AV Node Ablation and pacemaker

Hi all ,

Ive just joined the club as i wanted to see if anyone could shed some light on my situation as some of you may have been through it already.

Im 58 and had my aortic valve replaced 3.5 years ago now. Since then i have been in and out of AF. My periods in sinus get shorter and shorter being 2.5 years, 6 months, 4 months and recently 6 weeks. 

Ive had one ablation 5 months ago now. 

I have retired and want to lead an active life running, weight training, football and dancing. None of these to an extreme just average exertion. I cant do any of these while im in AF and it gets me down.

I have a second abaltion in mid October. I want to be positive but i cant help but think im destined to be in permanent AF.

I talked to my NHS consultant about AV node abaltion and pacemaker but he told me this was the last thing i wanted to do at my age and with my active lifestyle. However after reading some of your posts i dont know why i cant go through with it.

I know i should probably wait until after the second abaltion as 2 together have a higher chance of success. I have an enlarged left atrium and have virtually eliminated alcohol, caffiene, stress, weight gain from my life. Also just coming off artificial sweetners as read in the posts this could be a trigger.

So please can you give me some advice on where to go with this and give me some hope that i will get back to the lifestyle i want.

Thanks, Graham


AF ablation

by Selwyn - 2023-09-23 13:19:35

Welcome Graham, don't dispair, there is light at the end of the tunnel. I've had one flutter ablation and two atrial fibrillation ablations ( In fairness, the consultant was more upset than me when I showed him my Kardia print out that I was still in AF). My AF was always paroxysmal, and although I still get little runs of AF according to my pacemaker AMS readings, I don't really notice these.

With regards to activity, well I swim a mile regularly, play table tennis competitively for a couple of hours ( sometimes both on the same days) and manage lots of normal activity from gardening to hill walking. Like you, I also dance, though can find the Viennese waltz challenging unless I am properly warmed up.

 Personally, I've never had any complications, other than local bruising from the fibrillation ablations. I did have a general ananaesthetic - some times the ablations can take ages, and I believe can be painful.  I think the old motto, if at first you don't succeed try try again is appropriate.  I certainly struggled with physical activity whilst in atrial fibrillation.

Positive thoughts... positive outcome.

AV Node ablation and pacemaker

by Gemita - 2023-09-23 14:23:03

Hello Graham,

It seems to me that they have already arranged for you to have a second ablation in an attempt to try to stop your AF.  It often takes more than one attempt to successfully treat AF.

I see you are also considering something entirely different, an AV Node ablation, where the fast AF signals from the top chambers (atria) are prevented from passing through the AV Node.  This effectively isolates the atria from the ventricles and successfully stops the fast, irregular rhythm from reaching your ventricles and pushing your ventricles too fast.  

An AV Node ablation wouldn’t eliminate the AF which would still remain in the atria, but because you would no longer get high heart rates or an irregular rhythm passing through the AV Node to affect the main chambers, you should immediately feel better.  You would of course become pacemaker dependent immediately by ablating the AV Node but when a patient is so symptomatic in AF and when all other treatments have failed (like meds and a regular pulmonary vein isolation ablation), an AV Node ablation can be a good final option.

I agree with your EP.  In your shoes I would probably opt for the second pulmonary vein isolation ablation first since a second ablation will likely offer a higher chance of success.  In the event that it doesn’t give you the respite from AF you are looking for, then you can move to the AV Node ablation.  What have you got to lose?  You would certainly be better off trying to fix your AF first rather than moving towards an AV Node ablation, but of course a pulmonary vein isolation ablation requires a healing period, sometimes up to several months, when you might still get episodes of AF?  

AF needs to be stopped to prevent it from becoming permanent.  You still have a chance to stop it at least in the medium term, and I would take that chance before going down the AV Node ablation route, especially if you are symptomatic. 

I cannot tolerate the irregularity of rhythm when in AF or the rapid ventricular response rate that drives my ventricles so fast.  If my AF ever becomes active again in the future, I would not hesitate to move towards a pulmonary vein isolation ablation or an AV Node ablation.  Fortunately I have had immense success in controlling my AF with pacing alone since I was found to have bradycardia induced arrhythmias.  Treating the bradycardia and pacing at a steady rate of 70 bpm has effectively controlled many of my arrhythmias, but this is unusual and I have been particularly lucky.  For the moment I am only on a low dose of beta blocker.  I still get daily runs of AF but they are not long lasting and positional changes, extra fluids (water, no alcohol) and lifestyle changes have all helped.

Good luck Graham.  Having AF is miserable and we must all find our own unique way to stop this nasty rhythm disturbance which is becoming such a pest for so many of us.

AV Node Ablation and Pacemaker

by Mossy - 2023-09-23 14:54:35

Thank you all for taking the time to reply. It's great to know I'm not alone.

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