AV node Ablation

AV node ablation

by AgentX86 - 2023-06-04 17:54:49

I'm a little surprised at using an AV node ablation on tachy-Brady but perhaps I shouldn't be.  I had an AV ablation five years ago for very symptomatic Aflutter.  I flt much better by the time I got to the revcovery room. BTW, I'm 70 now (was 65 when I got my PM).  I plan on another thirty years. 😁

Being dependent doesn't usually mean that if they pacemaker goes away, so do you.  Tee heart has more than one pacemaker.  In this case the ventricles themselves can beat without intervention.  It will be a slow beat and perhaps not enough for you to remain conscious, but enouh to sustain life.  The fact is that pacemakers don't just "go away". They're incredibly reliable.

AV Node Ablation - my thoughts

by Gemita - 2023-06-04 21:45:49

Roxy, I wasn’t going to answer this post since I haven’t had an AV Node ablation, but because I considered having this procedure in 2018, I feel I have something to contribute.  

The indication for an AV Node ablation is clear, at least to me:

I would only consider an AV Node ablation as a last resort if I was so symptomatic and my atrial arrhythmias couldn’t be controlled by any other treatments like medication, a pulmonary vein isolation ablation, cardio versions.  At this point, I would ask myself why should I go through ablation after ablation, medication after medication, cardioversions, frequent trips to A&E, when a short procedure, taking only about 20 mins could effectively stop a fast atrial arrhythmia from reaching my ventricles and driving them too fast.  Not only this, but if I didn’t take action to reduce my heart rate I might develop worsening symptoms leading to heart failure, dementia and even ischaemic strokes despite being on anticoagulation.  So that is the indication for an AV Node ablation for me:  being symptomatic and having arrhythmias out of control.

Now I am going to do a brief list of the Advantages and Disadvantages of an AV Node ablation and let you decide whether it is right for you since I know you have a clear indication for an AV Node ablation, having failed meds, multiple ablations, cardioversions.  

Advantages of an AV Node ablation

AV node ablation with pacemaker implantation has a very high success rate and low risk of serious complications while being effective in alleviating symptoms caused by a rapid and/or irregular heart rate.

You should be able to stop some if not many of your meds.  Your fast heart rates would be controlled without the need for powerful medication.  You should therefore feel less symptomatic.

The “irregularity” of rhythm of an arrhythmia like AF which causes so many of us difficult symptoms would be confined to the atria following an AV Node ablation.  We should no longer feel these irregularities or at least "feel them less".  Your pacemaker would then pace you at a regular, steady heart rate.  

An AV Node ablation is a short procedure unlike a regular ablation that can take several hours to complete.  An AV Node ablation is usually always successful, unlike the regular pulmonary vein isolation ablation procedure which can take several attempts to get a successful outcome, as you have already experienced Roxy.

Disadvantages of an AV Node ablation

AF or other arrhythmias would still continue in the atria following the ablation..  An AV Node ablation is not a cure for AF or any other atrial arrhythmia.

You would become pacemaker dependent.

There is a small risk of developing heart failure from right ventricular pacing although my EP said he would watch me carefully with echocardiograms (window quality permitting!) and upgrade my dual chamber pacemaker to CRT should this ever become necessary in the future.  

As privately discussed, an AV Node ablation should work well to control atrial arrhythmias, but any arrhythmia starting in the ventricles (like PVCs) would still cause symptoms and might need treating with meds or ablation, so that is something to ask your consultant about?

I hope that has helped.  You may wish to do your own personal list of benefits/disadvantages to help you decide?  I am sure you will come to the right decision, so that you can finally put this behind you.  You could always consider a second opinion, although I know you trust your consultant.

Ventricular ablation

by AgentX86 - 2023-06-04 23:53:38

I just wanted to note that things would really have to get bad for them to attepmt anything like an ablation in the ventricles.  The atria don't do a lot. They add about a 20% performance "kick" at the high end, exactly like a turbo charger in a car.  Few would even miss that 20% from peak performance, since we never get anywhere close to peak.  OTOH, the ventricles do 100% of the pumping of blood to the body.

An ablaton creates scar tissue that isolate electrical signals.  That scar tissue is essentially dead muscle.  In the atria, this isn't so important.  Scar tissue in the ventricals is the equivalent of a heart attack.

PVCs suck (I'm having all sorts of them these days) but there really isn't much to do about them.  Antiarrhythmics can work but that's why we had the AV ablation, to get off these serious (toxic) drugs.  Adding them back in is counterproductive.  Since the pacemaker keeps the bottom end of the heart rate up, higher doses of beta blockers (and similar) can be used.  That works sometimes but the bottom line is that there really isn't a lot that can be done unless it's really serious.

BTW, I got a 6-lead Kardia recently.  There is some interesting stuff in the EKG.  It took me a minute for it to sink in that there is no 'P' wave with VVI pacing, only the pacing spike followed immediatly by the QRS.  The other thing I notice that, and is should have been intuitive, the blood is pumped in the cycle with the PVC and the beat after is the one that doesn't pump.

AV node Ablation

by Roxy - 2023-06-05 12:46:31

Thanks for your comments. I am amazed that only one member contributed as a person who has had the ablation.

I expected more to have had it done with their experience to pass on.

But as always Gemita has put things in perspective for which I am grateful.

Roxy 

Roxy and AgentX86

by Gemita - 2023-06-05 13:43:45

Roxy, I know it is not the same as hearing directly from a member but have you typed into "Q" (top right of Home Page) AV Node Ablation or typed Pacemaker Club AV Node Ablation into your main general browser and done a search?  This will get you lots of hits and you can then read the experience of other members.  

You will find many members have had an AV Node ablation and with good results.  When you read the threads, you could write privately to some of the members since they will be notified of any private message and so you should hear back, even if members are not so active on the forum anymore.

I agree, it is disappointing not to have heard from other members who have had AV Node ablations, but perhaps that is a good sign that they are well and too busy getting on with their lives to read our posts or to ask a question themselves?

AgentX86, I am sorry you are still having ventricular ectopics.  That is miserable.  I suppose they have tried adjusting your settings or any meds and they have checked your electrolytes?  I wonder where they are coming from;  what the trigger is?

You sound an expert with that new Kardia 6 lead mobile of yours.  I am still debating whether to buy one.  With the printouts, can we get longer printouts out of the system, so that we can get a better indication of the rhythm disturbance present?  You mention you noticed that the blood is pumped in the cycle with the PVC and the beat after is the one that doesn't pump.  That sounds to me as though you are understanding a lot about your ECGs.  I am impressed.

AV ablation

by AgentX86 - 2023-06-05 21:40:35

There are several here who have had an AV ablation.  I'm sorta surprised more haven't jumped in here yet.  It makes me wonder if EPs are jumping to the AV ablation without enough consideration.  It's an easy fix but has serious consequences.

I'm not sure what you mean by not being able to get printouts.  You can email a pdf ("share", actually).  The free version only detects Afib (I don't consider tachtachy or Brady "detecting").  THe subscription service is needed to detect PVCs and a couple of other things. The EKG can be sent to a cardiologist for interpretation too but I think that's $70. This stuff isn't cheap and I am. My cardiologist doesn't cost me that much for an office visit. It's about what medicare, my insurance, and I pay, combined.

I'm going to try to attach one page of one of my readings.  I've never uploaded anything to the club so it might take a while.  I've made some notes to show what I think is going on.

I don't know why the top and bottom are clipped when it's expanded (the thumbnail is "fine").  I reduced the resolution and changed the aspect ratio but it didn't help. Sorry 'bout that.

AgentX86

by Gemita - 2023-06-06 18:07:23

I think you have misread my comments, probably my bad wording.  I said "With the printouts, can we get longer printouts out of the system"?  Longer as in two or three pages of an ECG recording so that we can better assess the rhythm we might be in?  I know the longer the ECG printout, the better the chances of identifying the rhythym disturbance present, if any. 

Your gallery ECGs are really helpful and "clear".  Not sure that I would have identified Flutter!  The ECG looks an irregular rhythm here and there (?PVCs) but I couldn't have given the detail you have described apart from the obvious pacing spikes.  I will have another look.

I will definitely get a Kardia 6L to monitor Michael and then decide how much we are prepared to pay for someone to read.  Like you I will probably start learning myself once I know what to look for

Kardia

by AgentX86 - 2023-06-06 22:46:54

The EKGs are fixed at 30 seconds. Yes, indeterminate length would be nice but I don't think there is enough memory to do more than 30 seconds.

The flutter are the little wiggles inside the elipse I drew.  I didn't look closely but they looked to be about 200bpm.

I was thinking of buying a book on EKG interpretation but haven't pulled the trigger yet.  $29 might be worth it.  The Kardia was $120, so...

<https://ecgwaves.com/checkout/>