Pace and Ablate.

[Slidingdoors99]

Hi All,

Due to have a CRT-d implant quite soon and have been told that I won’t really feel much better than I do now (permanent AFib)

Will I feel much better after the AV node ablation?

Thanks everyone in advance.

[BobD Volunteer]

My understaanding is that after the AV node ablation your left ventricle (the main pumping chamber) will be controlled by the pacemaker. This means a regular pulse which should see the end of any fatigue although the left atrium could continue to fibrillate at will which you may become aware of. Moste people who have this double procedure do feel benefit.

[Slidingdoors99 in reply to BobD]

Many thanks Bob. When I’m in NSR I feel wonderful, good heart rate, blood pressure etc, but have been back in AFib for a month now and it makes me feel pretty miserable!

It has been explained to me that the three lead CRT-d alone won’t make me feel much better after it’s done… guess I’m just looking for some light at the end of the tunnel!

[CDreamer in reply to Slidingdoors99]

I went for same in 2018 and should have had the AV node ablated 6 weeks on. From the moment the PM was hooked up my AF stopped and didn’t have a flicker of a beat out of place so cancelled the AV node ablation. Since then I have had some bouts of AF following COVID and vaccines and pneumonia but nothing like I used to have and never lasting more than 5-8 hours. I think I am unusual but my EP told me he has had something like 10 patients for whom the CRT PM was enough so fingers crossed for you! No guarantees but maybe……

[Slidingdoors99 in reply to CDreamer]

Thank you. So pleased for you! That would be great!

My ❤️ is so damn stubborn though Dreamer!

I’ve never (so far) come out of AFib naturally.

When I’m in it, I’m in it until those volts hit me!

[Moonriver in reply to CDreamer]

How does the CRT PM work?

[CDreamer in reply to Moonriver]

Both ventricles are paced together so they don’t go out of sync which seems to just help me. In modern pacemakers there are also algorithms which can be programmed for AF and although it doesn’t work for everyone, it worked for me. I cannot take any heart drugs so drugs weren’t an option for me, ever and after 2 ablations I still had AF.

[Moonriver in reply to CDreamer]

I wonder in pace and ablate whether one can still feel the AF? I had three ablations, one recently but it’s been suggested that if this doesn’t work I may have to have pace and ablate and that I wish to avoid. I am glad your system is working for you.

[CDreamer in reply to Moonriver]

If AF continue then yes you will still feel the AF but your pulse will be regular so you should have a reduction in symptoms, which is the main reason for the P&A.

[Moonriver in reply to CDreamer]

Can your pulse be regular and yet still in AF?

[CDreamer in reply to Moonriver]

Ablating the AV node, the connection between the atria and the ventricles, is the whole point so that the chaotic pathways of the atria don’t travel through to the ventricles. That means the atria continues in AF but doesn’t affect the ventricles which is now paced by the implant. It does mean that you are then pacemaker dependent so it is a procedure that is usually not considered until all else has failed to help and because a pacemaker needs to be replaced every 10-12 years and there is always a small risk of infection every time that happens.

[Slidingdoors99 in reply to Moonriver]

Well, I’ve never heard of that happening!

[Tricia239]

I had a Pace and Ablate just over a year ago, and feel so much better. That said it has taken a while to get the pacemaker set to suit me - long story but initially they omitted to activate the button to allow it to speed up on exertion and so I was very breathless. Depending on the brand of pacemaker there are various tweaks they can make. Initially it will be set high and then brought down gradually over 3 months. I am pleased I had it done. Feel free to message me if you think I can help further.

[Slidingdoors99 in reply to Tricia239]

Many thanks for your reply Tricia.

I will definitely ask about the settings when it’s that time.

[Moonriver in reply to Tricia239]

Hi, does pace and ablate stop you feeling the AF? So glad you are feeling better.

[Tapanac]

Three lead which my husband has is said to be the Rolls Royce of pacemakers. When I had my two lead, the consultant made me laugh when he said no domestic arguments as Trevor has the 3 lead and you only 2.

He is brilliant and feels great. Me, well I did feel a lot better with a nice even heart rate, but after another bout of covid, then a chest infection/bronchitis/pneumonia together with a really painful knee, I'm afraid my afib has decided to return. Having said that now I have the pacemaker I definitely don't feel the afib like I used to so good luck I think and hope you will feel better yourself.

[Slidingdoors99 in reply to Tapanac]

Hi. Thank you. I’m sorry though to hear about your poorly chest and the return of the dreaded.

When I saw how little the pacemakers seemed after looking at the device I need, I must admit to feeling a bit jealous!

I suppose I should have expected it, with it being an ICD as well! 🧐

[Tapanac]

Well unless your ICD is different to my hubby's I'm not sure, but his is only the tiniest bit larger than mine and we thought that he is quite thin whereas I have more flesh (!!!). Truly though neither of us notice it and no problems.

Also the inserting the device is so easy and completely painless. My surgeon joked with me all the time and laughing I tried to keep still. Took probably less that 15-20 minutes. The only nuisance, if you can call it that, is you cannot stretch to reach up high cupboards or anything for 6-10 weeks. Actually it might have been only 6 weeks, I can't quit remember now.

You will find such a lovely feeling when you have nice regular beats. They set Trevor's at 80 to start with but he got spasms in his tummy so reduced it to 70. Mine was set at 60 which is the norm, but because of my afib quite often it reads 70, but I wouldn't know just our home monitor says.

All the best.

ps.....Trevor just said his is not larger than mine just the extra lead

[Slidingdoors99]

😂 Thank you! Just to check… you both have the CRT-d implants?!

[Hidden]

I did pace and ablate three months ago. I no longer experience the dreadful fatigue that comes with afib and drugs. I love having more energy again. Now if it could just fix my arthritis…..(-: Just fooling around. I DO feel better with my pacemaker, no question about it. And free again, free from drugs, CV’s, visits to the ER, etc. I guess you could say I love my pacemaker!

[Slidingdoors99 in reply to Hidden]

THANK YOU!!

PS I have arthritis too!😂

[Buffafly]

Hi, have you got a date? For the pacemaker I mean ☺️ Best wishes 💓

[Slidingdoors99 in reply to Buffafly]

Thank you. Pre op assessment on Friday! Have requested a date after Christmas, unless advised otherwise!

Unfortunately I need a CRT-d so a much bigger unit.🥱

So worried about it all, in a way that I never was with my cardioversions, or ablations.

I’m allergic to nickel but apparently that’s not a problem???’!!

[Eastwick]

pace and ablate was definitely the best thing I did. Gave me my life back.

[Slidingdoors99 in reply to Eastwick]

Thank you!