AV NODE ABLATION AFTER PPM

[Friendliarthur]

Greetings from Australia.

I am booked in for AV Node ablation in 2 weeks. I’ve had 2 unsuccessful atrial catheter ablations for my persisting AF but symptoms continue. Also have Brady- tachy syndrome hence the PPM to keep lower HR at 60. Tachy end is controlled by meds.

Nevertheless symptoms persist so my EP now proposes AV Node ablation. We’ve discussed all pros and cons and I agree with his view.

However there’s one aspect I neglected to ask EP about, and pabout which I can’t find an answer on Perhaps someone here can help.

With AV Node gone, the PPM will be programmed to control HR at a fixed level. This will take care of brady AND the tachy (currently controlled by meds).

My question is this. Say my PPM controlled HR is set at 60, what happens if I exercise to such an extent that a healthy heart would increase its rate to say 140? Will mine stay at 60, governed by the PPM? If so, how does my CV system cope with less oxygen than exercise requires? Or is exercising to any great degree after AV Node ablation just not possible.

Thanks to all in advance.

[Bjw49]

I have had the same question as I have the pacemaker fitted and av ablation next Wednesday. I was told it is monitored to see what the range is and can be set to allow the increase . Apparently I can resume my activities although not done much strenuous for a couple of years so a slow return to normal life.

[Friendliarthur in reply to Bjw49]

Thank you for your reply. We may both be in the dark a bit about this. You talk of the PPM being set to “allow” the heart to speed up, but as I understand it the heart is actually controlled and actuated by the by the PPM, rather than the PPM being an “allower”.

Ablation of the AV Node largely removes the capacity of the heart to control itself. But there exists small “pacemaker cells” scattered around the heart. In normal circumstances the sinus node or the PPM (if sinus node is isolated by AV Node ablation) overwhelm and dominate those small pacemaker cells, and control the HR.

But if after AV node ablation the PPM fails, those small “pacemaker” cells spontaneously set up an Escape Rhythm with sufficient power to keep heart beating, albeit at a brady rate till the PPM can be fixed. That’s an emergency of course.

That’s a bit of a rave. Sorry. But I still don’t know if or how the PPM speeds up the heart when an ablated-AV Node- person does exercise.

Hopefully some reader here will know.

Cheers

[Bjw49 in reply to Friendliarthur]

thank you … it is a scary procedure to put your heart beat solely onto the ppm but the medication over the past couple of years made me feel like a zombie and has had very little impact on my atrial fibrillation. So onwards and upwards … hope to get back my joke de vivre , ability to exercise , garden, dance

[Friendliarthur in reply to Bjw49]

Sounds very much like my circumstances. Good luck.

[Coffeeb in reply to Bjw49]

have you had your pacemaker and AV node ablation? Would love to hear how you feel. I had first part of operation ie pacemaker, developed an infection, so pacemaker removed. 8 weeks of hell ! Now have to decide if I try again. I to feel like a Zombie and spend hours lying on my bed. Would love to hear how you are feeling. Not enough information given to patients!

[Bjw49 in reply to Coffeeb]

Hi

I had my pacemaker 18th July and after a couple of cancellations had my ablation on the 9th October. It was all very straightforward and I felt a bit euphoric in the days following. No longer taking diltiziam which I think helps with my mood. I thought I would feel instantly better physically but when I didn’t I read that the ablation scar tissue takes time to form so it’s a gradual recovery.

I had my pacemaker set at 80 beats a minute but was reduced to 70 on the 31st October and will be reduced again to 60 on the 28th November.

I am starting to have more energy and more impetus to get out and about.

Still have some anxiety re being 100% paced but no longer a zombie where life comes to me.

I’m sorry you’ve had a set back ….. I feel very lucky mine went to plan as the last 3 years have been awful.

Apparently my pacemaker battery life at current use is 13 years so I’ll be 90 when it needs changing ♥️

I haven’t been given much guidance on the recovery only fir the first week ie no driving, no lifting etc

I googled my questions but there wasn’t a definitive website with any answers. It seems if you have no other heart issues you are just left to get on with it.

Sorry for the ramble … let me know how you go on. I don’t know anyone else who has had this dual procedure.

The good news was my travel insurance isn’t going to cost more money ? 🎉

[Friendliarthur in reply to Bjw49]

Yes, very glad I had the AV node ablated. Touch wood my present much better symptoms will be long term. Read my related reply to Coffee. for more info.

Hope your health remains good.

All the best from Aus.

[Friendliarthur in reply to Coffeeb]

Yes, had my AV node ablation 3 weeks ago. First thing I noticed was that I am no longer breathless on small tasks …… cleaning teeth, getting dressed, washing dishes etc.

Still some breathlessness on larger tasks (take garbage bins to the road) but I THINK not so bad as before.

Procedure was a breeze …… as usual the only slight pain was finding my veins for cannula. But that’s no problem.

I wrote here earlier wondering how my PPM knew to increase HR when needed. Cardio told me PPMs have accelerometer which senses how my body is moving and an algorithm makes the beating rate increase or decrease. So far I haven’t found my HR greater than 90 or less than 60.

Sorry to hear of your infection …… always a risk in any surgery.

I’m really glad I chose the AV node ablation. My Bisoprolol is now down to 1.25 daily and dizziness seems to have gone on holidays.

Good luck as you progress down this pretty long path

[Friendliarthur in reply to Coffeeb]

Hi,

My reply to you I accidently sent to Bjs49. Check it out there. Cheers.

[PadThaiNoodles]

A modern pacemaker monitors many different parameters including movement, body temp and myocardial impedance in order to determine the optimum heart rate. The algorithms to get there are extremely complicated, and include a lot of set-up parameters.

pmc.ncbi.nlm.nih.gov/articl...