May 18, 2012

AV Node Ablation: Why You Shouldn’t Have It

Share on Twitter
Share via emailSubmit to StumbleUpon

One topic, AV node ablation, makes the rounds of the atrial fibrillation discussion groups on a regular basis, and has just come back around again. All at about the same time, several afib patients’ doctors have insisted that they have an AV node ablation with a pacemaker implant. Thus they have come seeking others’ experiences.

In this procedure, the AV (atrio-ventricular) node is frozen or cauterized to stop electrical signals from being transmitted from the upper chambers, the atria, to the lower chambers, the ventricles, and a permanent pacemaker is implanted to control the heart’s electrical system.

Supposedly, at least according to some doctors, the AV node ablation will eliminate afib, or at least patients won’t feel it any more. Wrong, say many who have had the procedure. They still feel it, and they are just as miserable.

And whether or not you feel your afib, it’s still damaging your heart, and you’re still at risk of blood clots and strokes. Thus you’ll probably still be on anticoagulants, such as Coumadinâ or warfarin.

I don’t have anything against pacemakers – they do a great job of keeping people alive and of detecting irregularities. We’re lucky to have this technology.

But please, please, just don’t sever that AV node that connects the atria to the ventricles. It’s so FINAL. You probably won’t be able to take advantage of advances in medical technology, and if there’s a problem with your pacemaker, you darn sure better be able to get to an emergency room quickly.

So, lets see…

  • you’ll still have afib
  • you’ll still be at risk of strokes
  • you’ll probably still be on Coumadinâ
  • you’ll be pacemaker-dependant
  • you may not be able to take advantage of advances in medical technology

Now, why is it you would WANT an AV node ablation? Duh!

This controversy seems to be pitting patients against their doctors. One mentioned that her doctor thought she was obstinate for not wanting an AV node ablation. She’s not being obstinate. It’s her body, and she gets to make the decisions. She doesn’t want one, and considers the procedure prehistoric. She’s right!

Maybe for some patients it’s the only answer. But I suspect that applies to far fewer patients than actually get the procedure. Is this just another case of Clueless Doctors who are just not aware of what afib does to us? Or are these doctors unaware of all the other Options Available? Or is it an economic decision? I sure hope not. Is it naïve to still believe that doctors want the best for their patients and will help them find a cure?

What has been your experience regarding AV node ablation? You’re welcome to join the discussion, but before you jump over there, please share your thoughts and comments below. Thanks.

Share on Twitter
Share via emailSubmit to StumbleUpon
Post comment as twitter logo facebook logo
Sort: Newest | Oldest
aly5qt 5 pts

My good news that is a very strong position against ...which I think is not necessarily helpful. I signed up to this site to hopefully get the feedback of people who had had AV ablation for some people it does become a last call in the choice making process. I have discussed with both of my cardiologists in depth the pros and cons but they can't tell you how it will feel do you? I have had four ablations over the last six years I do suffer bad bouts of af each ablation bought me some time but no permanent end to it. I have just had 6 months solid horrid exhausting eventually I had a cardio version and I have had 6 weeks clear sinus now I want to feel like this forever unrealistic I know but some people who have had the av ablation talk of feeling that good afterwards. I already have a pacemaker so part of the job is done when I first had it fitted I was very aware of iit now not at all, maybe I will get used to the atrium remaining in af and my ventricles going steady, my two brothers both had strokes as a result of our condition so running in af does worry me.... Please try to keep an open mind we do need the medics as educated people we like to understand our conditions but the answer is we don't we can't keep up with it all Aly

Bill McNeil 5 pts

I've got one question will the AV node ablation stop the fast beating heart, Iwas told if the heart did'nt get any rest it would wear out sooner

mellanie 6 pts moderator

 Bill McNeil The pacemaker will keep the heartbeat in a normal range. A beta blocker slows the heartbeat, and should do that as well.

Bill McNeil 5 pts

I've got a question I have had a heart surgery for a large hole in my heart in 1999,and a Maze procedure in 2009 to fix afib,none of these have worked and I have had 3 ablations and 3 cardio converts since then,I'm now in afib and I have taken all the medicines they have for this condition, I was told on Tuesday that I needed to have another ablation by going thru the patch to the left side of the heart to fix the false signals but the problem is that this is very dangerous because of the patch,they don't know what this will do by going thru the patch if it will heal up or not I have also read that it takes more than once to correct this problem so do you think  that I  would be a canidate to have a AV pacemaker the drs said I might be able to live another 16 years if I have this

mellanie 6 pts moderator

 Bill McNeil We have lots of knowledge of afib, but the patch for a hole in the septum is not something we have much knowledge about.

 

Are you working with an electrophysiologist? If not, please do so. If so, please get a second EP opinion.

 

Any idea why the maze didn't work? Have you been in afib for a long time?

 

Mellanie

fiddlebill 5 pts

This is Fiddlebill again.  I have found the answer as to why I was blocke 95 percent in right coronary graft.  It was because the presentation shown on the ICD computer screen does not show abnormalities in the coronarys.  The ICD computer shows only a corrected screen generated by the ICD computer, and my coronary was getting blocked and nothing detected the problem.  The EKD or ECG for more of proper name has shown coronary problems in the ST wave for nearly a century.  But when the ICD is inplanted, it blanks out that information for the rest of our lives.  Contact me if you like and I will share my rear end chewing from the Patent Office, to the Food and Drug, to Medtronics for not giving patients on going wearning info to Cardiologist who have inplanted ICDs, to provide scans and oversight for coronary blockage.  Thousands have most likely died because this has not been done..  I've had 36 heart related procedures in 37 years, and I didn't know anything about Cardiologist being blinded to the facts.  billstan1@verizon.net

fiddlebill 5 pts

Heart problem with no available warning. I have ICD implant plus AV node ablation monitored and watched by electropsychologist frequently. Shortness of breath and much todo about meds such as Laskix, Digoxin, Enalapril, etc. I walked into ER and told them "I have advanced coronary stenosis, prove me wrong." I was right 95 percent blockage in right coronary graft, and no doctor had seen this coming on. Why????? Bill

I Am a 85 yr old woman. Had mitral valve surgery in 1994, so I have a ring in my heart. Three years ago I was diagnosed with A-fib. I was on Warfin and recently had a pacemaker installed. One week later another surgery because a wire had come loose. Now on Prodaxa. It seems to work well but went to Dr yesterday and he wants to do a av node ablation. He feels it should take care of a-fib. But what I read earlier it doesn't always cure it. I am afraid of being totaly dependent on a pacemaker. Not sure what to do. After reading some of the comments it doesn't seem to get rid of a-fib. How does one make a decision such as this. I am trying to read all I can about the procedure. I also did not know so many people have had pacemaker replacements. Any helpful info would be appreciated.

I'm 37 and was born with transpositon of the great vessels which was corrected in 1975 and then a procedure called the mustard procedure was don at eh age age of 2. In the 3rd grade my heart wasn't keeping up with my daily activity as I would come home from school and fall right asleep. I had my first pacemaker put in that year and the medication I was on at the time was digg and phenobarbotol(sorry about my spelling) That pacemaker lasted until 1990 and that year I went into atrial flutter and stayed at Kings Daughters Childrens hospital for 9mos that year. After trying numerous medications such as quendine and a few others, and multiple try at cardioversion to jump my heart back into sinus rythm, a Europen docotor along with my cardioligist at the time Dr. Ross performed a AV node ablation on me a the the age of 15. At that time I had a dual lead pacemaker put in to replace my old single lead pacer. All medications stopped and I have been fine for years having had at least 3-4 pacers since and being pacer dependent as my heart rate is only 30 plus beats a min without the pacer. During pacer checks when they cut the voltage back I tend to get slightly dizzy and almost faint, so the techs really have to keep a close eye and be very fast on their pacer checks.
Over the past year or so i have had a few chest pains, and tend to tire much faster that just a few years before, I actually don't know how much longer i can keep up my job in metal fabrication. As i know my circulation is not the best and I have a had a series of verriocos veins pop up rapidly behind my legs and around my ankles and tend to hurt after standing 8-10 hrs a day.

I was born with TOF I'm 28 yr old within the past 3 years I've had about 6 abolations for Atech also I had an ICD implanted about 2 years ago.. My ICD has fired at least 40 times for a tech and a flutter.. anyway to make a long story short my last ablation was the 3rd of the year and now I'm having the same problems been on several different medications that has worked for a while then all of sudden wasn't working so well.. my doctor said an AV node abolition was the next step.. I need to kno are there any other options?

I have tachycardia since 2007. I was put on concor 10mg. This medication helped for awhile. I had several bouts of tachy again. I then went to a Provincial Hospital and was given Tilazem 180 CR. I was then referred for cathether ablation after another tachy. I failed to keep this appointment because of all the reports I read about the side effects of this procedure. I wen t to the hospital again after another tachy and another doctor stopped the Tilazem 180 CR and put me on diltiazm tablets 90mg twice a day. During every visit to the hospital after a bout of tachy, I was given amediorone. I am very uncertain and reluctant to go for cathether ablation. What do I do?

Bill McNeil 5 pts

You can't stay on amediorone very long too many side effects it will cause liver failure and effect your lungs and eyes. I've taken it and my doctor has stopped it I have afib I have had the ablations done and they don't always work the first time you may have to go back several times before you get any relief,

I'm a 59 yr old woman who had been having heart arrythmias constantly for the past 5 years, with my first experience happening in my early 40's. They were frequent, many times a day lasting for 15-20 minutes. They seemed to have increased after I had lymes disease. I was told that everyone experiences pvc's, usually 100-1,000 per day. I was shooting 20,000 a day. Due to my family history, 4 brothers died before the age of 55 (only one of heart attack), mother died at 73 of heart attack, I was a good candidate for cardiac ablation. It was done on 9/30/11 at the Mayo Clinic. Typically they keep you under sedation but still awake as they found that once sleeping, patients quit throwing pvc's. Not with my case so was able to be put under completely. Yeah! They found one node causing the problem but because it was too close to a main nerve/artery (the one that controls breathing), they burned 7 spots all around it. It has worked beautifully and I am so thankful! Due to the pvc's I found I couldn't get enough oxygen to my muscles to allow me to exercise without fatigue. As a result I put on weight, didn't feel like socializing, quality of life lessened. In 2.5 months after the procedure, I'd lost 30 lbs, I exercise daily, feel great and no pvc's to date. Also noticed that I no longer have hot flashes like I was having previously (many a day). So, from my standpoint - a huge success.

New to Afib and sleep apnea but now I have both. I am 73 and am also taking atenolol/altace for BP and simvastatin for chlorestrol. I am also currently on warfarin and undergong a third sleep study on 1/19/12. The Cpap summary indicates that I may have central sleep apnea rather than OSA. I was scheduled for a conversion next week but the pulmonary doc is telling me that prior to that procedure the sleep apnea issue should be finalized and brought under control. If not, the conversion will not be successful. Taking this one step at a time. Any suggestions?

Joe,

Your doctor is right - the sleep apnea needs to be resolved in order for cardioversion to be successful.

Mellanie

Good to hear the stories above. I am 55 years old. I had open heart surgery when I was 19 to correct an ASD. I got my first pacemaker at 22. At that time I had had an incident of tachycardia. I was given quinidine which we found I was allergic to. Went into cardiac arrest and my heart rate stayed around 30 after that. Hence the pacemaker. I am now on my 5th or 6th pacer - can't remember which. I have had occasional problems with a-fib and flutter. In 2005, they got really bad, lasting for months at a time. I had my first ablation then. That lasted 3 years. Since 2008, I have had 5 more ablations. I've been cardio-verted many times. I am very symptomatic. I can feel this the second it starts and it just goes on and on.

My cardiologist who I have been seeing for over 30 years has been wanting me to get the AV node ablation done. Two different EP docs have said they don't agree. I am too young (I love them!) to have this done. I switched to Pradaxa last year after taking Coumadin for a little over 15 years. I will always be on blood thinners and always have a pacemaker. I seem to be allergic or have extremely adverse reactions to so many meds. The ones I can tolerate don't help. So my hesitation in doing this is that it takes away any hope of future technology.

Thanks for all of the opinions folks have posted.

Terri,

I tend to agree with your two EPs that you are way too young for AV node ablation. It's often a procedure of last resort, generally when folks are too frail for catheter ablation or surgery (often age 80+). With 6 ablations, obviously that is not working for you to solve the problem, so have you considered surgery (maze or mini maze)? You'll find more about these procedures here:

1) Mini Maze Surgery: http://stopafib.org/mini-maze.cfm

2) Maze Surgery: http://stopafib.org/surgical-ablation.cfm

Mellanie

Bill McNeil 5 pts

I have had afib for several years and have taken all the meds you could possibly take they did not work had 3 ablations they did'nt work the drs finally talked me into having a maze procedure done said it was a 90 -95 % cure all not true that was in 2009 still having afib found out later it is only a 50% cure not like they said,they want to go thru the ASD in my heart but told me there was some major concern about the patch,I don't believe everything they tell me anymore you have to check it out for yourself,

mellanie 6 pts moderator

 Bill McNeil Maze procedures are typically 90-95% effective, so I'm really curious about the 50% figure you quote. Was it an open chest maze, or are you talking about a minimally-invasive procedure, often called a mini maze (not exactly the same thing as a maze)? What energy source or tool was used on your maze procedure? Do you have any idea why this was less effective? The only reason it should have been a lower effectiveness would be if you had had afib for a long, long time and it was so set-in that they couldn't reverse it.

When I was between the ages of 14-16 I was diagnosed with a heart murmur, SVT (heart rate was up to 340 beats per min.), and Mobitz 1 and had an ablation of my av node. Within a few weeks the palpatations started again minus the heart rate increases. I am now 29....still have the palpatations that sometimes make me so tired I can barely move. No EP has been able to help, beta blockers haven't helped either. There is a family history of SVT and palpatations. My mother, her two sisters, grandmother, great grandmother, and 3 cousins. All of whom have been successfully treated with beta blockers with the exception of me and one cousin. We have both had the ablation. Mine 15 years ago and hers just a few months ago. Am I doomed with this for the rest of my life or are there alternatives?

Norman,

Congrats on your success.

Mellanie

i live in pa and had my second cather ablation done on sep 28 and it was sucessful; my medication has been reduced and will gey off the amiodorone on dec 13 and will get off pradaxa in feb; great young doctor who did the procedure at jefferson hospital in pittsburgh the key is exercise ; walking and light weights and keeping blood pressure under control; yours truly; norm

In the Fall of 1994 I was 29 years old and diagnosed with atrial flutter which progressed to atrial tachycardia. It was controlled nicely with the betablocker Atenolol. By the Summer of 1995 I was have episodes of atrial fibrillation, my EP doctor at St.Lukes Hospital in Milwaukee recommended a cardiac ablation. The procedure took 3-4 hours as there were multiple sites which required ablation. Two-three months later I was experiencing Afib again, this time they recommended a drug called Amiodarone. The drug worked really well, unfortunately there are numerous side effects, too many to list. After 4 years they did another ablation with no significant improvements. I was hoping to get off the Amiodarone due to it's many harmful side effects. By now I was taking Synthroid for my Amiodarone induced hyperthyroid, also was very photosensitive, burned easily in the sun if not wearing 60 sunscreen.
Around the year 2000, my heart rate was not getting much above 45-50 beats per minutes even during exercise leaving me very tired. It was at that time I had a pacemaker implanted and my quality of life dramatically improved over the next few weeks. It's been 11 years now, I'm on my second pacemaker and still doing well. I go for pacemaker follow-ups every 6 months and see my EP doctor once a year. Now I've been talking with my EP doctor regarding a change, either changing from Amiodarone to another drug to prevent AV node conduction or have a AV node ablation. I've been lucky with Amiodarone, but I don't want to push my luck as research suggest long term use of Amiodarone can be fatal as related to serious complications like pulmonary toxicity, lever dysfunction, etc. Only time will tell.

Desmond,

Wow, you're much too young to be on amiodarone for any period of time and really too young to consider AV node ablation, too. It's been 10 years since your last ablation and they have improved significantly. In addition, there is minimally-invasive surgery that wasn't available then either. I would think that the AV node ablation would be the procedure of last resort for you - it's usually recommended only for those for whom ablation or surgery cannot be done safely. But either catheter ablation or surgery should be an option for you, unless there are some things in your medical history that we don't know about. I think you may want to talk with a different EP for a second opinion. Good luck. Contact me privately (http://www.stopafib.org/contact.cfm) if I can help further.

Mellanie

March 1975 I had first open heart triple bypass. 1982 the second triple bypass and third triple CABG in 1992. Then started the graft and natural coronary blockage angioplasties. Then the stents, then the membrane blocked stents followed by treated stents. That is known in cardiology as work for the plumbers (opening blockage in the coronarys). Six years ago I started experiencing electrical problems, A Fib, A flutter, V fib. Then a pacemaker, that didn't do the job followed by ICD. Then I started sliding down hill, loosing weight, weak and all chalked up to mitral valve regurgitation and not a candidate for valve repair, according to a cardiologist. (The program after ICD implant the electropsychiologist turns patient over to cardiologist). I told the cardiologist my gut feeling was something's wrong in the timing of the heart. An echocardiogram showed need for adjustment in what I think was 200 milliseconds to 270 milliseconds which immediately put the ventricles back in sync. (VERY IMPORTANT THAT THE ATRIA AND VENTRICLES FUNCTION IN SYNCHRONY TO KEEP MAXIMUM BLOOD FLOW THROUGH THE HEART LUNGS AND OUT OF THE AORTA. Next day I was walking 5 flights of stairs in hospital and day before I was out of breath going to my car. Following day I changed cardiologist. The computer for my research, and the electrophysiologist that did 7 electrical procedures, 4 ablations, ICD implant, re-implant of atria lead put in wrong by a cardiologist has allowed me to enjoy my 83rd birthday. Also along the 34 procedures in 36 years, was wrong meds that were doing more harm than good. If you can read this then you have a computer and access to a world of knowledge about all I've mentioned above. Do the research on your meds, do the research about fluid retention (edema that shows in ankles) caused by weak heart dumping fluid in lungs causing breathing problems, chest pain caused by blockage and in my last case where ventricles were out of sync (change on ICD settings over four years)(but not detected by a cardiologist), but causing (the left ventricle not filling and sending sufficient blood out of the aorta). When I was resynchronized the angia (chest pain) disappeared over night. Try to find cardiologist who knows and get rid of the others who are not qualified. The world is full of good cardiologist and unfortunately those who have not kept up with the latest technology.

i just had a/v ablation and let me tell you i feel much better.i have afib, along with tachabradycardia and atrial flutter. the medication they tried was brutal.headaches, constipation, vision problems, lathargic,it was awfull. i was scared of depending on a pacemaker, but this is definitly the less of two evils.im back to my old self, and feeling great. working out everyday. best move i ever made. its a big move, and it may not be for everyone, but it really worked for me.

aly5qt 5 pts

Mike how are you now do you still feel the atrium fluttering beating. I have too make decisions on having a av node ablation what is you root cause of your symptoms I have HCM i have tiried so many beta blockers digoxin etc I am now seemingly permanently in flutter we tried a cardioversion last week but the sinus rythmn only lasted for 10 years and the AF is back !!

Bill McNeil 5 pts

Hey Mike I have afib and have tried all the meds and ablations and have had a maze procedure done the drs recommend AV ablations but say I'm too young I'm 60,I read the longer you stay out of rhythm the harder it is to get back,they also said the AV ablation and pacemaker won't get rid of afib just help you live longer,I was wondering as to how you are doing as I have to make some kind of decision soon,thanks

mellanie 6 pts moderator

 Bill McNeil Please email me privately (using the contact form at http://www.stopafib.org/contact.cfm). You're much to young for AV node ablation, so I'd like to find out more details and see if I can help. 

I am a sixty year male who has had PVC's for years now,
I can tell you honestly none of my Doctors in Bellingham, WA or Grangeville, ID nor at St. Lukes Cardiology in Boise, ID, have had the slightest clue about my PVC's nor what the level of PVC's I have can do to a person.
I have just recently been "Clocked" shall we say of having 32,000 PVC's in a 24 hour period via a 12 lead Holiter and have had a Echocardiagram.

Great to finally get confirmation but I was told by the clinic I am in that the only way to go is having a Ablation done...the one doctor...really a resident on a fellowship I found out said it would be 100% cure and the PVC's would not reaccur and that I could go home again right after the procedure...I am having to drive home...it is a 1,625 mile drive back home...does this sound right to you?

I have emailed the "lead doctor" four simple questions, three weeks ago. No reply...I feel like I am not getting the full story and this clinic is very large with their own hospital...I feel like I am a number not a person and I am beginning to not trust what I have been told and the majority of nurses seem very young mostly in 20's and not highly knowlegdable or not forth coming with info...in fact info seems to be kept tight lipped around here

What do you think about the ablation for PVC's is the "way too go"

I had an ablasion back in 1992, only thing I am not keen on is being dependant on a Pacemaker, there are worse things in life though.

I had Super ventricular disease and 2 small children to cope with prior to my pacemaker being implanted. I was constantly ill, heart beat dangerously fast to the point where they would not let me even clean my teeth one morning in hospital. I hated being ill at such a young age.

I took Amiodarone cordorone for 5 years.

Since I had catheterisation and a pacemaker fitted, well my 6th in 4 weeks time I have never looked back, no drugs to take for my heart exept an aspirin.
Only thing that kicks of my fast heart rythm now is Anaesthetic, and that calms down after a while.

I have never seen it as an old fashioned treatment, I saw it as a cure and so far I am fit healthy and have worked almost full time as a senior in a residential home.
I am now 57 years old and love life.

There probably are newer cures and drugs around now but I am so grateful to the Cardiologists that have helped me to stay alive.

I look forward to my retirement.

Mellanie, I am a 72 year old male and have had AF since my twenties, medicines such as Tykosin(?), Amiodorone and Multak as well as an ablation have not helped, By now my ventricle has enlarged to 6+ cm and my ejection fraction is 28%, as a result, a two lead pacemaker was installed june 2010. I feel very weak and with shortened breath. Among the pertinent medicines that I take are Toprol, Cozaar and cumadin. I have been in constat AF for years. Yesterday at my cardiologist, he suggestes a total av ablation and replacement of my pacemaker defibrilator to a 3 lead one, he will discuss this with my Electrophysiologist and contact me to arrange for the procedure. My concerns are the finality of the procedure and the total dependance on a pacemaker. Please give my your comments about this.

Thanks in advance for a prompt response,

Patrick Tocornal
6800 Brookbank Rd
Summerfield NC 27358
336-643-8260

Patrick,

My apologies for not responding sooner. I've been on the road for the majority of the past 3 months and just didn't get to all the blog posts while traveling.

You've had afib for a mighty long time, so I'm not sure that other procedures would be successful. But it couldn't hurt to have a consultation with a surgeon to find out your chances of success. I don't think that a mini maze would be effective with such long term afib, but it's possible that an open-chest maze might be successful. I sure think if I were in your shoes I'd talk with a surgeon before having AV node ablation done. My concerns are like yours, the finality of the procedure and being pacemaker-dependent.

Mellanie

I have had a-fib since I was 26. The first time it occured I was almost 4 months pregnant. I had other episodes over the years but I just dealt with it as it occured as one cardiologist said to do in a matter of fact way, like its no big deal. When I hit my late forties I began to have more episodes of a-fib and always symptomatic. I had to have a number of cardioversions done and went through most of the drugs to treat it, most of which gave me hives and did little for the a-fib. The last drug was Tikosyn and a week later I was in a-fib once again,another drug was added and I was still having episodes so when my doctor said we could add a third medication thats when I said enough and he recommended a catheter ablation which he and other cardiologists also suggested. I went for it and it went very bad. One "hot spot" was ablated and it stopped my heart but it restarted on its own then he hit another "hot spot" right next to it and it stopped my heart but that time it did not restart so an external pacemaker was placed due to complete heart block. I did not get any heart function back in the ventricles of my heart, he had hoped it would return within a few days possibly caused by swelling. Needless to say i now have a permanent pacemaker, its been two years now and yes I still have a-fib and some episodes feel worse than before. I am always tired and I get short of breath if I walk too fast but my doctor insists it is due to being out of shape. I was out of shape prior to this and did not suffer from shotness of breath. I more or less have ended up with an AV node ablation since the function was affected by hitting that one hot spot. I have not felt good since and would recommend that anyone who is told that they should have this done get a second, third opinion before commiting to such a thing. This has affected me not only emotionally but it has affected my job. I work in a hospital, with stroke patients, if they are having a stroke I have to find someone to go with them to MRI in my place since I can no longer be near an MRI, just makes an emergency situation more difficult. Being pacemaker dependant was not anything I ever thought would come out of this and if was told that this was goig to be the end result I surely would not have done it. Its final and I will never feel the same again.

im 44 and and had my 1st pacemaker at age 17 and was on alot of meds Verapermil/Digoxin/Sotolol and they made me feel very weak. im now on my 5th pacemaker and had an AV ablation back in 2006, it worked no more AFIB or meds and that was great, but last year i started to get AFIB back again but in no way as bad as it was before the opperation. i went to my GP and she informed me that some of her patients have had up to 6 AV ablation procedures! i was offered another ablation but i declined because after having the procedure my pacemaker batterys only lasted 5 years when the pacemaker i had before lasted 10 years...big difference. my other worrie is pacemakers can and do have faults thats why im on my 5th now, if this pacemaker has a fault i will be very worried now that ive had the AV ablation. I think for me if i could go back in time i would have declined the 1st offer of the ablation because my symptoms were not as bad as some paitents.

Howdy,
I am currently trying to get myself mentally and pshchologically prepared for an AV node ablation and upgrade to a CRT pacemaker on July 11, 2011. I had a triple bypass 18 years ago, two heart attacks 10 years ago, and - for the past two to three years have sufferred from the effects of CHF, Afib, and atrial flutter, all of which seem to have worsened within the last 90 days The doctors have been guiding toward the ablation for about a year, so I've finally consented to go through with it next month. I am a 74 year old great grandfather, and have previously enjoyed playing stringed musical instruments - guitar, fiddle, & mandolin. However, lately, I'm just not able to due to weakness and fatigue cause by the Afib. Are there any available sources of additional information? I don't seem to be able to find much positive input on the internet.

I was in Afib for about 12 years.On Sept. 12, 2010 I had a pace maker implant & 2 months later an AV Node Ablation. Why am I so tired all the time?

I have a question about something I read above.... that continuing afib in the atrium following an a-v node ablation could lead to heart failure. This perplexes me. If sufficient blood were pumped by the ventricle following a-v node ablation, wouldn't that be all that mattered? Thanks for any clarification! I do not think there is really any choice for me, but I want to be sure before going ahead.

Mellanie, it seems to me that an open-chest maze procedure would be a lot riskier than an a-v node ablation (mentioned as an alternative in a post above). I'm told any a-fib ablation (other than a-v node) would be too risky for me. I have had two heart surgeries and I have a mechanical mitral valve. I now have symtpoms of heart failure due to persistant a-fib following the mitral valve surgery 8 years ago. My ep is recommending the a-v node ablation, and I'm inclined to go ahead as it would mean: my heart failure symptoms would lessen or be eliminated and I could stop taking a lot of meds (other than coumadin, which I have to take anyway due to the mechanical valve). What's not to like? I am 57. Thanks -- this is an interesting blog.

Emma,

Your situation is one of the really complex ones. Since you are so young, it might be worth talking with a maze surgeon before opting for the AV node ablation. I know of a number of folks whose heart failure went away completely after having a maze procedure to stop their afib. I guess a lot has to do with how symptomatic you are with afib. Many people still feel their afib after an AV node ablation.

You're welcome to join us in the our forum if you'd like to discuss this further: http://forum.stopafib.org
(Instructions for registering & getting started are here: http://forum.stopafib.org/index.php?showforum=25)

Mellanie

i have had three catheter ablation and the third seems to be doing ok but i take alot of medication to keep my heart from beating to fast. one is metoprolol 200mgs aday and verapamil 240 mgs once aday plus my high blood pressure medication diovan 160mgs hct once aday,the medication seems to work but at night my heart speeds up to around 92 to 95 beats per minute and it stays that way till around five in the morning then i take the metoprolol and verapamil along with the diovan in the morning but i do not like that i have to wait alease three hours before i can go do anything, the wait is for the medication to take affect before i can go and ride my bike are do any kind of excise are if i do not wait for the meds to take affect i am at 91 to 97 beats per minute all day long, plus i take the new blood anticoagucant medication pradaxa twice aday. i am not on a pacemaker and i am glad of that but i do not know why my pluse goes up at night and this medication is surpose to be long acting. i think i will go back to the doctor to see why this is happening.

i have had afib, irregular heart beat, slow beat, really fast beat... i have had every medicaltion to man for it. still take carvederal and digoxin and coumadin.... this is my 2nd pacemaker and they want to do the a v nodal ablation ... i have to do something but am reluctant.... i have been told 2 times not to do this , i am at my wits end trying to make a decision. thinking about going to the mayo clinic for a second opinion. i have had the best doctors.. but still have a gut feeling about this. i am 65 now.
anyone have any good ideas ????i need help.

thanks
susan

My mom is 72 years young and has been dealing with flutter and afib four years now. Two years ago she recievd a pace maker to be able to increase her arthmia medication. Things have went well until now, her doctor has given her three options. The maze procedure [mini maze I asume, he said they would go in from the sides of thechest, the pulmonary vien isolation and the av node ablation. I 'm thinking the maze may be better due to the first time success rate of the ablation being 50 % as I was told by the doctor. I would like to know your thoughts. Thanks in advance.

Brandy,

I don't know what your current status is with your AFIB; however, I just had a very successful procedure combining the Radio Frequency and Cryoablation surgeries. I'll be more than happy to go over it with you in detail (pre-op, post op, recovery, meds etc.). Everyone is different and while there are no guarantees, I'm very pleased with the results thus far.

At your age, I'm shocked that they would perform a sinus node ablation when there are several other options. I would certainly inquire as to why this was necessary when other procedures could have produced far better results.

This blog may be a bit out of date, or maybe I don't understand the terms. I just returned from having AV node ablation in San Francisco, supervised by Dr. Melvin Scheinman, who invented the procedure. They ablated just the slow path through the AV node, leaving the fast path, so I am not pacemaker dependent. First, they induced the arryhthmia in the lab. Then they did the ablation, and then they tried, unsuccessfully, to induce it again. Total success. I am now on a weaker anti-arrhythmia med instead of Sotolol, becuase I also have PVCs, but no coumadin or other blood thinners. Life is good. Mellanie says that she is not a medical person. It seems strange, then, that she purports to be an expert in this area. Personaly, I'll trust the advice of an electophysiologist.

Sam,

Actually, I think it's a case of confusion of terms as you and I are talking about different things. I received your comments while on a flight back from the Western AF Symposium, at which Dr. Scheinman and I were both speakers. Also on the flight was a highly-regarded electrophysiologist, so I asked him.

He confirmed that ablating the fast path is usually done for an AVNRT (av node re-entrant tachycardia) ablation, and ablating the slow path is sometimes done, but not as an AV node ablation for afib. They are very different, even though the names are similar. It's easy to see how they could be confused.

I don't give advice on StopAfib.org. On the blog, I don't give advice either, but do give opinions. However, those opinions are usually informed by what I learn at medical conferences and from asking the world's top experts what they think or whether I'm on the right track. The EP I asked about your ablation confirmed that my opinion, as expressed in this blog post, is still on target for afib. He confirmed that AV node ablation should only be used on those who are too frail or too elderly for other procedures, which is what I believe as well.

As long as you're working with an electrophysiologist who has your best interests at heart, then you should trust him or her. But not everyone is in that fortunate situation, and that's why we're trying to inform about the risks.

Mellanie

in 1998 I had open heart surgery for mitral valve repair. Ever since I have had AFib that wont go away. I have had numerous cardioversions and went trught a long list of all possible drugs such as Amiodarone, Sotalol, disopyramide, Tikosyn, flecainide, diltiazem. I am also alleric to betablockers so my drug choices were somewhat limited. I went trough first catheter ablation in 2005. It failed. I had second ablation, it also failed. 4 years since my last ablation taking fecainide and diltiazem not helping much. Had TIA this past september and was put on Asperin 325 mg. I finally saw a different EP doctor (not the ones who did the two failed ablations) HE said that he would be willing to do a third ablation but success rate would only be 50% due to scarring from the two previous ablations and the procedure would take at least 6 hours and he would have put me under general anesthesia. I am scared of being under for such a long time since I have read articles about memory loss and i cannot afford to have it at my age at 67. Anyone know anything about this.??? He also gave me a choice to have AV node ablated and put in a permanent pacemaker. The kind that my life would be dependent on and it could never to turned off or I die I am really torn about this. I hated that ablation procedure plus all the tests (including TEE) and then have it fail since the chances are only 50%. Then I would have to have the pacemaker inserted anyhow. I t is a big dilemma for me. My new EP doctor was shocked that my cardiologist or PCP had not put me on coumadin. So now I am on coumadin while I ponder what I am going to do...............

Marie,

I'm so glad you're on Coumadin while you make the decision. It seems that you're too young for an AV node ablation though. Have you asked if surgery is an option (not catheter ablation)?

Mellanie

My husband is 82 and has had a history of heart trouble since 1990. Had two heart by-passed surgeries - the first one in 1993 and second in 2003 and a stoke in 1997 which he recovered from it completely. He never did recover completely from the second by-passed surgery. Although he was able to do light exercise such as walking up to 2 miles a day, but the energy level never completely return. He was hospitalized 2 to 3 times each year for chest pain and had received 5 stints. Finally, in February 2008, we were told that the stints in the descending artery had completed failed and was put on several different medications which often gave him nausea and had to stopped them. In Nov 2009, while shopping at Lowes, he passed out and fell, hitting his head on the concrete flood, was rushed to the hospital. Drs. gave him a one-lead PM, put on Pacerone for Afib, but couldn't handle the extreme nausea and had to stop it, then he was in the hospital four more times between Nov and Dec 2009 with kidney issues and sharp pain in his GI track, chest and eyes, then he had CHF for the first time. He was treated for his kidney problems and CHF, Lasix was added for CHF. He got better and did return to walking until the weather got cold here in Dayton Ohio, then all of the sudden in December 2010, his pains returned and was hospital three times in one month, he had a cardioversion and took Multaq to control Afib while in the hospital, but he couldn't take the severe pains and nausea and had to stop Multag. Finally, after five days, he was released with an increased dose of Lasix as he retained so much fluid in his ankles. A week later he oxigen level dropped to 86 and was rushed back to the emergency. By this time, his lungs were filled with fluid (severe CHF) and had to be treated with IV Lasix. He is in extended Afib and his heart is so weak that it is not pumping very well. On Jan 6, 2011, he got an ICD and Imdur and hydralazin were added to his already long list of medications. The recovery has been slow but he is finally able to go on short grocery shopping trips with me. Today at his follow-up appointment with the EP doctor, we were told that the ICD is working fine but his heart rate is still high. The AV node is working at 68% with the help of the ICD so he is scheduled to have the AV node ablation on 31 Jan to improve this condition. . After reading many negatives on the AV node ablation, I'm wondering if it is better off to leave things alone.

Lily

Lily,

Typically the av node ablation is reserved for those who cannot have other procedures, which is usually starting at about age 80. Once you pass that, it's more common to have it to improve the condition. I'm not a medical person, and thus can't give medical advice, but considering all he has been through, it may be that he will be more comfortable after an av node ablation so that the pacemaker takes over and gives his heart a break. I wish you both good luck and hope that he feels better and has more energy afterwards.

Mellanie