SVT - AV Node ablation with pacemaker

I am 24, with SVT and have had 2 ablations since I have been diagnosed 2 years ago. I have been on many different beta blockers to regulate my heart rate (it peaks to the 170s a couple times a day) and often just races for no reason. After each ablation I was okay for about 6 months before experiencing a regrowth and ended up back on the meds both times. Once on the medication, it seems my body gets used to them after 3-4 months which leads to the drs increasing the mg which causes my blood pressure to go very low which then lead to putting me on 4000mg of salt tablets a day.

Now that I am basically back to square one, my dr suggested the AV node ablation with pacemaker. This is something I am very interested in doing because I unfortunately formed this condition at such a young age and it seems like the meds are just not working and I don't think I want to go down the road with more ablations.

If I was able to be stable on the meds I would prbly not consider this route. I am also very concerned about pregnancy being most of the meds you can not take during pregnancy or at least the first trimester. If anyone has experience with pre, post pacemakers/ablations with pregnancy, I'd also like to hear about that too.

I appreciate any advice!

Amanda amandalee.i@live.com

3 Comments

Don't do it now!

by golden_snitch - 2013-03-23 04:03:31

Hi Amanda!

Do you know what kind of SVT it is? Nowadays, most SVTs can be successfully treated with catheter ablation, but if yours can't, I wonder if it's some kind of ectopic atrial tachycardia that originates somewhere where it's difficult to "reach".

At your age and with a history of "just" two ablations, I'd definitely not go for an AV-node ablation. AV-node ablations should always be the very, very last resort after multiple ablations and drugs have failed - been there, done that. You mentioned that you have tried several betablockers, but what about other anti-arrhythmic drugs like Flecainide, Propafenone, Verapamil? Those can be very effective in the treatment of SVTs. They have bought me time again and again.

AV-node ablation will lead to you being paced in the ventricles 100% of the time. Google "heart failure + right ventricular pacing", and you'll find quite a lot of information on the risk of developing heart failure due to permanent right ventricular pacing. This is a risk that should not be underestimated, especially not in someone your age who'll likely be paced for 60 years or so.

You probably think this is an easy fix, the ultimate solution, and I must say that I'm a bit shocked that your EP is recommending it to you, given your age and history. But believe me, there are very good reasons that this procedure isn't performed often, and especially not in 24 years olds. It's usually a procedure performed in patients with chronic atrial fibrillation that's drug resistant and for that catheter ablations have failed several times.

So, what would I do? I'd probably go for a second opinion at a clinic where they specialize in electrophysiology and perform more than, let's say, 1000 catheter ablations per year. The fact that your EP suggests AV-node ablation to a 24 years old who had just had two ablations, makes me think that he probably isn't very experienced.
There are different mapping and catheter ablation systems for arrhythmias, and not all clinics have them all or have the best. Sometimes an arrhythmia that cannot be successfully ablated using one system, can be healed using another that's more precise.
Secondly, I'd consider trying some anti-arrhythmic drugs instead of betablockers.

Good luck!

Inga

BP

by 1024LAKE - 2013-03-23 06:03:30

Go to "Stop Afib.org" for more comments on AV node ablation.

Don't do it!!

by tah0009 - 2013-04-27 12:04:48

I was 24 when I had my 3rd ablation, at which point they ablated my AV node and left me pacemaker dependent. I'm 33 now, and had a 4th ablation done Sept 2011, as killing my AV node did not stop regrowth, and I still hit 170+.
Honestly, life sucks. I feel like crap daily, and my EP in Dallas says there's nothing else they can do until medicine evolves more. I'm one of those cases, as it sounds like you are, that it just grows back and medicine doesn't work long term.
I'm in nursing school right now, but plan to see Dr. Andrea Natalli in Austin after I graduate. He studied in Italy, ran the Cleveland Clinic for 11 years, and started the Texas Cardiac Arrhythmia hospital in Austin. He patented many of the procedures that EP doctors are using now. I'd avoid this pacemaker business if I could do it all over again. I'm in no better shape than when all this started. I have persistent SVT with paroxysmal Afib now. Please seek a 2nd opinion before you do this.

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Member Quotes

I had a pacemaker when I was 11. I never once thought I wasn't a 'normal kid' nor was I ever treated differently because of it. I could do everything all my friends were doing; I just happened to have a battery attached to my heart to help it work.