40 Responses to “AV Node Ablation: Why You Shouldn’t Have It”

1. Terry Loveless // Aug 2, 2008 at 1:17 pm

   I have had AV nod ablation and a pacemaker,but the Doctor said I was not pacemaker dependent. Can this be?

2. Richard Kelly // Aug 8, 2008 at 12:14 pm

   I have had Afib for two years and I am on deltizam 360mg per day . This controls my blood pressure and heart rate–rate control . I have been recommended an AV node ablation and pacemaker as the best treatment to cure my Afib . When I last had a follow up visit with my cardiologist I mentioned pulmonary ablation using a Stereotaxis or Hansen system and he asked what those systems were !

3. Mellanie // Aug 11, 2008 at 8:24 pm

   Terry,

   You said: “I have had AV node ablation and a pacemaker, but the Doctor said I was not pacemaker dependent. Can this be?”

   The AV node ablation burns out the heart’s natural pacemaker, and the implanted pacemaker takes its place. It doesn’t make sense to me that you would not be “pacemaker dependent.” You might want to ask your doctor to clarify further.

   Mellanie

4. Mellanie // Aug 11, 2008 at 8:26 pm

   Richard,

   It sounds like your doctor is not keeping up. Maybe it’s time to find an electophysiologist (a cardiologist that specializes in heart rhythms).

   Mellanie

5. Lois // Aug 27, 2008 at 7:47 pm

   My afib started when I was 50 years old. I was on many drugs including Amorodian. I was in and out of the hospital sometimes twice a month. My cardiologist finally suggested an ablation. I had to have 4 ablations to finally stop my afib. After the first ablation I had to have a pacemaker. But now, life is great. Instead of spending time running to the emergency room, I have my life back. I feel absolutely nothing and have had a great quality of life that I didn’t have before. Yes, I still have to take coumadin but it is better than going to the emergency room and always being scared to death what was happening with my heart.

6. Mellanie // Aug 31, 2008 at 8:10 pm

   Lois,

   Congratulations. I’m glad that you found a solution that worked for you.

   Mellanie

7. Moises // Sep 6, 2008 at 8:13 pm

   So, if I have ablation, I will need a pacemaker

8. Mellanie // Sep 6, 2008 at 8:57 pm

   Moises,

   No, you don’t need a pacemaker for a Catheter Ablation. You do need it with an AV Node Ablation.

   Yes, it’s confusing, so please read http://www.stopafib.org/catheter.cfm to understand the difference.

   Mellanie

9. David // Sep 23, 2008 at 12:33 pm

   Mellanie,

   My father just had the AV node ablated and pacemaker put in. He is 80 years old and when they 1st tried ablation at clev clinic 6 or 7 months ago they said he had so much scare tissue and short circuits in his upper chamber that they would have done AV node ablation and pacemaker right then and there if pre surgery authorization had been given. So they waited a while to see if it took. It did help a little but it persisted. The surgeon was worried that my dads persistent afib would wear out his heart (i forget the tech term), and so were we, and it made sense. they tried all the latest and strongest drugs before and throughout. I just now see you article of caution and got worried, but i think at 80 my dad did not have time to wait for the next advance as this was taking a toll on his heart. I appreciate your comments, there is logic especially in the finality of it for a younger person, but persistent AF is not a good thing, right? Do your words of caution change as a patient gets older and more frail? This was just done yesterday and dont know yet how well it is working out. We thought it was the right thing, but your article has me a bit worried.

   PS: Mellanie, what is your medical background or experience?

   A worried son,
   thanks,
   david

10. Mellanie // Sep 23, 2008 at 8:32 pm

    David,

    I’m sorry for what you and your Dad have been through. In your Dad’s case, this was probably the best option.

    Generally catheter ablations and surgeries are done up until about age 80, though some over 80 have done quite well.

    However, with extensive scar tissue, a failed ablation, and the risk of heart failure, the AV node ablation was a reasonable choice.

    Surgery is always another option, but with the extensive scar tissue, it may not have been a good choice in this case.

    What bothers me is when AV node ablation is chosen without these kinds of issues in a younger person that will have to live 30, 40, or more years with a pacemaker and will be unable to take advantage of advances in medical technology. It does happen.

    Regarding my background, I clarify on our parent site, http://www.StopAfib.org, that I’m not a doctor or a clinician. I’m a patient who survived afb. With my scientific background, I have dug in to learn as much as possible about afib and treatment options to help others who don’t have the time or inclination to do the medical research. It’s about helping others get the education they need to partner with their health care team.

    Good luck to you and your Dad.

    Mellanie

11. Hazel // Sep 24, 2008 at 9:42 am

    Hi -I’ve just learnt that my son has been in a fib for the last seven years - he has had a pacemaker for twenty-two years because of complete heart block after surgery for a congenital heart condition. He also has a prosthetic mitral valve and is generally leaky around other valves. I have a feeling I have seen research which suggests that long-term pacemaker dependency causes afib and cardiomyopathy, but don’t understand how this can come about. Anyone know?

12. Mellanie // Oct 12, 2008 at 8:56 pm

    Hazel,

    I’m sorry about your son’s afib.

    It’s quite possible, though I haven’t run across anything suggesting that afib is caused by long-term pacemaker dependency.

    With the multiplicity of concerns, it might be worthwhile speaking with a cardiac surgeon who understands all of these areas and can help. I know that when you fix one, you’ll likely want to fix them all.

    Good luck with this.

    Mellanie

13. Margaret // Nov 28, 2008 at 4:44 pm

    I had an AV oblation 5 yrs. ago and a one lead pacer implanted after dealing with many trips to the er and so on. I’m now 70 and I’m concerned that my left ventrical is tiring. I’ve had sleep studies - negative, pulmanary breathy tests - normal and still find I get out of breath doing usual normal things. I was surprised to understand that after removal of the AV node there is a total disconnect to the ventricals.

    I’ve talked to my doctor about another lead on the pacer to help the right vent. assist. I’m still in AFib, which you know and on Coumadin. I still feel palpatations and sometimes I know my pulse is out of sync. I’m recently getting a 2nd opinion about the 2nd lead. I feel there is something still not right but I don’t know what.
    p.s. I had no idea that oblation of the AV Node was not such a great idea. You are right, with newer procedures, resynchronizing (3 leads) it is new on the
    use of the pacemaker. My sister just had it done and she is 69 and feeling great. A major change in her general health.

    Any comments would be appreciated.

    Thanks, mme

14. Eric // Dec 15, 2008 at 2:39 pm

    Hi To All,

    I have a question.

    Are there any minerals, amino acids or vitamins that cure afibs? Does excersisie and meditation help?

    I refuse to have my heart cut ,burned or electricuted.

    I eagerly awaite your responses

    To better health.

    Eric

15. Jeff // Dec 16, 2008 at 9:11 pm

    Mellanie,

    I am an electrophysiology PA.

    Please don’t forget to tell your bloggers that persistant pacing of the right ventricle (like after av node ablation) can cause the heart to weaken and potentially lead to Heart Failure.

    Please refer to “the DAVID trial.” . . . “in this trial it appeared to increase the combined end point of death and hospitalization for heart failure.”

    Thank you,

16. Mellanie // Jan 8, 2009 at 4:39 am

    Margaret,

    It sounds like a second opinion is warranted to figure out if anything else can/should be done. Good luck.

    Mellanie

17. Mellanie // Jan 8, 2009 at 4:44 am

    Eric,

    You asked, “Are there any minerals, amino acids or vitamins that cure afibs?”

    Some folks that have lone afib (no underlying heart disease) have had good results with supplemets and diet. You can learn lots more over at Hans Larsen’s Lone Atrial Fibrillation Forum - you’ll find the link in our list of Afib Forums on the right side of this page.

    You also asked, “Does excersize and meditation help?”

    Some people have had good results with meditation and breathing control - there’s some discussion of that on the Lone Afib Forum as well. Exercise can help some people, and triggers afib in others, so that’s something that is very individual and you may have to experiment with. Remember, all things in moderation.

    Good luck.

    Mellanie

18. patrick wood // Jan 24, 2009 at 10:43 pm

    i am going to get an ablation.I cannot tolorate tha medicine anymore.Where can i find the best doctor around illinois to do it.What is the best hospital.Is there any guides to go by that rates the best overall people to trust for the procedure.I only get arrythmia sometimes but the medicine is makeing me very sick and i have tried afew and my doctor said my options are limited.

19. Mellanie // Jan 25, 2009 at 9:35 am

    Patrick,

    We’re doing an atrial fibrillation patient information program in Chicago (Schaumburg) March 7. Can you wait that long?

    We’ll discuss treatment for afib, including catheter ablation and surgery. Here’s where you can find out more:
    http://www.stopafib.org/newsitem.cfm/NEWSID/138/

    Feel free to e-mail me privately to discuss doctors in IL.

    Mellanie

20. Jeff // Feb 7, 2009 at 9:44 am

    Patrick,

    I am an Electrophysiology PA.

    I assume you are talking about an AV Node ablation with pacemaker implant. If so, see my note above.

    Before you procede, please look up Pulmonary Vein Isolation on Google. Most cardiology groups with an EP are doing this -potentially curative- procedure these days. It is a great way to cure a “paroxysmal atrial fibrillatior” like yourself without putting you at risk for heart failure.

    I have seen too many bad things happen when a doc performs AVNode - Pacemaker.

    Good luck, Jeff

21. Lioba Hanley // Mar 22, 2009 at 10:51 am

    Dear Mellanie,

    A year ago I had AV node ablation because of frequent trips to the hospital with Afib and taccardia, extremely high blood pressure and medication no longer held me in sinus node. I have done well since then but
    am now having very hard knocks in my heart, like bangs. Also, when I lie down at night I feel like a bunch of bricks are weighing my chest down. Are these two symptoms normal? Or can something be done? I am on Coumadin and Labetalol.
    Thank you, Lioba Hanley

22. Lioba Hanley // Mar 22, 2009 at 1:04 pm

    Dear Mellanie,
    Four years ago I received a pacemaker because my heartbeat was usually at 40. Last year I had an AV node ablation because no medicine would continue to keep my heart in sinus node. I have Afib and had taccardia with extremely high blood pressure when taccardia set in. I wa was hospitalized many times with Afib and taccardia. I have found much relief, especially from frequent hospital visits. But now I am having trouble with pvc’s and Afib. Often I have “banging” around in my heart. At least if feels like it. And I have pvc’s. At night when I lie down it feels like I have a pile of bricks on my chest. Are these symptoms usual for patients like myself? Is there anything I can do to quiet them? I am on Labetalol and it does help some. I should mention that I was on Amiodarone for a few years to try to keep me in sinus node and before that, other beta blockers.

    Thanks you, Lioba

23. Mellanie // Mar 24, 2009 at 11:34 pm

    Lioba,

    The “pile of bricks” on your chest sounds scary–that’s often a heart attack symptom, or might be due to lung damage from amiodarone.

    The banging around sounds scary, too, but I don’t know what that could be. Please get to your doctor immediately to find out what is going on.

    I have heard that sometimes you can have surgery for afib even after an AV node ablation, so you might want to find a surgeon. If possible, see an integrated center that has EPs and surgeons that team together to find the right solutions for you. You can search for Afib Services in your area by going here:
    http://www.stopafib.org/find.cfm

    Good luck.

    Mellanie

24. pinnacle security // May 12, 2009 at 9:36 am

    I told some critical care nurses I had an ablation for AV node re-entrant tachycardia and they never heard of it. It is supposed to be a fairly common reason to have an ablation. I am so thankful to have seen a sign board which said “Prairie Heart Institute”. Top 5 in the nation. They cured me there. I thought I was going to die and no one would be there when I did it. Dr. Kreigh Moulton is a genius. He fixed my broken heart.

25. Donna // May 24, 2009 at 2:03 pm

    My husband has been battling cardiomyopathy and Afib for the last 7 years. He is only 48. We’ve had 2 ablations, been flown to several heart centers, had more conversions to even count and he will make gains in feeling better and then take losses in his heart infraction rate. We are staring down an av node ablation and pace maker on the 7th of July( last severe ablation happened in March and only help for a few days) Has anyone done any research on the “Maze” procedure verses AV node ablation? This was suggested to us a couple of years back when my husband was in intensive care at UNC heart center with complete heart and renal failure? Is this a viable option before a 48 year old man kills the “natural” order of his heart for a “man made” pacemaker? Anyone have any info please anything feedback will be appreciated!

    Donna

26. Dot // Jul 31, 2009 at 11:58 pm

    My mother-in-law is taking amorodian for her heart problems. Now she has developed pulmonary fibrosis. Is it well known that this heart fixing drug causes lung problems?

27. Mellanie // Aug 1, 2009 at 8:56 am

    Dot,

    Yes, it is well known that amiodarone can cause pulmonary fibrosis and a number of other very serious problems. Doctors should be mentioning this to patients, and testing for a number of issues while patients are on it.

    In my testimony before the US FDA Advisory Committee, I talked about a number of issues that afibbers have had to deal with from taking amiodarone. You can read more of that here:
    http://stopafib.org/newsitem.cfm/NEWSID/151

    The FDA has approved an amiodarone replacement, called Multaq (dronedarone), that is not toxic, but is slightly less effective than amiodarone. It became available in US pharmacies this week. You can read more here:
    http://stopafib.org/newsitem.cfm/NEWSID/180

    Mellanie

28. Zac // Aug 4, 2009 at 1:17 am

    Be careful with Multaq (dronedarone). Someone starting on it should be monitored for at least the first 48 hours. My father started on it last Friday. ~18 hours after starting, it dropped his heart rate from about 80 (resting) to 50 which made him feel extremely short of breath and his blood oxygen fluctuated wildly, dropping down to below 70% (the lowest reading possible on the pulse oximeter) at times. And he has an SJM pacemaker (with the AF suppression algorithm) to provide rate support. Oddly enough, the base rate of the pacemaker is set to 60 bpm so it’s unclear how/why his pulse dropped to 50. He stopped taking it for 24 hours then reduced the dosage by half (to 400 mg/day). He feels better, but still has lots of afib. He is still undecided whether he will continue on it.

29. Robert Head // Sep 6, 2009 at 11:20 am

    After 3 years that has included, 3 ablations, 5 cardioversions, and three different drug therapies, i don’t think the pacemaker is a bad idea. As i have researched some material on pacemakers, there are some cardiologists and electrophysiolgist that share the view that some cases of A-fib cannot be cured regardless of how many times the patient has had the abaltion surgeries or drug therapies coordinate along side them. I am 51 years old and i could only see the pacemaker as a postive hope now. It certainly can’t be any worse than the last 3 years have been.

30. Mellanie // Sep 6, 2009 at 10:03 pm

    Zac,

    Thanks for sharing. I hope your Dad is fine now.

    Was your Dad also on beta blockers? I’ve heard of a couple of cases where patients’ heart rates dropped, but were fine once their doctors adjusted (or discontinued) their beta blockers because Multaq has beta blocking properties, too.

    Mellanie

31. Mellanie // Sep 6, 2009 at 10:15 pm

    Robert,

    I’m so sorry about all that you have been through.

    Regarding the failed cardioversions, is there any chance that you have sleep apnea. Untreated sleep apnea is a common reason that cardioversions fail.

    In addition to catheter ablations, there are also surgeries - mini maze and maze - that cure many people, especially those that have afib that comes and goes, or that have had afib for only a few years. You can learn more about them here:

    Maze: http://www.stopafib.org/surgical-ablation.cfm
    Mini maze: http://www.stopafib.org/mini-maze.cfm

    Pacemakers, in and of themselves, are good. It’s when they do an AV node ablation, which is final, that it’s a concern. That way, you really can’t take advantage of advances in treating afib. You’re pretty much stuck.

    With you being in your early fifties, there will be so many advances in your lifetime in treating afib. You should be able to take advantage of them.

    Good luck.

    Mellanie

32. Brown // Nov 19, 2009 at 12:47 am

    I believe that if anyone is having second thoughts about their treatment for afib, they should be going to a different cardiologist for a second opinion. I am a Cardiac Stepdown RN, and I do not agree with what is being stated about the AV node ablation. Just because a person has had afib, doesn’t make them a clinical expert. Everyone has opionions. If you have questions, please ask an expert, meaning someone who has clinical experience with the disease, i.e. doctor, cardiac nurse.

33. Mellanie // Nov 20, 2009 at 7:00 pm

    Brown,

    That’s the point exactly - don’t just blindly go into an AV node ablation, but instead get another opinion.

    Would you recommend an AV node ablation for a 40 year old woman with afib and no other problems who has failed one medication and hasn’t had a catheter ablation or surgery yet? That doesn’t seem to make good sense, but we know of several who almost followed the first doctor’s directive and had AV node ablations.

    We just want folks to know to ask a lot of questions, and get a second opinion if needed. This info comes from several patients who had the procedure and wish they hadn’t as they are much worse off now. They tell others not to let it happen to them.

    We appreciate your opinion.

    Mellanie

34. George // Dec 2, 2009 at 11:27 pm

    I’ve had afib for about 6 years. Took and failed 3 medicines and had 2 cardioversions. I went to UCLA Medical for 2 pulmonary vein ablations–unsuccessful. A year later, I had a mini MAZE procedure–in sinus rhythm for about 2 months. Took 2 beta blockers–sotolol and metotropol (sp) and they slowed me down where I was non-functional. My afib turned into a-flutter. Had another ablation procedure in April 2009–redult, left atrial tachycardia. My heart rate is at 100-114 daily at rest. Had another cardioversion in July 2009–sinus rhythm for 1 week. Back with left atrial tachychardia. I was on drondarone for about 3 days in Nov 2009. Did not like the side-effects, i.e, bloating, weight gain, tiredness. The last EKG on Tuesday Dec 1 showed that I have both afib and a-flutter. The consulting cardiilogist recommended “the quick and dirty” (his words) AV node ablation with pacemaker or go to Michigan and have another catheter ablation with “one of the best cardiologists in the USA”. Success rate, however, he said, was 40%. I’m 59 years old. The quality of my life has been drastically affected, i.e, weight gain, tiredness, etc. I have 2 new grandchildren and I am exhausted when I play with them. I’ve run and finished 18 marathons and have been active in water sports all of my life. My daughter, mother of my grand kids, wants me to have the AV node ablation to improve the quality of my life so I enjoy my grand kids and my life. The thought of going to another strange hospital in Michigan does not please me. However, Iunderstand that the AV node ablation is permanent and that door is close done I walk through it. I see my treating cardiologist next Tuesday. I will have to pray for guidance. Anything you can recommend will be helpful. Thank you for this blog.

35. Robert Gray // Jan 30, 2010 at 2:06 am

    Hi,

    I have had afib for around 10 years now. I have had a dual chamber pacemaker inserted a couple years ago, also had 2 radio therapy abilitations.

    These RTA’s have not cured my afib, the next step they are considering is to burn away the Av node.

    I’m still unsure if i really want to go down this road, but i cannot go on the way i am just now.

    I have been cardioverted over 20 times in the last few years…

36. Cindy Lieberg // Feb 13, 2010 at 3:27 am

    My electrophysiologist states that he would have to overdose me with radiation to do the pulmonary vessel ablation due to my ‘thick’ body. I have had paroxysmal atrial fib, uncontrolled rate, and I can feel it, since 1997. I am now 54 years old.

37. Cindy Lieberg // Feb 13, 2010 at 3:30 am

    I also use a CPAP and am on 3 meds that have been upped in strength over the years. The uncontrolled rate is what is so difficult. I have asthma as well and can hardly do anything any more.

38. MUKARRAM // Mar 4, 2010 at 8:33 pm

    I liked the way you have approached the subject of AV nodal ablation in setting of atrial fibrillation. This is not a procedure that is recommended to all patients with atrial fibrillation. In the EP community, we usually offer AV nodal ablation with pacemaker implantation to elderly patients with chronic atrial fibrillationwho have uncontrolled ventricular rate inspite of being on medical therapy.
    We usually implant a pacemaker then wait about three weeks and then proceed with ablation of AV node. Patients above age 75 years report a sense of well being and medications that control ventricular rate(such as beta blockers, cardizem, verapamil, digoxin) can be discontinued.

39. Jonathan Pitts Crick // Mar 12, 2010 at 5:15 pm

    Most people with AF are over 70 years old and want a simple procedure with a high success rate which will relieve their symptoms at low risk. If you look carefully at the published results of left atrial ablation in continuous AF the success rate (no AF, no drugs) is barely 50%. With AV node ablation the success rate is about 95%.

    For younger AF sufferers it should also be understood that there is NO information on long-term (10 year) effects of left atrial catheter ablation - recurrence or complications, whereas we have 20 years experience with AV node ablation and pacing.

    When people do have symptoms after AV node ablation it is often because the setting of the pacemaker has not been optimized to provide a natural heart rate when resting and with exercise.

    Obviously it is theoretically better to prevent the AF than just to mask the effects but these practical issues are important as well.

40. Mellanie // Mar 12, 2010 at 5:34 pm

    Jonathan,

    The facts you’ve stated may be the case in the UK, but may not be the case here in the US. While many afib patients are 70+, a huge and growing segment ranges from their thirties to their fifties and sixties. Those folks just should not be resigned to an AV node ablation, even those with persistent AF.

    While success rates for those in persistent AF may not be high for catheter ablation, surgical success rates are higher for them.

    AV node ablation has a place for those who are too frail and elderly for other procedures, and may give them some relief from afib. But for those who can have other procedures, why should we relegate them to life with constant afib? That seems cruel. I wouldn’t want that - would you?

    Mellanie