AV node ablation

I had an AV Node ablation

by Gramzo - 2023-12-12 23:17:12

I had my pacemaker/ICD put in at the beginning of September and had the AV Node ablation the next day.  I had lots of PVCs for the first month to month and a half after.  They are starting to decrease.  I feel I was not prepared well for what to expect after the procedures by my EP, but have received lots of info from very knowledgeable people here.  Search my posts and the replies and you'll get a fairly good picture of what my recover was like.  The heart needs time to adjust.  I was not told this by my EP.  But the ablation was done to keep my ventricals from misbehaving as much.

An AV node ablation is final and you would become pacemaker dependent

by Gemita - 2023-12-13 05:10:14

Trixie, I see I have already commented on an AV Node ablation (see your earlier post).

After an AV node ablation the AF signals coming from the upper chambers of the heart will be prevented from passing through the AV Node to adversely affect your ventricles, so you should feel less symptomatic, but you would become 100% pacemaker dependent.  An AV node ablation is always a last resort procedure, when all other treatments (using medication, a regular pulmonary vein isolation ablation, cardioversion) have been tried and have failed to control your symptoms.  

How symptomatic are you?  Is your heart rate under control?  Are you taking any medication like a beta blocker or an anticoagulant?   Do you feel better with your pacemaker? 

If you have few symptoms, have your heart rate under firm control, are taking an anticoagulant for stroke protection if required, you may wish to wait before making a decision about an AV Node ablation. 

Your AF will not be stopped by an AV Node ablation, you must know this.  AF would still continue in the atria, but the irregularity of rhythm and any fast signals wouldn’t get through your AV Node to push your ventricles, so you should feel instantly better with fewer symptoms.  

I see you are in permanent AF so I assume that a more curative ablation (pulmonary vein isolation ablation) has already been tried?  So many questions, I know, but without answers we cannot really help you to decide whether an AV Node ablation would be right for you at this time.  What does your doctor recommend based on your symptoms and medical history?

AV Node ablation

by Trixi - 2023-12-14 14:30:39

Thanks Gemita and Gamzo. Of course I realise that the AV Node ablation is a final step and hence my post.

The first thing to say is that I am in the UK and things here can work slowly and detailed information sometimes difficult to get.. Pacing appointments for example are annually and we don't necessarily see the EP/Cardiologist at the same time.

I have had my initial pacing check a month ago (PM x 3months) and now await an EP appointment in order to discuss AVNA.  I have had previous ablation, cardioversions and a period of Amiodarone and beta blocker which I no longer take. I take Edoxiban (blood thinner) daily.

My right atrial pacing was .94% and and right ventricle 52%. 62 episodes of mode switching due to AF. 

Generally I feel much better with the PM, but can still experience chest discomfort with some exercise and short bouts of tachycardia. So I guess the question for me is are the symptoms enough for me to agree to that final step? And might there be a medical alternative?

Trixie

A big decision

by Gemita - 2023-12-14 17:23:14

Trixie, I am in the UK too so I know how slowly things progress here, especially with cardiology.  

The alternative to an AV Node ablation would be another regular ablation as you had before (the more potentially curative one around the pulmonary veins) or going on long term anti arrhythmic medication like Amiodarone, Flecainide, Sotalol, plus a beta blocker or a calcium channel blocker to keep your heart rhythm/heart rate under control.  I get chest pain with AF if my heart rate is too high, otherwise I’m okay.

You are pacing quite a lot in your right ventricle at 52%.  Do you have heart block (your Bio is empty) since I see you are only pacing 0.94% in the right atrium.  I am paced almost 100% in the right atrium with only 1-2% right ventricular pacing.  I have loads of mode switches/high atrial rate episodes, far more than you have quoted.  My mode switches are in the range 1500 per annum but even so the total percentage time spent in AF is surprisingly low around 3-5%.  I have in and out AF which is not long lasting. 

I see you have stopped taking Amiodarone and a beta blocker, so that suggests that you and your doctors are happy that your AF is being controlled without the need for powerful medication, and that you are not so symptomatic that you need to be taking regular medication, if I have got that correct?  I am also taking Edoxaban and so is my husband (both on 30 mg), adjusted for age and low body weight.

I refused an AV Node ablation in 2018 because I was concerned that I might develop ventricular arrhythmias afterwards that they wouldn't be able to stop. I am much better with a pacemaker anyway, so I made the right decision not to go ahead.  I have tachy/brady syndrome and intermittent Bundle Branch blocks as well as several atrial and ventricular arrhythmias.

From your comments, your AF has clearly progressed to “permanent AF” which might be difficult to stop even with further cardioversions or another regular ablation.  I am still having “paroxysmal (intermittent) AF” and am in normal sinus rhythm for most of the time.  In your shoes with permanent AF, I would want to try to stop it completely if at all possible.  An AV node ablation wouldn’t stop your AF but if your doctor says that your AF cannot be stopped at this stage, and you are so symptomatic, then what have you got to lose by getting an AV Node ablation?  Alternatively, if your AF episodes cause few symptoms and only intermittently, you might feel it would be best to leave well alone or to delay a decision until you have fully tested your pacemaker?    A big decision that only you and your doctor can make

AVNA

by Trixi - 2023-12-14 18:10:18

Thank you Gemita for thoughtful and helpful comments. It's always helpful when someone summarises the kind of stuff that goes round and round in one's head. 

Interesting to hear your comment on my ventricle pacing rate. I've been wondering about the implications of that (on my list for next appointment!) As far as I'm  aware my  problem is permanent AF which I know can never actually be cured. Beyond that I don't pretend to understand the implications of some  of the technical stuff. Hence am glad to have found this group. 😊

Trixie

AV Node ablation

by Gemita - 2023-12-15 07:38:20

Trixie, I know it is horrible to have to make such a decision.  With AF there isn’t always a clear right or wrong way to proceed, but what is important is to receive anticoagulation if required (which you have done) and to keep our heart rate under control if required (which you appear to have achieved also).  With both these factors firmly under control, AF is usually not too much of a concern to our doctors.  However if the patient is truly symptomatic, even if they only have severe symptoms once a year requiring perhaps medical help, then my EP is more than happy to treat it with an ablation if medication fails to help.   So “symptoms” are what is important.  Based on symptoms, you make your decision.

In your shoes I would probably say to myself if I am still well enough to ask myself what I should do, perhaps it means that things aren’t so bad otherwise I wouldn’t hesitate to take action against my AF.  

If you are in permanent AF anyway and “tolerating” it symptom wise, you can perhaps afford to wait a while to decide what action to take.  You doctor may also wish to experiment with other meds first other than a beta blocker or Amiodarone, although if Amiodarone doesn’t work, I am not sure that you will find a better med.  It is one of the most “effective” to stop AF although it is also one of the most toxic, if bloods are not carefully monitored.  I was offered it too, but declined, choosing Flecainide and Digoxin instead.  I was told beta blockers or calcium channel blockers were safer than anti arrhythmic meds.  I am now off all anti arryhythmic meds and only taking a low dose beta blocker.  My AF thankfully is now only intermittently occurring but I have been extremely fortunate since AF usually progresses.

So good luck Trixie!

All fine

by laura1brown23 - 2023-12-16 02:57:10

Hello!

I had a PM and ablation and all fine. I was put under local anaesthetic and they went through my groin. Completely painless and quick.

i had a stay at the hospital for 1 night and took it easy on my leg for a week afterwards or maybe longer.

ive had no issues since and that was in 2016. I felt lucky to have the procedure.

good luck

laura x