Av node ablation

I am getting a AV node ablation done for AFib , the cardiologist is going to put in the duel biventricular pacemaker first, then do the ablation about 5 weeks later, is this a good idea or would it be better to have it all done at once?

4 Comments

Even though

by Theknotguy - 2015-03-20 08:03:37

Even though I haven't had an ablation, I'd go for the PM implant first. It does take a while for the heart to settle down after it has received the PM. So you'll want to get things settled before having the ablation.

Another thing to consider, while it is a very remote possibility, is that the PM may reduce your afib sessions. At that time the EP may want to wait and see if you really need the ablation. But, as I said, that is a very remote possibility.

It was recommended that I get an ablation as soon as possible after leaving the hospital. My EP held off, first because I was too weak. Then he held off because my PM had reduced my afib sessions. While it was gradual and took place over most of a year, it was a reduction for which I am very grateful.

In any case, I hope things go well for you. I wish you the best for the future.

I agree with Sparrow

by Grateful Heart - 2015-03-20 10:03:16


Check with your EP. We do not know your medical history and we are not Doctors.

I think it is very dangerous to rely on definitive advice regarding which surgery to have first. We don't always have an answer and that's ok. Nothing wrong with saying "I don't know".

Grateful Heart

Not uncommon

by golden_snitch - 2015-03-21 02:03:34

At least it's not unheard of. There are or have been members here who had it done this way. As Theknotguy said, it might be a good idea to get the pacemaker first, heal, and adjust a little to this, and then have the ablation done. But, of course, there are also patients who fear every hospital stay, and who prefer to have as much as possible done at once. I think, in this case it has a lot to do with patient's/doctor's preference, not with a medical reason. Maybe it's really just that your doctor wants to give you time to heal from the implant first. Don't think the pacemaker will reduce your Afib episodes, because usually when AV-node ablation is scheduled for an Afib patient, the arrhythmia is permanent or at least very persistent and has not responded to drugs or cardioversions.

Are you in heart failure, too? Or is the bi-ventricular pacemaker just a precaution? This might not apply to you, but there are a few doctors out there who think that it's a good idea to implant everyone, who'll be paced 100% in the ventricles, with a bi-ventricular pacemaker - just in case. However, there is no data supporting the patients' benefit of that CRT device. AHA, HRS etc. guidelines say: No CRT, unless the QRS (ventricular pattern in the ECG) is wider than at least 120ms, better 140ms. It's important to make sure that the indication for the CRT is really given, because otherwise you could get in trouble with insurance. Also, the CRT device is much bigger than a conventional pacemaker, and the lead for the left ventricle is a bit more difficult to place, so it's nothing to get just as a precaution.

Good luck, hope you feel better after the procedures!

Mine Was Done At The Same Time

by Many Blessings - 2015-03-21 12:03:12

I had mine done at the same time. Mine is a Bi-V, 3 lead as well, and was done a few years ago. That being said, please make sure to get MULTIPLE "2nd" opinions from various EPs & Cardio docs, to make sure you actually need the AV Node ablation, and to make sure it will even help you enough to make it worth it. Even with the AV Node ablation and CRT-P, I am still in A-fib 24/7. It is now controlled vs uncontrolled A-fib, but it is still chronic (24/7).

Also, ask a LOT of questions to those who have had the AV Node ablation and CRT-P themselves, especially what to expect before, during and after the procedure. This is a longer procedure, and there are more things that can go wrong. This is not a single lead, PM or PM procedure. It is much more, especially if you have already had open heart surgeries. Scarring from previous OH surgeries can make lead placement difficult, and sometimes, impossible for one of the leads needed for synchronizing the chambers. My EP was able to place that lead, but it is not in a "good place", as he said, due to the scarring from multiple OH surgeries. Luckily for me, it is actually working VERY well, so he did good!

Make sure there are absolutely no other options and that you have tried everything out there lifestyle change, prescription and procedure wise. Make sure your EP has an excellent reputation, and has done this procedure and CRT-P many times before. You don't want someone who is new or one that is only doing this to "get one more under his belt". To be a candidate for this, I had to fall under certain criteria (Less than a year to live without a transplant or this, EF below 30, CHF and Cardiomyopathy levels at the highest stage, and more). This should be similar to your EPs criteria.

I totally agree with Angry Sparrow and Grateful Heart. Be very careful when collecting opinions from people. Especially, those who have not gone through this particular procedure, or have the CRT-P with AV Node ablation themselves. My sister has been a cardiac nurse for VERY many years, and not even she would give anyone advice on this (or anything else) not knowing their cardiac or medical history!

One thing my sister did for me, is brought home the different company's PMs/CRT-Ps so I could look at the difference in sizes. Mine is a St. Jude, and I chose that because it was the smallest and I didn't want it to show as much. You might want to make your choice on other information, other that pure vanity, but for me it worked. LOL! I am very happy with my choice with the St. Jude, as I know others are with their different choices, so research them all to your heart's content. Ask your EP doc to see them all!

I am in no way trying to talk you out of doing this, but I do want to make sure you have researched it thoroughly and that it will truly help what you are trying to "fix". When I had mine done, I was told point blank, "this will not fix anything or reverse any damage that you have going on, but it will slow things (damage and rate) down in the future, make you more comfortable, and give you a few more years".

I will end on a positive note: I am still able to work full time. I lead an active life, and although I have had to slow some things down activity wise, I do know this has helped me live a longer, more comfortable life. So, for that alone, I am grateful!

Good luck in your decision and feel free to private message me if you would like to.


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