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Hi, we are new to this forum, my husband has been in a fib for a long time, at first it was controlled by meds, when that stopped working he tried several cardioversions and has had 2 ablasions ( sorry about spelling) just met with a new doc and he is giving us the option of a pacemaker. Husband is concerned because he will be completely dependent on the pacemaker. Also worried about it not helping. He has felt like crap for years now, he is 65. Heart rate has been anywhere from 90 to 120 or higher. He just started a new med and is down to 72 but he is still tired all the time. We need to do something his heart is getting tired, another option is another ablasion since technology has improved. But as you know there is no guarantee it will work and if it does for how long. If anyone in a similar situation would like to share your experience it would be appreciated. Thanks Beth

5 Comments

Ablations to treat Afib

by golden_snitch - 2013-07-04 02:07:52

Hi Beth!
So, basically you're given two different ablations for a choice:
1. AV-node ablation + pacemaker implant, and
2. Pulmonary vein isolation (PVI) to stop the afib.

Now, what you need to understand is that the first option will not stop the afib. Your husband will, therefore, need to continue his blood thinning medication, but will not need any anti-arrhythmic drugs any longer. What this ablation will do is simply cut the electrical connection between the heart's upper chambers (atria) and the lower chambers (ventricles). The atria will keep fibrillating, but the AV-node will no longer pass those fast and irregular impulses coming from the atria on to the ventricles. Instead the pacemaker will stimulate the ventricles at an appropriate and steady rate. This so called "ablate & pace" approach is usually offered to patients who have persistant or even permanent afib, and in whom drugs and cardioversions or other ablations have not worked. Your husband should not be too worried about being pacemaker dependent afterwards as there usually always is a so called "escape rhythm" that kicks in in case the pacemaker should ever fail (which happens very, very rarely). I had my AV-node ablated for a different reason, and my escape rhythm is running at around 40-50 beats per minute, so even if you switch my pacemaker off, I won't pass out.

The second option is a pulmonary vein isolation (PVI), a special type of ablation to treat afib. Today, EPs know that afib is caused by foci that are firing from inside the pulmonary veins. So, what this ablation does it to create a ring of scar tissue around the pulmonary veins (either around each of them, or around two and two). This ring of scar tissue serves as a kind of barrier: electrical impulses coming from inside the pulmonary veins cannot pass this barrier, and therefore cannot make the atria fibrillate. This is what your husband has probably had already done twice. But you're right, technology has improved, so it might be worth another try. PVIs often require several procedures. After just one PVI the chances that the afib is being stopped are around 60%, but after two or three PVIs success rates are higher, at around 80%. In some cases, the PVIs will not stop the afib, but will only reduce the number of afib episodes. What has also been observed is that while PVIs didn't stop the afib, the arrhythmia was controllable with drugs again after these interventions. I know a couple of patients who have had between 2 and 4 PVIs, and are now afib-free.

May I ask when your husband has had his first two ablations? If that was like 5 or more years ago, I'd probably give the PVI another try since EPs have made great progress here. I think, before I'd have my AV-node ablated and a pacemaker put in, I'd have three or four PVIs. The AV-node ablation plus pacemaker should always be the very last resort; once done, it's done, and there is no way back.

Hope this helps a bit.

Best wishes
Inga

Afib, my story

by Bill T - 2013-07-04 10:07:12

Hi Beth, about 12 years ago I started having Afib that was controlled with meds for a while. In 2007 I had a minimally invasive high intensity focused ultrasound (HIFU) cardiac ablation (entry through the right side with transducers placed around the back of the heart). Darned near put me under but I recovered and had the Afib under control for 3 years but it came back stronger. Stronger Beata Blockers and a dual lead PM for the slow pulse. Okay for a year but Afib got worse, 2-3 episodes weekly and I felt like crap afterwards. In 2011 I had a complete AV Node ablation and upgraded to a CRT-D. My EF increased for the 30s to the low 60s (normal). Now I still have Afib, 10-15 episodes a week but unless they last several hours I don't notice them. I feel much better and have no regrets having the AV Node killed.

Hope things work out for Jim,

Bill T

Welcome Beth!

by Many Blessings - 2013-07-04 12:07:47

Mine is a similar story as the others. Chronic (permanent) A-fib (uncontrolled, high rate) since 1987, where no meds, cardioversions, ablations, or procedures worked any longer.

Like so many others out here, I also have many other heart problems (most since birth), had procedures, OH surgeries, stroke, chronic TIA's, etc., which eventually cased high level Cardiomyopathy with heart failure. My A-fib caused a brain stem stroke at 27 (I'm 53 now).

Luckily, I was young and strong (and I'm a fighter), so I had very little permanent damage, but it was a struggle for a good year afterwards. I say these things only because I want you and others to take A-fib seriously and to know what problems it can cause if you're not able to treat it (especially, chronic, uncontrolled/high rate A-fib, which is what got me to the situation I am in today.)

Last year I was given less than a year to live (EP said 3 months) without a transplant or CRT-P w/AV Node ablation, etc. I had the AV Node ablation and CRT-P put in a little over a year ago. I also had some other procedures/surgeries done as well. Make sure to research, ask questions, etc., as much as you can before making your decision, as like you said, he will be 100% dependent and there is no turning back. I was told I didn't have a choice in the matter if I wanted to live. I wanted to live, so I had it done (but I did resist for quite some time before, and even afterwards.)

Golden-snitch is correct. It will not stop the A-fib. I am still in chronic (permanent) A-fib, and always will be, but because the rate is now controlled by the CRT-P, the rate is not out of control high like it used to be 24/7. I am set at 80-150. This will make him feel a LOT better. For me, it did "slow" (not stop) future damage regarding the heart failure and cardiomyopathy, but what was there prior is still there. My TIA's have slowed down considerably and my EF is above 30 now, which is awesome! This is important to know too, in case he has those issues. I am still on Coumadin due to my A-fib, and I also have a mechanical mitral valve.

My escape rate started at 40 in the hospital after my procedure/surgery, but in less than a year, dropped to 20. I will find out next month where it is at now. It is different for everyone, so that is something to consider as well, if you are really concerned. For whatever reason, that isn't a concern of mine as I trust my CRT-P and my doctors, but I could see where it might freak someone else out.

On a very positive note. I have not been in the hospital once since I had this done, where I was having to go in for CHF/Cardiomyopathy symptoms quite often prior. I also can hike, exercise, and live a "normal" life again since having it done. I am not able to hike as much as I could 5 years ago, and have had to change my exercise habits to a lower level, but I'm out there every day doing something. You can't stop me once I'm outdoors, especially if I see some kind of wildlife. Camera in hand, off I go to get a closer look, tired or not. I think your husband would notice a difference in his activity endurance as well, as his heart will be working more efficiently.

I also have always been super positive, kept in shape, tried to eat right (I love sweets), never drink, never have or never will smoke, and always keep my weight down (okay, part of the weight thing is because I'm vain, not for health purposes LOL!) These things are really important to me so I can always feel as good as I can. I hope your hubby will do the same. Remember too, a positive outlook & attitude can work wonders in life!

I hope this wasn't too much for you to read. I just want to make sure you (and others) know as much as you can when trying to make your decision. I just didn't have the knowledge I do now, when making my decision, so I'm a freak about making sure others do their homework before making theirs. Search this site (top right corner), ask as many questions as you can (new posts), and never feel any question isn't worth asking! Ask away!

I'm with Golden_snitch too, that if you can put off the CRT-P with AV Node ablation by doing another procedure or two, do it. Use that only as a last resort. But, if that's what needs to be done for him to live a normal life like it was for me and others do it! :)

Good luck, and feel free to private message me any time if you have any more questions that I can help you with.

Hi Beth,

by janetinak - 2013-07-05 03:07:12

I am in Afib & have been since Jan 1999. It is permanent & gave me a lot of symptoms-SOB, extreme fatigue. Tried several cardioversions & multiple med's (every 2-3 wk's to see if work & if not on to another). None did & I was offered AV node ablation & PM after almost 2 yrs of trying. No other options were available in late 2000 so I went with it. I have never regretted it & am only on Coumadin which I have no problems with. No SOB or fatigue anymore. EF in the 60's now. I agree with the others I would research the newer options & see how you feel. You can use the Search button at the top of this page & put in what you want to look for in other posts & that may help. Good luck with your decision.

Janet

Choices

by Tracey_E - 2013-07-05 07:07:39

Two thoughts,

the anti-arrhythmics have a lot of side effects including fatigue and brain fog. he may be feeling that as much as the afib.

And, dependence is no big deal. It's a state of the art computer, much more dependable than our wonky hearts. I've been paced every beat since 1994 and lead a full, active life. We are also dependent on a computer every time we get on a plane or drive a car, etc, and we think nothing of it.

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