Ablation

I have had my  PM for almost 1 year and had an ablation before it was implanted.  I now have almost constant flutters and will wear the Holter again in Jan to see if something else needs to be done.  I have no symptoms and plenty of energy for my age (79),  work out 6 days a week, Curves and a gym.  My Dr said another ablation might be considered.  How does that work with a PM and another person told me that age might be a factor in not having another ablation.  All these decisions!  I know I will have a lot  of questions for my next appt. in Jan.  Thanks for help.


3 Comments

ABLATION

by Gemita - 2019-12-13 06:14:15

Hello Rebeccaanne,

I am in a similar position, although I am 71.  My doctors tell me that I have up until the age of 80 to make up my mind about whether or not to have an ablation for my several arrhythmias.  I guess the older we are the higher the risks of any procedure and the more likely our arrhythmias are to have progressed, making the procedure longer/increasing the risks.  You sound very very fit though !!

I have a dual chamber pacemaker and I am somewhat concerned about protecting the leads during an ablation. No doubt in experienced hands an ablation is a straightforward procedure but I still feel that the leads might somehow get in the way, or be prone to damage, but perhaps I am completely wrong in thinking this way.

You say you have no symptoms and plenty of energy, so my doctors would probably tell me to leave well alone.  But on the other hand, arrhythmias can progress rapidly causing many unwanted symptoms over time and if you feel well enough to go through the procedure again, why not ?  I presume you have Atrial Flutter which is usually a more straightforward fix than an ablation for Atrial Fibrillation.

Yes so many many decisions.  I wish you well 

Ablation

by AgentX86 - 2019-12-13 08:44:53

This is something that needs to be done sooner rather than later. The heart tends to get "used to" arrhythmia and ablation has a lower probability of success.

Gemita is right about Aflutter being easier to ablate than Afib, as long as it's "typical Atrial Flutter", or right-side flutter. If it's flutter in the left atrium, it's not so easy. The difference can usually be spotted on an EKG. "Usually" because in a small number of cases right-side flutter can be retrograde and look like left-side. If it's atypical flutter they have to go into the right atrium (it's where the venus blood enters the heart) and punch though the septum to access the left atrium. From what I understand, it gets complicated operating the catheters in there. I had three failed ablations for left-side flutter in 18 months. Mine was caused by a Maze procedure, for Afib gone wrong, so it's somewhat unusual. This is why I had the AV/His ablation and an now pacemaker dependent. My ablations were before the pacemaker, so I can't answer that question.

I was also quite functional, if you consider going weeks and months with maybe two hours of sleep each night somehow  "functional".I was walking about 12mi a day at the time.

Age may certainly be a factor. For many reasons, you want the best ablationist possible, even if you have to travel (it's only a couple of days in a hotel).

Long-term excessive heart rate is damaging

by crustyg - 2019-12-13 11:29:12

I echo the wise words from Gemita and AgentX86.

Long-term excessive heart rate can lead to heart muscle damage, so it's something that needs to be addressed.  Also, if your AV conduction is very good, you may have episodes of very high ventricular rate, driven by the flutter impulses - and this can be potentially very serious.

If your EP doc is willing to offer the procedure, then your age isn't a significant obstacle.  You do need a real expert to do this procedure, someone who really does a *lot* of these.  I suspect a lot will depend on the examination of the Holter recording after it has been done.

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As for my pacemaker (almost 7 years old) I like to think of it in the terms of the old Timex commercial - takes a licking and keeps on ticking.