Contemplating AV Node Ablation and Pacemaker

Hi everyone.  I'm new to the group.  I'm 78 and active, but have had 3 unsuccessful ablations and am just sick of feeling my heart do it's continual acrobatics.  My little circus is a lifetime of Afib, extra beats and tackycardia, and also brady and longer qt intervals at other times with HR in the 50s.  It all seems to be diet related, because I have so many food and chem intolerances that set it off.   I also feel like I'd go down quickly with a Covid infection.  I'm contemplating AV Ablation and Pacemaker, and am wondering if with this new equipment, there are things you can't or shouldn't do, like use an electric blanket, go thru standard security lines at the airport, etc.  What's the word?



by AgentX86 - 2020-08-27 16:21:28

I went through most of that (including 3 failed ablations) two years ago. I needed a pacemaker anyway SSS, tachy/Brady, and asystoles) caused by the antiarrhythmic meds.

The only problems are that you'll be pacemaker dependent with AV dyssynchrony. Also remember that an  AV ablation doesn't fix the problem, just covers it up so you don't feel it.  It works but is extreme and it's a one way street. There's no going back.

As far as electric blankets and such, forget what you've been told. The only restrictions I've been given are the same as any other pacemaker recipient but with the warning that if it upsets the PM I might not be able to get away from the problem.

Basically, anything normally found around the home is fine, with the exception of arc welding  and because I am dependent, I can't operate a riding lawn mower. I also have to be careful with car ignition systems, specifically the alternator.

After the surgery,  I felt great and I could sleep again! Now I can do anything I want to do. Since covid, I don't go to the gym but I walk 10mi first thing in morning (beat the heat). I wouldn't go back but it is a serious step and it's forever.

AV Node ablation/pacemaker

by Gemita - 2020-08-29 08:33:39

Hello Pegamyheart,

I do not have personal experience of an AV node ablation but I did seriously consider this option a few years ago when I was given the choice of a 

.  regular ablation (pulmonary vein isolation ablation)

.  AV node ablation/pacemaker

.  pacemaker alone to help treat Sick Sinus Syndrome/Tachy/Brady Syndrome + meds to control tachycardia  

I chose the latter option since I had heard some worrying reports of failed ablations and/or complications, or needing several ablations to achieve a good level of arrhythmia control.  My feeling was that if I could keep my heart rate from falling too low and keep it steady during periods of normal sinus rhythm, I could perhaps overcome my many ectopic beats, leading to arrhythmias like AF.  My feeling was spot on (and actually supported by my EP).  My higher heart rate is indeed working well to keep me largely arrhythmia free.  So the pacemaker alone for me was the best possible choice, at least for the moment.  I can always revisit a regular ablation or a final AV Node ablation at a later stage if my situation changes.  

Your post however seems to suggest that you are more concerned about the restrictions of having a pacemaker rather than being worried about an AV Node ablation.  To be honest there isn’t a great deal you cannot do with a pacemaker implanted in your chest, at least once you are healed, so I wouldn’t let that aspect concern you.  I would though maybe give a pacemaker a chance to show what it can do for you to help with your extra beats in particular.  I find that these extra beats often lead to more troublesome arrhythmias like AF.  My pacemaker being set at a higher heart rate of 70 bpm night and day, keeps my extra beats largely at bay and without these I am less likely to slide into an arrhythmia like AF.  Maybe trial a pacemaker first before making a final decision about taking out your AV Node?  You may be pleasantly surprised just how much a pacemaker can help to smooth out the pauses, the delayed beats, the AF induced bradycardia and all the other nonsense.  

Are you in permanent AF ?  If not, it might be worth asking your EP about what other options are available to you.  I have a dual chamber pacemaker so that synchrony between atrium/ventricle can be maintained and then my EP has been experimenting with pacemaker settings to find a good balance for me.  Even if my arrhythmias cannot be totally fixed, I find that I feel them less now, so have fewer symptoms generally and after all, all treatment options are aimed at just that:  “to control our arrhythmias and to help with our symptoms” since realistically there is no real cure for an arrhythmia like AF, although many may have enjoyed successful ablations which can last for years.  Clearly you have not.  I hope for the very best for you

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