Confused and Frustrated

So in Jan 2015 they did a av node ablation and put in a two wire pacemaker. much to everyone surprise this caused new issues. I have gone through another ablation procedure that failed they started me on sotohol. I am told that my SA node is making my heart try to beat on its own even though they ablated the av node. One of my cardiologist said that they need to figure something out fast because the new medicine is causing me to have prolonged qt's which in my medical state says can and will be life threatening. Has anyone had both AV and SA node ablations? It was mentioned that if they did this they would have to change out my pacemaker to a different kind.

Sorry did not mention what the problem was, The problem I am having is the SA node is causing a heart beat of its own and causing a tachycardia situation even with the pacemaker, but the one good thing is the pacemaker is able to record the events now. Now with the new medicine, My blood pressure is very unstable and goes up and bottoms out.

I guess my question in a round about way is again has anyone had both node ablated, what kind of pacemaker is used, any suggestions I just know I have felt like total crap since my first surgery and the medicine makes me feel worse. I can't keep going feeling this way and I really dont know what to ask my doctors to do. One cardiologist tells me that the SA node needs to be ablated and then a pacemaker/icd needs to be inmplanted. I know I am rambling but any help would be great.

1 Comments

SA & AV-node ablation

by golden_snitch - 2015-09-07 06:09:52

Hi!

I have had several SA node ablations due to permanent sinus node reentry-tachycardia running at 120-140 bpm 24/7. And 12 years later I also underwent AV-node ablation due to an fast junctional rhythm.

What I don't understand about your story is that, if you had an AV-node ablation plus pacemaker, I'd expect that you were in (at least) persistent atrial fibrillation and that all other treatment options had been exhausted. AV-node ablation plus pacemaker, also called "ablate & pace", is usually used for atrial fibrillation patients as a last resort therapy. So, if you have afib, how come the sinus node can cause any issues? Afib is much faster than the sinus node...

If the SA node is causing tachycardia, you can try betablockers or, better, Ivabradine which is the only direct sinus node inhibitor. Also, the pacemaker can be programmed in a way that it switches modes when it detects an atrial tachycardia. You have to program at which atrial rate it should switch, and then when you have an atrial tachy running at that rate or higher, it switches to a mode in which it simply ignores what's going on in the atria. This is possible, if you have complete block, which you have an after AV-node ablation. Actually, if you have Afib and had the AV-node ablation, I'd have expected that your pacemaker is already programmed to ignore the atria. So, again, it's strange that the SA node is causing any issues.

SA node ablations often do not work after just one procedure. Plus, after an SA node ablation, you'll need the pacemaker's rate response function to adjust your heart rate to activity. That often comes with limitations, too, depending on what kind of rate response sensor you have.

Best wishes!

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