AV Node Ablation Procedure??

I am a 54 year old male who had been in Atrib-Fib consistently since Oct. 2007. I have been diagnosed (2007) with heart failure (cardiomyopathy), a low EF (20-25%) and an enlarged heart. In addition, my a fib has been having premature ventrical/atria contractions (PAC's, PAC's) with rapid heart rates greater than 170 bpm sporadically after wearing a 24 hour heart monistor. I have been cardio-verted twice in 2008 with no success and been on every known heart medication known. I have been extremely leary of have the ablation procedure performed because of success rates and the not being a good candidate for success. Recently, my cardiologist said it was time to talk with the firm's EP specialist and take some action. After a great deal of discussion, the decision came down to performing an AV Node Ablation procedure. I am aware of the fact this is a "last resort' / "nuclear decision" (meaning no turning back, however there was some discussion about a "conguent/maze procedure". My question is this: Is there anybody out there who has had a AV Node ablation and what there results were? Would you recommend it or not? Why or Why not? I am a young 54 year old who has major concerns about the procedure and will be seeking a second opinion; however, I would welcome any input, recommendations or counsel concerning the AV Node Ablation procedure. Thank you for you time. effort and consideration. Eric

8 Comments

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by Tracey_E - 2014-03-07 01:03:09

I assume you've had ablations already trying to get the source of the afib? That should be tried before av node. I'm sure you'll get multiple responses from those who have been through it, but if you check out the search feature (upper right), we have quite a few members who have had this done successfully. Yes, it's a last resort, but it can give you relief. If nothing else works and your quality of life isn't good, what do you have to lose? I would choose ablation over medications with side effects, but that's a personal choice.

Do you have a pm now? If not, ask about CRT, which is a 3-lead pm that synchronizes the ventricles which can make the heart beat more efficiently and raise EF. I have no idea how that works with an av node ablation, put that on your list of questions for your doc.

PAC's and PVC's happen. They're generally considered harmless. Drugs, ablations, etc, do not stop them.

I would not do a maze, no personal experience but multiple horror stories for every success story.

AV nodal ablation

by philip.thecyclist - 2014-03-07 03:03:14

Hello Ericc,

Yes, I have had av-nodal ablation, nearly 20 years ago now, when it was a standard procedure rather than the last resort as it is regarded now. I had to receive two attempts, as the 1st one was unsuccessful. The cardiologist assured me at the time that I was very unlucky that it did not work, and I was only his second patient where it had not. He said it was because my av node was in a tricky position to get the ablation leads correctly positioned.

My subsequent experience was that having an artificial pulse rather than a natural one was quite limiting, but it was far better than having to endure prolonged bouts of AF. I was able to continue running and cycling - albeit at reduced levels compared to my non-AF states. So on that basis, I would recommend at least exploring it further.

About 3 years ago, a pacing check revealed that I had experienced two fast but short ventricular runs over 200 bpm and an echocardiogram revealed that my LV ejection fraction was down to 38%. This explained a lot, as I felt my exercise capacity had been reducing for some time. After further tests and medication, I now have a bi-ventricular PM for CRT, and the effect of pacing my LV was immediately noticeable. From my reading of the research summaries, there is a good chance the E-J fraction will improve over time.

I do get frequent spells of PVCs, but I am assured this is nothing to worry about, although they can be alarming.

So, hesitant as I am to actually recommend something as important as this, I can say that on the whole things have worked for me - and I'm still cycling at 70.

I had an AV node ablation in 2000

by janetinak - 2014-03-07 04:03:25

when the newer procedure were still very new. My AV node ablation was done twice with 1st getting single lead ventricle PM & AV node ablation repeated few months later with great success. Am now on 3rd PM & still dong great. Just had an echo as I had a fall just before Christmas & didn't report it as I felt fine. Have not got the results as yet but it was just a precaution & assume all OK. You put up with chronic Afib longer than I could. I went into Afib in on 1/99 & tried every drug available plus 4-5 cardioversions w/o any luck. On max doses of 3 med's which kept my HB at 120 but still very SOB & fatigued. All went away except Coumadin (not one of 3 med's) & I have very little problem with that. I hope you have as good a response as I have had.

Janet

AV-node ablation vs PVI

by golden_snitch - 2014-03-08 03:03:57

Hi Eric!

There is an ablation procedure called "pulmonary vein isolation" (PVI) which, in contrast to AV-node ablation, directly targets the area where the Afib originates. However, your EP has most likely not taken this into consideration because you have been in Afib consistently for years. Studies have shown that the success rates of PVIs are rather low in patients like you. They are much more promising in patients who have paroxysmal Afib.

You can find an interesting abstract of such a study at:
http://www.ncbi.nlm.nih.gov/pubmed/23062545
It was done at the clinic where I was treated for 12 years. They perform around 2000 catheter ablations per year, so it's a very, very experienced team.
Success rates in this article, even after multiple ablations, are 20%-45% while in patients with paroxysmal Afib you'd achieve 70%-80%.

I have had an AV-node ablation, though not for Afib. However, it has helped a lot. Your atria will still be fibrillating, so you need to stay on a blood thinner, but the ventricles will beat at a nice and steady pace. Since your atria are in fibrillation all the time, your sinus node is inhibited, and you will therefore need the pacemaker to adjust your heart rates to your level of activity. This is probably something to discuss with your EP. Different manufacturers offer different sensors for this rate response, and what's best for you depends on what kind of exercise you'd like to be able to do.

Best wishes

Inga


Inga

by kmom - 2014-03-08 06:03:59

question for you--if your atria are still fribrillating do you still get lightheaded dizzy and have the other symptoms of AF since you had the node ablation and the PM??

Altho question to Inga I'll

by janetinak - 2014-03-09 06:03:52

respond for my experiences. Once PM adjusted for me & my activity level, no symptoms of Afib. If I didn't know better. I'd have thought it went away but it hasn't. Paced 100% in ventricles. Hope that helps.

Janet

AV-NODE

by Vinnie - 2014-03-09 09:03:38

I'm 76 years old, have AF and heart failure-- I was fitted with a 2 wire pacemaker in 2007 and had my AV-NODE ablated in 2009 all went well but was tired most of the time---- I was due for a new pacemaker in June 2013 and was fitted with a CRT-P ( 3 wire ) Medtronic CONSULTA model pacemaker--- This model was FDA approved in 2011----it paces both ventricles and monitors my lungs for liquid build up. I transmit readings from the pacemaker each month by phone. I have more energy than I had with the old pacemaker. I thought I'd pass on my experience; hope it helps you. Good luck.
Regards
Vinnie

AV-node ablation

by golden_snitch - 2014-03-09 11:03:59

Hi!

I didn't have the AV-node ablation for Afib, but for an arrhythmia that "sat" in the AV-node itself (junctional tachycardia). Since I also have a very complex history of atrial tachy-arrhythmias, and had problems with retrograde VA-conduction, the decision was made to ablate the AV-node. It was ablated in the area - you never ablate the complete node - where the junctional tachycardia originated. That caused a complete block. If I should ever go into atrial tachy again, the pacemaker would now be able to switch modes and ignore what the atria are doing - just like if I had Afib and an AV-node ablation.

But at the moment I do not have any symptoms. I'm paced 97% in the atria, and 100% in the ventricles. I do feel when my own atrial rhythm kicks in and I'm paced in the ventricles only, but that's also because I'm very sensitive to rhythm changes. In your case there is no atrial rhythm to kick in, you atria will always fibrillate and you'll be paced in the ventricles. So, no going back and forth between rhythms.

Best wishes

Inga

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