AV Node Ablation

[Ozette]

If you have had one, I’d like to know how you feel after .

[IanMK]

Hi OzetteI had one a couple of years ago as part of my treatment for SVT. I have been fine ever since and able to lead a normal life. I’m an active (not athletic) 67 year old male.

[Ozette in reply to IanMK]

Thank you. Do you see any downsides? I’m 77 female with good health other than arrhythmias I have had 3 ablations in 9 years. My last ablation was last August. Doctor found 3 places to a ablate. He did two but the third disappeared and was in a location too dangerous to ablate, so he had to leave it. So now I am in arrhythmia 27% of the time with chest discomfort, shortness of breath and low energy. It’s hard to walk even a normal pace. I’m on several of the usual medications used to control arrhythmias. I’m thinking about the AV Node ablation. For the most part I feel great when in a normal rhythm. Stay healthy! Ozette

[IanMK in reply to Ozette]

I had my first ablation in June 2018 after an initial diagnosis of heart failure caused by a complex arrhythmia (at its lowest, my ejection fraction was 25%). My ECGs showed atrial fibrillation, runs of atrial tachycardia, frequent atrial bigeminy and periods of ventricular ectopic beats. My EP chose RF ablation but realised during the ablation procedure that some of the sources were dangerously close to my AV node, so had to leave those. I was subsequently offered the options of long-term (i.e., lifetime) amiodarone or a further ablation with a high risk of AV node damage requiring a pacemaker. I opted for the risk of relying on a pacemaker over a lifetime of strong pharmaceutical products. I am a (now retired) electronics design engineer and somewhat familiar with the design of state-of-the-art electronic systems. Although this may sound strange to many people, I was very comfortable making this decision. To me, relying on a pacemaker is similar to relying on my spectacles to be able to see clearly. I had my 2nd ablation in 2019 and came around after the anaesthesia with a pacemaker fitted. Not an ideal result, but very acceptable. My ejection fraction has now recovered to a normal level.

Downsides?

1) After my wound healed, I was left with a 'badge of honour' as I have little body fat to cover the device. This could be a problem if one let it be so.

2) My device will need to be replaced in 9 years' time.

3) I need to be more careful of where my device is located if I’m carrying large heavy objects (or the position of a car seat belt if sat on the left).

Although I previously had a largely sedentary occupation, I had always considered myself to be in good condition. My heart failure demonstrated how easy it is to be wrong. However, I still consider that I am in better condition than many others of my age. I now feel great most of the time and I try to correct a lifetime's underactivity by doing more exercise. I don't feel any limitations with walking or cycling although I am occasionally tempted to push myself too hard in my home gym. As I'm now 100% ventricularly paced, my pacemaker limits my heart rate so it's great to have this additional safety feature.

I can well understand your discomfort and the restrictions placed on you both emotionally and physically. If you have confidence in your EP and they offer a further ablation and (possible) pacemaker as being in your best interest then all I can add is that I have no regrets.

I hope this helps.

Best wishes,

Ian

[Ozette]

Hi again. I was given a pacemaker in 2013 right after my second ablation because my heart was pausing. I just received a new one last September so at this point it would just be having the AV Node Ablation. I do trust my electrophysiologist and will discuss it more seriously with him. I appreciate your sharing. It can be very lonely living with the sometimes debilitating symptoms of AFib.

[IanMK]

Some people can have AFib without even realising (which comes with dangers of its own) but for others like yourself it can make life very difficult. Pacemakers are very reliable devices with built-in redundancy and fall-safe modes. Even if the worse were to happen and my device fail totally, I know that in my case I still have a natural 'escape rhythm' of 48bpm, which is not enough for me to maintain my present levels of activity but will keep me going 'on two cylinders' until my device can be replaced. Your existing pacemaker (probably with an integral defibrillator capability) will be programmed to operate in a different way in the event of AV node ablation. If you don't already know, you may wish to confirm that you have a 3 lead device (for pacing of both ventricles). I wish you all the best.

Take care.