afib pacemaker question

My Dr has said I need a pacemaker. The proceedure he has suggested would be to ablat the av node and then use a pacemaker to send a pulse to the ventricles. My question is what would cause the ventricles to continue functioning, if the pm fails?

5 Comments

I have Afib & because nothing

by janetinak - 2013-02-05 05:02:59

helped so I went the AV node ablation & PM route in 2000. I am not sorry I did it but I believe there are newer procedures now. Maybe I am wrong but I bet others here will answer this question with info if there is a new procedure. As you probably know this is a permanent fix & no going back. As I said I am glad I did it as had no other choices @ that time. You may want to look at other
posts here on this subject. Go to the top of this page & under "Search" button put subject you want to research there.
Also I was very nervous about being totally dependent on a PM. What if the battery failed, etc? I am now on my 3 rd PM. And the PM will give plenty of warning about time to be changed out. Also a subject for the search button. But to summarize, I get a check-up every 3 months (either phone or office) & the status is checked in office check & when gets close to replacement time, get monthly office checks & when time (usually 90 days left on PM) PM goes into a save mode & pulse stays at 60 (for me) & get tired, etc. Then gets changed out usually day surgery. Hope this helps. Did you get told will need to be on a blood thinner rest of your life too?

Janet

Last Resort

by ebfox - 2013-02-05 06:02:02

Hi Ray,

What your doctor is suggesting is an absolute last resort- have you already tried drugs (rate and rhythm control); cathether ablation (at least one, lots of people have 2); and/ or minimally invasive surgery (mini-maze)?

Unless you have already tried all these options and failed, you need to get a second opinion. Are you seeing a regular cardiologist? You need to see an ElectroPhysiologist (EP); EP's specialize rhythm problems.

So unless there's a whole lot you didn't tell us in your post, then NO, do not do that.

EB

SA node?

by Tracey_E - 2013-02-05 09:02:22

First, go with EB's advice, av ablation is a last resort so try everything else first, but it can help people in your situation when other options fail. Ask about doing the SA rather than the AV node. Definitely get another opinion before doing something permanent.

As for being dependent, lots of us are! I was born with av block, which is more or less what you end up with after an av node ablation. I've been dependent for almost 20 years now and feel great. You don't think about it after a while. It felt weird at first, now I rarely give it a thought. The heart usually develops an underlying rhythm of its own after a while. It can vary how fast it is. My underlying rate has been as low as 20, once it was 60! That's super speedy for me :) But none of that really matters! Pm's are highly dependable computers. On the off chance they'd malfunction, they have a back up mode that paces at a steady 60 bpm. It probably won't feel good, but it'll keep us going long enough to get it fixed. I've never heard of that happening, btw.

Last resort

by golden_snitch - 2013-02-06 04:02:14

Hi!

I agree with EB's advice: "Ablate & pace" should be the last resort. If you're one of the permanent fibbers who has it 24/7, I'd try drugs first and maybe a maze procedure; the "normal" ablations for Afib, so-called pulmonary vein isolations, do not work very well in permanent fibbers.

I do not agree with SA before AV node. Makes no sense in atrial fibrillation! The atriums are fibrillating, the SA-node is inhibited and no longer playing any role due to this arrhythmia, so how should an SA-node ablation make a difference in afib?
And in other cases, one should keep in mind that the SA-node is not a clearly defined node that can be ablated easily. SA-node modifications in most cases require several attempts, and the scar tissue that is created can lead to narrowing of the superior vena cava/right atrium junction. Plus, with an ablated SA-node you rely on the pacemaker's rate response function, and this limits your ability to exercise.

Best
Inga

AV node ablation

by pete - 2013-02-07 04:02:49

I am in exactly the same position as you. A pacemaker pacing both ventricles and an AV node ablation. Doctors tried to talk me out of it but I insisted on having the AV node ablation as I had worked out I needed it . Not just guesswork either. Result was amazing . That was in 2007.
only 18 months left on the battery. I have no rescue rhythym or residual pacing so replacement will be alittle bit risky but the chances of dying are still quite slight. If your PM fails you would certainly die, but that is quite a remote possibility. You have a lot more to worry about if you have an ICD !! Pacemaker sudden failure is almost unheard of these days, they usually just start playing up.
Peter

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