I had a AV node ablation after having a clot in my heart back in 2016 which didnot resolve at that time. and progress could not be made. This procedure has an 80% chance of sucess but I was in the 20% that didn`t.  As the breathlessness was still a large problem my EP sugested a PVI after a check to see if the clot had resolved. This was in an effort to resolve my breathlessness.  He gave it a 50% chance of success due to my age(75) and the length of time I had been in persistant AF.  This again didnot resolve this problem so I will see what he suggests on the 7th October.

This EP has thirty years of experience and heads up the team of EP.  He also lectures and teaches. His credentioals are impecable so I can only think to have a second opinion will muddy the waters.  

I am one of those patients who is difficult to treat with any degree of sucess.  My problems are all electrical related and I have no structural problems and clean arteries.


AV Node ablation

by Gemita - 2019-10-02 08:42:31

Bilboesylvia, so disappointed for you.  I too have AF (with a rapid ventricular response rate) and have been offered an AV Node or a PVI ablation.  It is difficult to know which way to go because I am 71 and have several health conditions which would make the PVI ablation riskier than the AV Node one.  I was told there is a small risk following AV Node ablation to develop heart failure and should this occur, I would be offered an upgrate to a more sophisticated pacemaker (with an extra lead(s) to ensure a more natural physiologic action - if I have got that correct) and this should improve the pumping of my heart.  Of course following an AV node ablation we will still have AF causing havoc in our atria although this havoc should be prevented from getting through to affect our ventricles (the main pumping chambers of our hearts), but we will still lose some power from our atria because of the AF.  It is so very complicated and I wont pretend to know a great deal about any of this.  Suffice to say that if you have complete confidence in your EP, then continue to trust in his judgement and in your own.  Dont lose sight of getting better, because you will.  Like me you are probably so symptomatic in AF and loss of synchrony between your atria and ventricles is acutely felt.  There are many tools in the cupboard, so I do wish you well.  

AF and AV Node Ablation

by AgentX86 - 2019-10-02 09:06:31

I can't imagine that there is less risk in an AV node ablation than a PVI but that's why we hire specialists. I'd certainly want a second opinion before making that choice. IMO, an AV node ablation is the absolute last choice, only done after everything else has failed.

As far as pacemaker induced cardiomyopathy goes, they gave me a CRT-P right out of the gate. My EP didn't wait for it to develop. The risk/reward isn't there.

I didn't even notice the loss of AV synchrony, though I really thought I would. If your heart is otherwise healthy, the "atrial kick" (or loss of) would only be noticeable by athletes. That's how my EP and cardiologist explained it, before I went that way. I'm not an athlete, by any means, but I do walk a lot (110-130 miles a week, ~500/month).

(Edited for typos)

PVI Ablation

by Gemita - 2019-10-02 09:12:27

Bilboesylvia, I was told the PVI procedure may need two attempts to fix my arrhythmias because I have several, including AF and Flutter/tachycardia.  Do you mean that your AV node has failed because it is still allowing your AF to pass through your AV Node to affect your ventricles, or rather that it was successful, but that you are still breathless because of your continuing AF ??  Hopefully they will check to make sure that there were no complications following both ablations, like nerve damage around the pulmonary vein causing breathlessness with your second ablation.  I was told AV Node ablation is successful (95% or more) first time but that there would be no guarantee that I would be "completely" free from all of my symptoms because of my continuing AF and being "out of rhythm" in the upper chamber(s)

Multiple ablation attempts may be needed

by AgentX86 - 2019-10-02 13:47:35

I only went for the AV ablation as a last resort. I'd had a full Maze procedure for Afib, which left me in permanent flutter. Three ablations for Aflutter and antiarrhythmics causing Bradycardia and asystoles meant that I need a pacemaker, in any case, so an AV ablation wasn't a huge stretch anymore. Again, it's a big, irreversible, step. Make damn sure there aren't better alternatives.

AV dyssynchrony worried me a lot but it's turned out to be a non problem. The atrium kick amounts to about 20%, IIRC. An otherwise healthy heart has a lot more reserve capacity than that.

Don't be confused. Keep your eye on the ball. Getting as much improvement as you can.

by Gotrhythm - 2019-10-02 14:07:12

I have no experience with your diagnostic issues, but I have a lot of experience with second opinions. 

It's good that you're already seeing someone tops in his field. But here's where you are: you have been following his recommendations and so far, there is no improvement.

I must challenge your fear that a second opinion would "muddy the waters." In the first place, the second doc might concur with the first. The way forward would become clearer, and your mind would be easier.


The second doc might offer some new insights into your condition and how to improve it--in short his opinion might differ from the first's. But why should that confuse you? If what you have done so far hasn't worked, what do you have to lose by listening to a different idea--perhaps trying a totally different approach. 

Keep your eye on the ball. What you want is not some specific surgery or treatment. What you want is improvement in the problem of breathlessness. That's why you're seeking a second opinion.

One more thought. With your history and given that you are already consulting the top person in your area, you're right. You aren't likely to get a useful second opinion locally. For a second opinion that will mean anything, you will need to go to the top of the top. Somewhere like Mayo Clinic or Cleveland Clinic. 

Travel if you have to.

Getting second opinions

by Elisabet - 2019-10-06 05:13:01

Doctors who are at the top of their field rarely are bothered by the idea of second opinions. In fact they sometimes seek them out themselves - they call it consulting with colleagues. 

I've gotten second opinions for several things in my life and I'm a great beleiver in them. It can be incredibly reassuring to talk through the issue with another specialist before you take take a big step like surgery. In one case it saved my life (and yes I got a third opinion to be the tie-breaker) but more often they've given me confidence that my first doctor was on the right track, and that reassurance is very good to have.

Some big places can do opinions remotely with imaging studies etc. I would definitely go somewhere beyond the immediate circle of influence your doctor has simply because you don't want other doctors to be deferring, consciously or unconsciously, to this person's judgement. You want fresh eyes. Since your doctor is older, you may want to get a second opinion from someone younger who may not have as much experience but who also may be more up-to-date with current ideas and newer technologies. If there are differences of opinion each should be able to explain to you why they differ. 

Best of luck to you! 

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