AV NODE ABLATION + PACEMAKER AND A PVI ABLATION.

I posted previously regarding the fact that even after these procedures I am come out of sinus and are picking up arrythmias on my BP machine.  My BP is all over the place and I am breathless most of the time especially after eating.  I know when I have an arrythmia as I feel really ill and breathless and when it goes away I feel better and can go shopping or do my housework.  This is done at a slow pace otherwise I come to a fullstop.  My pacemaker is working as it should be.  I was taken to hospital last week with very low potassium and spent 6 days being given potassium and I saw my other cardiologist who kept me there so I could have another echocardiograph this had not changed from three years ago.  I have to go to see my EP tomorrow and I hope that he may have a few more answers. I am sure he will get there in the end.  He is a cautious man which given that electrical problems cannot always be seen straight away, is better to go slow so I don`t have to suffer procedures that may make things worse.


4 Comments

ABLATIONS AND PACEMAKER

by Gemita - 2019-10-06 09:04:11

Hello Bilboesylvia,

I note your PM is working fine and that you have had another echo.  After any procedure there is a blanking period where the heart is healing and your symptoms may get worse before they get better.  Sometimes, also if we have several different arrhythmias, requiring different approaches, a second ablation may be needed to fix the problem.  When I am experiencing arrhythmias, like AF, Flutter, my BP is all over the place too and so is my heart rate but I have come to realise that a digital BP monitor may not accurately assess these when heart rates are fast and irregular.  

if I were in your shoes I would 1) make sure that none of your meds are causing electrolyte disturbances like low potassium and this may need to be monitored long term  2) review all your meds to see whether any of them could be "pro arrhythmic".  I certainly found Flecainide "pro arrhythmic" and now that I have stopped it, my arrhythmias are more manageable with only a low dose beta blocker and my dual chamber PM which is now doing a great job.

Yes I agree go slow and don't suffer needlessly.  You can't undo what is done, but I really hope you get some answers tomorrow.  I wonder if your PVI ablation has unmasked another arrhythmia.  They can hide behind each other and when one is fixed another can reveal itself I am informed.  

AV node ablation

by AgentX86 - 2019-10-06 13:28:12

Note that Sylvia had an AV node ablation,  not an ablation for AF or AFL. If the AV node ablation worked, she cannot be feeling the Afib or flutter. There is no such thing as a "blanking period" after an AV node ablation.

However, the heart is still irritated and may fire off all sorts of junctional or ventricular arrhythmias. In this case I think the low potassium says it all.  Low potassium  (or sodium or magnesium) can cause all sorts of heart problems. It's quite dangerous,  in fact. Dehydration can cause any of the above.

In addition to other tests, it's probably a good idea to have the kidneys checked too. They regulate these elements in the blood.

ARRHYTHMIAS

by Gemita - 2019-10-06 14:50:38

Hello AgentX86,

?? My understanding is that Sylvia had an AV Node ablation AND a PVI ablation (for AF) as her statement (under General Posting, 1.10.2019 seems to confirm) :

" . . . I had this done as drugs were not effective and my shortness of breath increased.  My pacemaker is set at 70bpm.  I am due to return to my EP next month after having a further pulmonary vein isolation which left me after 8 weeks back in AF and breathless . . ."

I would suggest that it is possible to still have symptoms from AF following an AV node ablation, even though any high heart rates will be prevented from getting through to the ventricles.  Some of us just dont do well when in AF, which is probably why Sylvia had a PVI ablation after her AV Node ablation because she was clearly still symptomatic.

Very confusing, I agree

by AgentX86 - 2019-10-06 18:59:41

An AV node ablation completely isolates the ventricles from the atria.  Unless her doctors have done something really weird, like implanted a two or three lead AAI or DDI PM to bridge the AV node  (why bother with the ablation, then?), no atria-related arrhythmias will get through to the ventricles.  That's the whole point of the AV ablation - to relieve the symptoms of AF/AFL/AT. It works.  Every time (as long as the AV ablation was complete).

Unless the AV ablation didn't work, the above quote makes absolutely no sense.  You cannot feel contractions of the atria. The only thing a PVI ablation would accomplish after an AV node ablation would be to reduce the chance of stroke (and that makes no sense either).

There is something going on here that we're not being told. Perhaps her heart isn't strong enough to deal with the dyssynchrony?  PVI isn't going to help with that, either. 

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