Pace and ablate for Afib -- what are the risks of it not helping?

Unfortunately no

by Theknotguy - 2018-07-29 13:21:53

Unfortunately at my (our) level we aren't doctors, and not knowing all of your case history, can't really tell you if what is being suggested will help.  Even if I did know your case history, I'm not a doctor and still wouldn't be able tell if what is suggested would help.  And, if you press the doctors, they probably can't tell you either.  Probably about the best you can do is get a percentage of optimum help but I feel it's just a best guess on the doctor's part.   Sometimes you have to roll the dice and take your chances.  If I were in your situation I'd be looking for second and third opinions.  

One other suggestion I have is to ask about Medtronic's pacemaker that uses programs to control afib.  I have the Medtronic Advisa Surescan and it has two programs running on it for afib.  APP (Atrial Preference Pacing) is the first and it works about 10% of the time.  Minerva is the second and it works about 80% of the time.  Between the programs and medications for afib I get along fine even though I'm in afib about 17-19% of the time.  It's definitely not a cure but it is a big help.  Question in my mind is if your EP has considered this option?  The other question is if your medical insurance will allow you to go that way?  
I also don't know if you are a candidate for the Medtronic pacemaker control so maybe it isn't even an option for you.  If not, sorry 'bout that.  Wish it would be a help.  

Hopefully you can gather some information to ask questions of the doctors and see if you have some other options before you have to take the all or none option.  

Believe me when I say I wish you the best because I may be facing your situation at some time in the future.  

Pace and ablate

by DAVID H - 2018-07-29 14:49:51

A bit confused on my part ------- your statement " All he can offer me is 'pace and ablate' -- pacemaker plus 6 weeks later total ablation of the AV node."  In short, my tale: 4th try at atrial ablation appeared successful..... 7 months later, I developed a Normal Sinus Rhythm of 125. EP at TCAI was not concerned, and did not address the issue because I felt OK. Subsequent cardiologist remarked that time frame of no treatment probably contributed to my developing a cardiomyopathy. 3 1/2 months later, I developed a he-man A-Fib event...............couldn't walk 10 feet to the bathroom. Original EP had already washed his hands of me. New EP offerred another try at ablation and I refused. I had had enough! The next day, he performed an A-V Node ablation with pacemaker.  Immediate improvment in quality of life. I'll typically exercise 1 - 2 hours daily (not crazy exercise, 3 - 4 miles treadmill/walking track, 1/2 hour on a Nu Step device.) -----It was the right choice for me.

AV Node Ablation

by AgentX86 - 2018-07-29 20:07:58

I've told this story a lot, so if others are bored, they can tune out now.

I've had AFib for about 12 years, though it was manageable until I had bypass surgery in 2014.  At the time they also did a Maze procedure to try to "fix" the Afib.  Instead of fixing anything, it caused severe atypical Aflutter.  Both were very uncomfortable (Aflutter was worse) but I didn't have the problems you've had, except for the first time (HF).  I had three failed ablations trying to get rid of the flutter, the latest in January.  I had a near syncope even in February and an event monitor found long pauses.  Since I needed a pacemaker anyway, we decided to go for the AV ablation and biventricular pacemaker.  Both were done at the same time and it was pretty uneventful.  I felt great and with the exception of a few weeks in the spring and early summer, I've been feeling really good.

Your situation is a little more complicated, so I wouldn't count on jumping right out of bed and running a marathon but it is a good choice after all other alternatives have failed and you still can't function normally. It is the last option that should be considered.

Talk to your EP about a biventricular (CRT-P) pacemaker, though.  Single ventrical pacing is known to cause heart muscle remoldeling and heart failure, long term.  Biventricular pacing helps, though some only use CRT devices after the damage has been done.

More natural than CRT-P.....

by Terry - 2018-07-29 21:50:22

Studies show how high percentage ventricular pacing can cause what your doctor calls "pacing induced heart failure" in 10% to 15% of pacing for a year or two. He or she can also tell you that this can be avoid by providing natural ventricular activation at what is called the His bundle (Google that or see <www.His-pacing.org>. Go to the "Papers" page and scroll down to the section on ablate and pace.) In case your doctor is not trained in His bundle pacing, get a second opinon - Mayo, Cleveland Clinic or a university hospital near you.

Terry

Responses to all

by atiras - 2018-08-01 09:49:26

Apologies for not responding sooner, but my PC is a lot more unreliable than I hope my pacemaker will be. (Dead motherboard, now replaced).

Generally, re second/third opinions, this is my second opinion already -- neither of the specialists I've seen believe that either different drugs or routine ablation for AF will achieve anything.  The first specialist advised  against pace and ablate because it's irreversible (not because it wouldn't work) but he doesn't have to live with my condition.

To TheKnotGuy, yes, I know you/we are not doctors -- I was hoping for patient experiences. The doctors tell me it will almost certainly help but in a small unquantifed number of cases can make things worse (as their hearts don't 'like' being paced, which is why they wait 6 weeks between putting in the pacemaker and ablating the AV node). I pressed them and they said it was a very small percentage in their experience; of course they aren't all knowing so I take some comfort from the 6 week delay -- worst comes to worst, they can disable/remove the pacemaker and leave me as I am.

Re Medtronic pacemaker, I'll ask but I suspect that being in Afib with a massively elevated heart rate 100% of the time means that it won't help -- delighted to be proven wrong. Medical insurance not an issue -- I'm in the UK.

To DavidH, it's been explained to me that the delay between the pacemaker and the AV node ablation is (1) to check that a pacemaker is right for me and (2) to ensure it's bedded in completely before I become dependent on it. They do do both ops at the same time in an emergency (which I'm not, thank goodness). I'm glad to hear it was the right choice for you -- gives me very cautious hope.

To AgentX86, never planning on running a marathon; just walking around the supermarket would be good -- but glad to hear your experiences. The consultant has said they will put in a single-lead left-ventricle (hmm; I need to check this -- the drawing they did said left and they implied the right one was 'fiddly' and harder to get in position) pacemaker and evaluate reponse; if they have any doubts they will put in the second lead  straight away. I'd certainly prefer a dual-lead pacemaker to reduce the risk.

To Terry, thanks for the info -- I'll definitely ask. I'm going to the Bristol Heart Institute which is a university hospital in the uk and I know they're looking at it for heart failure.