace/ablate.
One question for you...Are your AFIB symptoms improved? My current symptoms are extreme weakness and fatige, no energy at all at times. Really affects my quality of life.
So your post and the posts of others seem to confirm what my EP has been telling me.
So thank you again and i hope that you continue to do well. Please continue to keep us informed.
My weakness and fatigue are noticeably improved. My main symptom was breathlessness, which has come on over the past year with the return of my crazy constant afib. I still have a bit of breathlessness because I need to lose weight. My chubby old dog and I both are panting a bit during the mile walks we have taken daily after the P&A last Tuesday.
But losing the chaotic HR and the anxiety it caused is a major game changer. Today I started looking at travel sites again.
Thank you so much for your response. I have heard that it may take a little time to see the max improvement.I see my EP on Oct 21, and i am going to schedule my procedure.
Hopefully it will make big improvement in the way you feel. It already has for me.
Please share your experience, if you have time and inclination.
I am going to keep posting and looking out for other people's experiences, as I think P&A is becoming a popular option for EP's to resolve intractable afib.
I am particularly interested in the type of procedure, eg: CRT, single lead, dual lead, HBP, or LBBP, which is what I now have, and how they work out.
I definitely will. I'm planning to dicuss the options of this procedure. I already have a pacemaker to limit my hr from going too low. So for me a 30 min or less procedure.Thank you and good luck.
Both for you and for me as I figure that P&A is likely on the agenda for me at some point too.
Please could you expand a little on the unstable tachycardia you have experienced in the last year or two ? I'm assuming you mean 'proper' atrial tachycardia ? How often, for how long and how fast ?
I had an extreme emotional hit at the beginning of the year when a very close relative was diagnosed with paranoid dementia. That seemed to trigger a return of my very symptomatic atrial fibrillation, despite the anti-arrhythmic drug Tikosyn I had been taking for years, and also triggered widely variable tachycardia, from 60 bpm to 150 bpm within seconds. Very scary. Prior to that I had on and off afib for years while on Tikosyn after a failed ablation. But my HR was never quite so high or so variable, and the afib was not nearly as debilitating. But then afib became permanent and very disruptive, when coupled with the wild HR.
Both pacemaker and a/v node ablation were done during same procedure. I had expected two entry sites, but the doc surprised me and said they could to the a/v node ablation through the same chest entry point. I believe this is not widely done yet, and takes an unusual level of skill and training.
I'm in the U.S. and lucked into one of the best EP's one could hope for, who also trains Fellows. He is a cautious and pragmatic person, who has been very conservative about ordering cardioversions and ablations. I know of people with other EP's who have had five or six failed pulmonary vein ablations and 10 or more failed cardioversions. It generates revenue for the hospital and doctor I suppose, but the poor patients on the receiving end are definitely depleted and disheartened from all those mostly unhelpful repetitive interventions.
Glad everything went well for you. Having had PAF for many years and over time seeing how many people had to have repeat cardioversions, ablations and various other things done and although I knew P&A was irreversible I decided to take the plunge in 2022 and have never regretted it. There were a few bumps to get over in the first six months but it has been wonderfully to be free of the awful attacks I had been having over the past 10 years or so. You can grab life again and actually plan your life at last without having to worry about cancelling at the last moment because of an episode!!
I’m the one with the pneumothorax. It has resolved completely. Whew! And now, after that bump, I’m delighted, as you are, to have a pacemaker. I got it three weeks ago. I started feeling like my old self very soon after. (Had to get the iatrogenic pneumothorax sorted out first). As a side note, at three weeks the incision site looks good but is still covered with glue!
My energy, my oomph, my fun in daily life is returning, has returned. My brain fog has lifted; my thinking and speaking feel sharp again. I’m still a little lightheaded on occasion, but I believe that’s multifactorial. No more dragging myself through the day like a wet dishrag.
I feel engaged in life again as the person I know myself to be—who is not that person on awful drugs like amiodarone (yuck, yuck, yuck) or in tachycardia for weeks on end, or bradycardia due to drugs, not the person who had hopes dashed with two failed ablations and couldn’t maintain a cardioversion more than two weeks. With the pacemaker, all of that is thankfully behind me forever.
A pacemaker was truly my only option and one I lobbied for after doing my research. Mine is a single lead; my atria can just misfire away at will but my ventricles will pump at a steady rate and nourish every cell in my body as they need and expect. My pacemaker is set at 80 right now, like yours, but will gradually be reduced. My EP started at 85 because I was at 125bpm going in and he didn’t want to lower it too drastically too fast.
I just wish we’d done all this sooner, but I understand drugs and ablations need to be tried first.
Perhaps most importantly, my capacity for joy has returned —to the extent that I got a puppy two days ago! I think that shows how much better I feel and ready to take on a full life again. She’s an English Springer Spaniel and beyond cute and cuddly. I’ve had lots of dogs; training a puppy is no problem for me. Just need lots of freeze-dried chicken pellets in my pocket. (-: I’m one of those people who can’t be without a dog. Now Puppy makes three. She’s definitely part of my healing program!
With my Watchman and now pacemaker, I’m good to go. Baby aspirin is it for drugs. Whew, whew, whew.
Franny50, I’m really happy for us! And wish everyone well!
They gave me the same happy drugs I think they generally use for colonoscopies.
Propofol and fentanyl, I believe the anesthetist said, although I might be mistaken as I was already getting happy and fuzzy on the procedure table. It's probably on my chart app. but I haven't checked it out.
I was very dimly aware of voices, esp. my doc's voice, and movement around me, but zero pain or discomfort.
I think they could've sawed off a limb and I wouldn't have minded, until the happy drugs wore off. Everything seemed very fast and very painless.
Thank you! I am actually better than I ever hoped for. Once they adjust the pacemaker down from base 80 bpm I think it will be even better. I am still a bit breathless upon exertion. But the experts know best and will examine the pacemaker's data record when I return for follow-up. I also need to lose weight. Big time!
Been fighting the weight battle even longer than fighting afib. And turning 75 makes it even more of an uphill climb, Hoping the pacemaker will get me back to walking 2-3 miles/day soon.
I was told to take it very easy after implant and to be honest that was 9 years ago so hard to remember. Had my second one fitted last summer. Did give me a new life as I was so bad before
Hi Franny 50.. I had a dual pacemaker put in just over 3 yrs ago with intervention of having pace and ablate. I got the pacemaker but not the av node ablation.. I'm off to a private cardio tomorrow and I'm hoping that my cardio will have it done for me as I am really struggling with drugs which I am scraping the barrel over. Beta blockers are giving me headaches and memory probs, chest thumps and dry hot center chest coughs, burning feet fatigue and nausea ability to excersise as well I'm permanent afib now for 2 yrs. I'm sure the pace and ablate is the eay to go but our local cardio are all neg on this just want me to put up with drugs. I've had enough what should I do I think my private man is on my side last month so here's hoping. Any thoughts. Having .
Well, I can't give medical advice, and only your doctors know all the variables of your condition, so I can only relate my personal experience.
The Pace and Ablate procedure made drugs unnecessary, except for apixaban (anti-coagulant), because the atria continue to fibrillate; they just can't communicate with the ventricles that do a majority of the pumping.
I don't know why some docs oppose Pace and Ablate. I suppose because it permanently eliminates the a/v node and makes one totally dependent on a pacemaker for life. But there are studies showing P&A better than drugs for people with HF and other conditions, but it clearly depends on your personal medical issues.
Perhaps you can find a doctor willing to do it. Here in the U.S. it seems to be becoming a common recommendation for old people like me that have tried everything else unsuccessfully.
I'm 9 days out and doing very well. Still have a bit of breathlessness on exertion, but it might be the 80 bpm initial setting, which can be adjusted downward. We shall see.
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pace and ablate
Pace and ablate interval
My 40 day post-ablation update
