pace and ablate

[katecla]

I have had AF for about 20 years. During that time I have had 5 cardio versions and 3 ablations. My paroxysmal Af finally became persistent in May this year. This has left me pretty ok when at rest but very breathless when walking up a slope or stairs or just rushing. My arrhythmia nurse has suggested pace and ablate and I am on the list to see the consultant but goodness knows when that will happen. My worry is that if i have this I will be dependent on the device. The nurse says any patients she has who have had this have had relief and the pacemaker has never failed. I would be interested to hear the experiences of anyone who has been on the pace and ablate route.

[BobD Volunteer]

Not personally but I know several who have. The dependency is not as frightening as you might think by the way since the heart wouldn't stop completely if the PM failed, just run so slowly that you would not be able to do much at all. You wouldn't die is what I'm saying.

It is of course a one way ticket so only you can decide if it is right for you.

[Borderterriorist]

I'm on the waiting list for an AV node ablation, I already have a pacemaker. Unusually I've only had one cardioversion, having gone in for an ablation for atrial flutter it was found that mine is atypical ie left atrium and I think I'm correct in saying that an AV node ablation is more straightforward than a left atrium ablation and at nearly 76 I don't want repeated attempts to stop the flutter, my QOL is important to me now.

I trust my pacemaker, ATM it means I can take a big dose of drugs to help control the flutter without my HR dropping dangerously low (I've got LBBB and a grade 1 heart block). I've done quite a lot of research and feedback from people who have had pace and ablate are very positive using expressions like "life changing". I've just had an echocardiogram to check the structure of my heart, which seems to be OK, and although my pacemaker was quite uncomfortable, in the last week it's suddenly much better almost as if it's shifted a little. I'm assuming that you'll have the pacemaker fitted first, which tbh I'd definitely advise although I know in the US it seems they often do both at the same time. Do your own research but I'm happy that it's the best option for me.

[Whataperformance]

I already have a Pacemaker, for 2° Heart block, found by chance. I also have PAF as well. My Pacemaker is set AAI - DDD.. Which means it Atrial paces which should keep the Atrials regular, keeping the AF at bay. It's also an Anti AF Pacemaker, ( but struggles if too fast) However I get fast AF, quite bizarre only about once a year, this fast rate seriously compromise's me.

I going to get an Ablation as my recent Cardioversion failed to revert me back. I had another one 6 weeks later (10 days ago) which reverted me back to SR but I had to take Amiodarone prior the DCCV. Need to stay in SR until this happens.

Personally I would have it done if this was me. I work in NHS Pacing as a Cardiac Physiologist, to me a no brainier.

Pacemakers last over 10 years, some last 15 years. I recently booked a Pacemaker change on a lady who was 101 years old.

Pacemaker are amazing, they have so much on going development. You don't even need to go into clinic for a check as they are now Bluetooth, all checks done by kit at home or via your phone.

Best of luck

[Jajarunner in reply to Whataperformance]

Are people still able to undertake physical activity like hiking uphills, cycling, jogging etc if they have this done? 👍

[Whataperformance in reply to Jajarunner]

I can't see why not..? But you need to speak to your Cardiologist on their point of view. The Pacemaker will track your Heart rate ie when going up the stairs etc at 6 weeks post Pacemaker, you can start playing Golf etc.

Lot depends on how you feel, but this is something you need to ask.

[Jajarunner in reply to Whataperformance]

I'm not at pace and ablate yet (🙏) but was just curious as I thought I'd heard it curtailed a normal active lifestyle. Thanks for the reply 👍

[Ppiman]

I suspect many of us have been offered this for some point in the path of their AF. I was a bit shocked when it was mentioned to me earlier in the year, but there we are - if it's needed, it's needed. I feel exactly like you but have one read good reports of it.

Steve

[Nannysue1]

I know exactly how you're feeling. I had the pace and ablate 2 yrs ago and it was a big decision for me to make. I'm 70 now and I was fed up with how AF was impacting on my life . I can only speak for myself but it was the best decision. I no longer take any medication other than apixaban. I lead a relative active life with no restraints caused by heart problems. I have HCM but it doesn't impact on my lifestyle.

I would never advise anyone ether way with this decision but I can say, it's one of the best decisions I've made.

Good Luck Sue.

[ahcm]

I agree with Nanny Sue, I haveHCM too and my life was non existent. I had long episodes of AFib every 2 or 3 days so couldn't make any plans to do anything. I was very symptomatic. I had my pace and ablate 2 years ago when I was 73 and it has changed my life. I feel so well all the time and can do anything and actually make plans! Plus I could stop taking Diltiazem and now only take Apixaban and Furosemide. Unfortunately , Pace and ablate doesn't stop you catching Covid! I'm suffering it at the moment, horrible!

Carol.

[Marina_D]

Hi Katecla,I had a pace and ablate back in 2019.

My AF and flutter was paroxysmal but I was very symptomatic when I had an attack.

The docs tried fleconaide and bisoprolol.

The flecanaide didn't touch it and the bisoprolol just ended up causing pauses.

Plus I already have a low blood pressure so meds made that worse. I did have a chemical cardioversion done but it just made my heart speed up and dropped my BP in my boots. Not good.

I chatted with my cardiologist after doing some research. He offered a PVI ablation but said it was probably likely to have 70% success. So, I opted for pace and ablate.

It was the best thing I did. I wake up every day feeling a regular heartbeat and can get on with life. In the beginning a few tweaks were needed but let's face it, we are all individuals and one size does not fit all. I am paced at 70 bpm minimum and around 150 bpm max, that works well for me.

One down side, that doesn't affect the majority, is that I have developed a mild PICM (pacemaker induced cardiomyopathy). I haven't had symptoms, it was picked up on a chest x-ray last year.

I am on the waiting list for a CRT-p (cardio resynchrony therapy pacemaker).

This involves a box change with an extra lead to pulse the left side of my heart.

Hope that helps allay your apprehension.

[katecla]

thank you to everyone who has replied so positively to my query - and definitely put my mind at rest. I think pace and ablate is my way forward - I think I may get my life back at 79!!

[reinaway in reply to katecla]

I had this done in 2022 when I was 84 and haven't looked back since. Fantastic difference in my life now!

[Texmosart in reply to katecla]

I am getting a pacemaker on 4th Dec followed by AV node ablation few weeks later. Been good hearing positive feedbacks for this procedure. I am 77 had 3 ablations now in permanent AF with pulse around 150 to 50 - also have HOCM. I take comfort that once done the AF won’t dominate my life so much, I know it’s not a cure but want to rely on pacemaker to keep me on even keel.

[Borderterriorist]

I'm really pleased that my EP consultant hasn't decided to go down a more conservative route with me. I want to live my life not hang around on waiting lists that may resolve my problem for a few months (or not at all) only to go back on yet another waiting list. When I was recently admitted to A&E I had flutter, fib and SVT all at the same time and it took 15 hours to stabilise my heart rhythm, I did wonder if my number was up. Today I walked the dog for an hour and a half at a decent pace with minimal discomfort on the last stretch of a lengthy incline but some days I struggle to walk on the flat for 15 minutes. It's so difficult to plan ahead and has stopped me looking forward to things in case I get a lengthy period of arrhythmia.