Waiting for pace and ablate

HI

First post I am awaiting a date for me to have a Pacemaker fitted and then 2 months later to have my sinus node removed to make me pacemaker dependent. I have a lung condition also so exercise is out, should I see an improvement to how I feel straight away or does it take time?

2 Comments

Sinus or AV-node?

by golden_snitch - 2014-04-08 12:04:19

Hi!

"Ablate and pace" is usually used to treat persistent/permanent Afib that doesn't respond to any other treatment (drugs, cardioversions, pulmonary vein isolations). And it does not include removing the sinus node, but the AV-node. "Removing" is not the right term as the AV-node is simply cut through, but not totally removed. You cannot do that with a sinus node as it's not a clearly defined node, but rather an area that looks different in everyone. One ablation procedure will never "wipe out" the whole sinus node. I have had four sinus node modifications through catheter ablation, but I still go into sinus rhythm sometimes. Also, if they should really target your sinus node, you'll not be pacer dependent afterwards as the AV-node, the His-bundle and the Purkinje fibers can still produce an escape rhythm; if the AV-node is cut through, you are somewhat more pacer dependent, but will most likely still have an escape rhythm. In addition to my sinus node ablations, I also had an AV-node ablation, and my ventricular escape rhythm is usually around 40-50bpm.

Will you feel better immediatly? Well, hard to say since I'm not sure what your condition is. I'd guess it's Afib. If so, there are many members here who had the ablate and pace approach and do a lot better now. I had my AV-node ablation for a different reason, namely a tachycardia that originated in the AV-junction, so of course once this was ablated, I was feeling much better. The AV-node ablation to treat Afib is kind of an indirect treatment since it doesn't stop the atria from fibrillating. You'll need no more antiarrhythmic drugs afterwards, but you'll still need a blood thinning medication.

However, if I am wrong, and they are indeed modifying your sinus node, then this is a whole different story. In that case, your condition probably is a permanent sinus tachycardia which they are trying to slow down with the ablation. You don't modify/ablate the sinus node, unless the sinus node itself is causing the arrhythmia. If you have a permanent sinus tachycardia, and you undergo one ablation procedure, it could be that this first attempt to slow the sinus tachycardia down is not successful. I don't know anyone who had sinus tachycardia, and in whom just one ablation did the trick. In my case it took three procedures, and then six months after the third, the sinus tachycardia was back, so I needed a fourth procedure. Ever since then I have not had any inappropriate sinus tachycardia.

Hope this helps. Best wishes!

Inga

It is AV node ablation

by offcut - 2014-04-09 07:04:52

Thank you for your detailed reply. I got out my letter and it was a pace and AV node ablation.
I have had a heart attack and was diagnosed with AF in 1992. I have had many changes to tablets 12 Cardio versions and my first ablation was a PVI and the second was a Circumfential ablation that lasted for 7.5 hours and I had 38 Burns. To help things along I have an iodine allergy which meant I had to have steriods and was injec.ted with Adrenalin when my BP dropped.
I have had long term atrial Tachycardia 125 bpm and atypical Atrial flutter plus my lung consultant has found I have Pulmonary atrial Hypertenstion
My Last EP confirmed reginal wall montions abnormalities and scaring within my Atrium. Which is why they have made this my best option?

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