Time for a new pacemaker.

I have 30 days left to make a decision about a new type of pacemaker, this one has been recommended, does anyone know about this one. BIV-Pacemaker-CRT The Dr wants me to have an AV NODE Ablation six weeks after and thinks this pacemaker would work best with this procedure. Any thoughts out there on this, or anyone that has this type.

6 Comments

No Defib

by joy2 - 2013-10-07 09:10:22

Correct.

We sure do

by PacerRep - 2013-10-07 09:10:43

What would you like to know? Just to clarify your getting a CRT-P and not a CRT-D right? No defibrillator?

Why the AVN ablation?

by PacerRep - 2013-10-08 01:10:52

Do you have Atrial fibrillation? How fast does it conduct down to the bottom of your heart?

Ablate & pace

by golden_snitch - 2013-10-08 04:10:15

Hi!

I guess that you are in permanent or very persistent atrial fibrillation, if they have suggested the "ablate & pace" approach to you. And usually, when that approach is suggested, all other treatment options have been exhausted. Have you tried drugs, cardioversion, pulmonary vein isolations (catheter ablations)?

There is some good data out there which supports CRT-P implant after an AV-node ablation vs. a dual-chamber pacemaker. One study from 2011 finds it superior to right ventricular apical pacing in reducing the clinical manifestations of heart failure --> http://eurheartj.oxfordjournals.org/content/early/2011/05/22/eurheartj.ehr162.full.pdf

There's another study on the role of AV-node ablation in CRT-patients with AF and heart failure which came to the conclusion that ablating the AV-node in those patients is better than treating their AF with drugs -->
http://www.ncbi.nlm.nih.gov/pubmed/22340263

The latter is only relevant, if you are already in some stage of heart failure. And with regards to the first study one needs to point out that apical right ventricular pacing is something many doctors try to avoid today; they place the right ventricular pacemaker lead at a different site in the right atrium, not in the apex.

I think I have read somewhere that in the U.S. you need an EF lower than 35% - so you need to be in heart failure already - in order to qualify for a CRT implant, but that might be different depending on your insurance. Do you know what your EF is? Normal would be around 60%-70%.

Regarding the AV-node ablation, I agree with Many Blessings: Make sure that you have indeed exhausted all other options. But, if you have done so, and are still doing poorly, this ablate & pace approach could really improve your situation. And then, if I were you, I'd go with the CRT-P implant if the EF is already a bit reduced; if not, I'd go with a normal dual-chamber pacemaker.

Don't know what happened to you, Many Blessings, but the ablate and pace stories I have heard so far from afib patients are all success stories. I remember one person telling me that she still feels that her atria are in afib, but she no longer has that very irregular rhythm, and that has improved her quality of life tremendously. The others didn't even say that they still feel the afib, they just said that they feel a lot better. I have had an AV-node ablation myself, but not because of afib. I'm doing much better. Have a dual-chamber pacemaker, but it paces my left atrium and ventricle which significantly reduces my risk of developing heart failure.

Best wishes
Inga

AV-NODE ABLATION + CRT

by Vinnie - 2013-10-08 09:10:28

I had AF for many years ( 60 years ) and finally ran out of medicines etc in 2007 -- was fitted with a dual chamber PM ---- in 2009 the dual chamber did not help any longer plus I was on the last pill -amiodarone ---- I had the AV- node ablated in 2009 after 4 unsuccessful catheter ablations---- was ok until 2013 when we discovered my EF went from 51% to 40% in one year--- in June 2013 I was fitted with a MEDTRONIC CRT-P ( Consult ) and up until now I'm feeling much better than with the DUAL CHAMBER---- when I had the dual chamber it paced my atria & ventricle ----- hope this info helps you
Regards
Vinnie

I have one

by Many Blessings - 2013-10-08 12:10:40

Hi Joy2,

I have a St. Jude, CRT-P with AV Node ablation. I've had it for about 1 1/2 years now.

Do you homework on the AV Node ablation. Make sure there are no other options for you, and make sure you do it as a last resort, as it is not reversible.

There are many pros & cons to the device and the procedure. Just make sure you know them all.

As others out here know from my past postings, I would not do it again (AV Node ablation) if given the chance, but would more than likely go for the CRT-P without the AV Node ablation. It's just a personal preference.

There are others out here that don't have problems with theirs, and are glad they got it done. Make sure to listen to them as well, as it's different for everyone.

Feel free to private message me if you want to. I will be honest with you on why I like it and why I don't.

Best of luck with your decision.

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