Sinus node nicked

I see a lot of people have had their sinus node nicked during an ablation and now need a Pacemaker. Was that the surgeons mistake or is it just something that happens?


4 Comments

**it happens.

by AgentX86 - 2021-04-11 00:03:55

This is just part of the risk you signed off on when you agreed to the procedure.  It happens and it's not negligence. 

Sinus node damage

by Gemita - 2021-04-11 01:52:27

Linnie,

I agree with AgentX86 and I would further suggest that when we need an ablation it is sometimes the case that the sinus node is already beginning to fail as a result of any arrhythmia and remodelling (scarring of heart tissue) and that an ablation may just unmask the problem further.  Which comes first the arrhythmia or the sinus node disease?   This is the real question.

Of course damage can be sustained during any procedure and an ablation is not without risk, however good the EP.  I note you sustained injury to your sinus node in June 2020 following another Atrial Flutter ablation, for which hopefully your pacemaker will be an effective treatment. 

I attach a link on the connection between atrial arrhythmias and sinus node dysfunction.  It is hard to know which one came first and whether you would have gone on to develop sinus node problems in any event, even without an injury?   My EP tells me that one arrhythmia frequently hides behind another and it is only by taking out one can another be seen.  Frustrating stuff I know.

Good luck Linnie and hope your pacemaker will allow you to get back to your normal activities soon

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.018011

Use of endocardial mapping reduces this risk

by crustyg - 2021-04-11 04:28:58

I think that the standard has improved over the last decade or so.  These days, if the EP-doc manages to ablate something important (AV-node, SA-node) and wasn't using an endocardial mapping tool, then I think that's arguably a basis for a negligence claim.

There's plenty of time for the EP-doc to rest the ablation catheter against the inside of the heart and pause to see where the tip is, relative to the markers established during the initial mapping, before putting a foot onto the pedal that activates the ablation diathermy.  It's that pause that ought to prevent accidental damage to important stuff.

Agent is correct that there are no guarantees, and internal mapping isn't perfect, which is why, if you have a choice, you find an EP-doc who does a lot of ablations with a very good success rate.  Skill is important, and the technology augments that skill.

Writing as someone whose SA-node is useless anyway, I can think of a lot worse things to have happen to my heart than needing a PM.  But it's all about perspective.

Also one of them

by Snake - 2021-04-11 11:57:20

I was also one of the (un)lucky ones that needed a PM after ablation.

I had my first ablation which stopped AFib for just 3 weeks and then it was back. The second ablation a few months later (with endocardial mapping and an experienced EP-doc) went wrong. They hit something which resulted in no more signal.  They kept me going with escape rythm and medicine and they put a PM 2 hours later.

Now, 4 years later I am quite happy with my PM no more irregular heartbeats and I can do everything I want.

 

 

 

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