Pacemaker dependency

I'm headed towards an AV Node Ablation not unless some other divine intervention pops up in my doc's head for me to try. I'm really trying everything except Amiodarone which I feel is just too toxic for my 33 yr old body. I'm anxious as all get out about the possibility of AV node ablation, and doc (who's a total sweetheart) isn't really excited about it either. He wishes that he had more options for me. I wish it wasn't my decision. What happens if I go through with the AV Node Ablation, am totally pacemaker dependent, and the pacer quits working.? Will I just drop dead then? Gee, that sounds like a great choice. This is the biggest decision I've ever had to make in my entire life, and probably will forever be. I just don't know what to do. I'm almost just about ready to accept that the way I feel now is just the way it's gonna have to be.


CRT/ICD option?

by chiliman - 2008-06-25 05:06:12

Have you discussed getting a biventricular icd? I just had my pacemaker changed to a CRT/ICD and it has made the most profound difference. (I'll be posting more about this soon) I was definitely headed for an AV ablation but ultimately didn't need it.

The key point here is whether or not you have significant atrial dyssynchrony. I did (determined by a tissue doppler echo) and that qualified me. I feel so much better!

I totally understand your reluctance, and if that's the only choice left than do it. But if a CR-D has any possibility of improving your condition, pursue it first.

Life should be easier...


by chiliman - 2008-06-25 05:06:31

I meant to say "VENTRICULAR Dyssynchrony."


by peter - 2008-06-25 06:06:22

Lots of us are 100% dependant including myself. I have an AV node ablation. You are extremely unlikely to drop dead. Pacemakers can develop problems but the usually creep up on you giving the doctors time to correct the fault. If you had a pacemaker for 50 years you have a 1% chance of having a pacemaker fault. Im quite happy with that statistic as pacemakers are getting more reliable all the time. I understand your concern about the AV node ablation because you will be "crossing the rubicon". It only took me seconds to make up my mind even though my doctor seemed to have changed his mind. If you have a CRT pacemaker the job is only half done if you do not have an AV node ablation as well. That is not my opinion but it is the overwhelming opinion of electrical physiologists across planet earth. You are far more likely to be run over by a car crossing the road to buy a newspaper than to "drop dead" because your pacemaker suddenly conked out.
I went walking with a number of people the other day. Two of us had a CRT pacemaker and an AV node ablation. I was ahead of the pack and at the end of the walk most of the other walkers seemed to have swollen ankles. My pacemaker friend and I did not !!!

Me too

by janetinak - 2008-06-25 11:06:28

I agree with Peter. I am 100%-er with an Ablation as you describe. I had it done in late 2000 & am very pleased 'cause I lived with Afib (fast rate, sob, NO energy) for two years & tried all meds available at that time & none worked. Plus 5 cardio-versions w/o any changes. Finally my Cardio said its PM time or just live with it try different meds as they come out. I am in my 60's & I am sorry that you have to face this in your 30's but I feel great & it worked for me just like my EP said it would.

As to PM quiting on you I really worried about that but as my EP & his ANP/RN said it gives you warning (increase of SOB, etc) & goes into "save" mode so you have time to get it replaced. I was a real nervous nellie & needed both the EP & ANP/RN to re-assure me. Well, after 3 yrs (probable lead problem) I got SOB & lo & behold PM in save mode so got a new lead & PM & been good for 5+ yrs so far.

Hope this helps in ypur decision making.


AV node ablation yesterday...

by jenn985 - 2008-06-28 12:06:54

I have been fighting tachycardia on and off for 7 years with the last 2 being the worst. I am now 35, so I went thru quite a few years of "you are too young to have a heart problem". I finally found an EP who took me seriously and diagnosed me with Inappropriate Sinus Tachycardia. I tried different meds, but none of them worked and the side effects were out of control. Finally they tried an SA Node Modification but were unable to proceed so they placed a dual chamber pacemaker 5 weeks ago and then ablated my AV node yesterday. The procedure was really easy and I only spent one night in the hospital. I feel great today and it is so cool to have a "regular" heart rate! I wish I would have had this opportunity years ago. I am now 100% paced, but even if my pacer quits I will have an escape rhythm of 40 beats per minute-so no worries. Good luck with everything!

PM dependency

by shockbox340 - 2008-06-30 11:06:38


Very few patients who are "pacemaker dependent" - even post-AV node ablation patients - have ZERO heartbeat without their pacemaker. The slowest any pacemaker can pace is 30 beats per minute (or one pace every two seconds). If we slow the PM all the way down to 30 and you are still pacing, you are declared PM dependent. However, hearts have more than one natural PM, and the PM of last resort is in the ventricle itself. It makes a really slow, really ugly heartbeat, but it works. Very few dependent patients literally have NO underlying rhythm. Also, what peter said about the reliability of these things is pretty impressive. The wires are the weakest link in the chain, but they still very rarely have issues where they completely quit working with little or no notice. Good luck!!

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