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Heart Disease  (Expert Forum)
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AV Node Ablation
Answered by
Cleveland Clinic -
Cleveland - OH
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MedHelp Member's Question

AV Node Ablation

by Guenter, Feb 08, 2004 12:00AM
What is it that they do when they do an AV Node modificaton?  What is the expected outcome for this procedure?  It is being proposed for treatment of re-occuring atrial flutter.  Will there be an underlying rhythm so that one would not need to be totally pacemaker dependent?
Doctor's Answer

by Cleveland Clinic, Feb 08, 2004 12:00AM
Guenter,



The av node essentially is the electrical patheway that connects the top chambers (the atria) to the bottom chambers of the heart.  For people that have difficulty with rapid conduction of their atrial fibrillation or flutter, it is usually due to the rapid conduction through the AV node.



There are specific inputs into the AV node that can be electrically modified or ablated to prevent the rapid conduction of the beats into the ventricales. In pure AV node ablation a pacemaker is usually inserted to ensure the ventricles beat at a rapid enough rate, in modification specific inputs into the AV node are ablated until a sufficient ventricular response is achieved.  The pure outcome of theis procedure is control of the ventricular response, to prevent it from being too rapid, thereby decreasing symptoms.



Other options for treatment of fibillation and flutter include ablation or antiarrythmics.



good luck

Member Comments (21)

by Irene, Feb 08, 2004 12:00AM
I had an AV node ablation three years ago and am pacemaker dependent.  Your're left with some heart rhythm but the rate is very slow - I think it's termed an 'escape rhythm'.

My life was transformed by this procedure, and although of course it's best to avoid pacemakers if possible, it is not nearly such a 'disaster' as others who contribute to this forum would suggest. Apart from extra frisking at airports, life with a pacemaker is very ordinary.  I hope yours goes well.

by Guenter, Feb 08, 2004 12:00AM
To: Irene
Yes.  I do understand the theory of an AV nodal ablation.  But, what I wanted to know was what is considered a modification of the AV Node.  I would much prefer a modification as the Doctor described instead of a complete AV nodal ablation.  If at all possible, I want to preserve what I have and just treat the problem.  I do know that pacemakers are pretty reliable and dependable but to me they are still technology with all that implies.  Being cardioverted relatively often has not been a problem for me.

by sunnygirl, Feb 09, 2004 12:00AM
I wanted to post this as a main question, but of course, they only accept about two questions per day so I can never hit it right.  



From time to time I Google to see if there is much PVC ablation going on - just for people with frequent PVCs.  Tonight I did such a search and found that some doctors in Thailand of all places did a very small study and consider it to be a valid therapy for frequent PVCs.  My question, on behalf of all of us who suffer from these annoying, scary PVCs is:  Is this going to catch on in the United States????? What I see most of the time now is that it's not really recommended unless you have some other arrhythmia; a re-entry site, a-fib or something.



The article is pasted below.  If anyone has any info, please share!! Thanks a lot. You can e-mail me at ***@**** if you want.  



From PubMed:



Radiofrequency catheter ablation for frequent premature ventricular contractions: a preliminary report of 15 cases.



Raungratanaamporn O, Bhuripanyo K, Krittayaphong R, Wansanit K, Kangkagate C, Chaithiraphan S.



Her Majesty's Cardiac Centre, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.



Between February 1995 and March 1997, 15 patients, 13 women and 2 men, underwent radiofrequency catheter ablation (RFCA) for symptomatic frequent premature ventricular contractions (PVC's). The mean age was 43.3 +/- 11.9 years. Thirteen patients (86.7%) had right PVC's and the remainder had both right and left PVC's. RFCA were done under local anesthesia, using both earliest endocardial activation time and pace mapping in complement. The immediate success rate was 14/15 (93%) with only minor complications in 2 patients (13.3%). The fluoroscopic and procedure times were 40.6 +/- 24.0 and 170.7 +/- 81.2 minutes, respectively. From the Holter monitoring, total PVC count, per cent of PVC per total heart beat in 24 hours and couplets count were significantly reduced, (more than 90%, p < 0.05), by RFCA. Triplets and repetitive ventricular tachycardia were totally abolished. During the follow-up period of 10.1 +/- 7.5 months, 2 patients (14.3%) had recurrences of right PVC's within 2 weeks after ablation. Reablation was successfully done in both patients without recurrence, giving the final success rate of 93 per cent. In conclusion, RFCA could be safely performed with a high success rate in patients with symptomatic frequent PVC's. It can be considered an alternative treatment in patients resistant to medical therapy.



Publication Types:

Clinical Trial

by parunuweap, Feb 09, 2004 12:00AM
I haven't heard of PVC ablation but I do hope eventually something could be done for some varieties of PVCs.  I'm going through an especially bad time with them right now and even though they're not considered dangerous they are a terrible distraction and certainly don't feel good.

by Momto3, Feb 09, 2004 12:00AM
To: sunnygirl
I have had 2 successful ablations for very frequent pvcs.  However, I must tell you that my doctor does not generally advocate for ablation as a treatment for pvcs.  In my case, the pvcs were actually causing harm (cardiomyopathy). My options came down to anti-arrythmics for life or an attempt at 1 or more ablations.  I was (am) multi-focal and so I knew that it might take one or more attempts to get at the foci. The first ablation reduced the number of pvcs, but there were still frequent (6000/24 hours). The second ablation has significantly diminished their existence.  I get an occasional flip-flop, but NO remarkable runs, etc.  It is absolutely amazing!  



Although I am enjoying the success of the ablations, my doctor reiterated last week that she does not normally use ablation as a treatment for pvcs (even frequent ones). She said it is extremely rare, but in some cases, the patient can develop a cardiomyopathy and in that case, it is important to treat the pvcs aggressively. Last week, I received the official report that the 2nd ablation was indeed a true success.  My 40% EF went back up to 55%!!!  YEAH!!!



Try not to worry about the pvcs. They are almost always harmless. Have you tried beta blockers for symptomatic relief?  They can be helpful to some people.  Good luck to you!

by LynnSB, Feb 09, 2004 12:00AM
>>You are indeed a success an EF of 55% is the low mormal. 55-75% is considered normal ranges at most institutions. 53 -70% at some.<<



I was told an EF of 55 to 70% was normal with 50 being borderline "low normal" and anything over 70 being a possible hyperdynamic heart.



I  think "normal" varies with the med center and echo technology being used.



Lynn

by Momto3, Feb 09, 2004 12:00AM
To: Hankstar
No doubt about it Hank, I know how exceedinlgy rare a CM is in the presence of frequent pvcs. I am just so relieved that my doctor checked out a "hunch".  I sure believe in miracles..lol! Prior to the drop in EF, I had an EF of 55%. Last year, I dropped to 45%, then 40%. After 3 months on anti-arrythmics, it was back up to 45%. After the ablations, I became the proud owner of a 55% EF! Hallelujiah! The absence (or near absence) of pvcs is just icing on the cake :)



I am defintely aware of the debate as to whether frequent PVCs really can cause cardimyopathy. In my doctor's words, "It is EXTREMELY rare". As I understand it, my records have been reviewed by doctors at a number of conferences as well as many in Cleveland. The doctor has considered writing up a case study...YIKES!



Here is a link to a study titled: "A case of cardiomyopathy induced by premature ventricular complexes". You are right, there is NOT much out there. But, I thought you might find this interesting. When you get to the site, go to Vol 66 (2002), Number 11, pages 1065-1067. It's real short, but it gets to the heart of the matter....lol!



I still want to stress to the other posters that pvcs are almost never harmless.  If the CM wouldn't have showed up, I'd still be walking around with thousands of pvcs/day, and I would have been just fine. So for the majority of you who have them, try not to worry. I do not want people out there to think that they will develop CM because they have pvcs...I had them for 20-25 years. I only share my experience so that in the event someone develops a CM in the presence of frequent pvcs, they will be inclined to check it out.



Thanks for the well wishes! Hope you are staying well also! Connie

by Momto3, Feb 09, 2004 12:00AM
To: Hankstar and EVERYONE
OMYGOSH!!  Hank, you are right!!  YIKES!  



In my earlier post, I stated:  I still want to stress to the other posters that pvcs are almost never harmless.



What I meant to say was:  I still want to stress to the other posters that pvcs are almost never HARMFUL!!



OH NO! I hope I didn't start anything with that typo!!!



Thanks for your theory on why this happened in my case. Had me stumped for sure!! In December, my doctor said, "I think this is the first time I've ever heard your heart beating normally." It has definitely been a new experience for both of us. Like you, I was used to them, so I learned to live with them. Isn't it strange how they can be so eposidic? I also think it's strange that I never really had the characteristic "thump". Hmmmmm....Are you serious, only 10% of persons with pvcs feel them? WOW!!



Hey, 20-30 pvcs/day...those are just to keep you on your toes!  Glad to hear the meds are working for you. I had the same probem as you did with the BB aggravating the pvcs, but not always. Another strange phenomenon, I suppose. You are right, once you accept the fact that the pvcs will probably come back, it's a bit easier to deal with each new round.



Thanks again for your thoughtful words and helpful posts. I know that many of us enjoy reading your posts also.  This board is an excellent place to exchange ideas and find support from others who really understand.  



I do believe in miracles! I do! I do! I do believe in miracles!

connie

by dodgybeats, Feb 10, 2004 12:00AM
To: momto3
I'm so glad you are better - what a relief for you and your family! I was just wondering if your PVCs became worse when you were pregnant?  I am 12 weeks and my PVCs have flared up really badly, I even had long runs of them this morning which was sickening but I never feel haemodynamically compromised.

They are really bad when I throw up with morning sickness - good grief what a misery I am at the moment lol.

Even though it is rare I am concerned about PVC-induced CM as my brother died from it some years ago - he had SVT and PVCs for 2 years before he died suddenly.  



ps. sign me up for the ablation tour of thailand

by Momto3, Feb 10, 2004 12:00AM
To: dodgybeats
I love your nickname!! Very clever!



Thanks for the kind words! When I was about 19, I was told that I had heart murmur. My GP said, "You have the heartbeat of a 70-year old man", but not to worry as I would be fine. So, I didn't give it any more attention. When I was 22, and at the doctor for my first OB physical, he said my heartbeat sounded strange and that I might want to check it out further. He didn't bring it up after that, so I let it be. Fast forward to second pregnancy, age 24. Same thing happened at about 10 weeks. This time, the dr. insisted on checking it out. He found someone to do an EKG right then and there...and so the story began. I was off to my first cardio visit at 24 and have been going for over 20 years. So to answer your question, yes they reared their ugly head in each pregnancy... I was fortunate not to have morning sickness and the pvcs didn't "bother me".



Congratulations on the pregnancy!  Sorry you are having pvcs on top of morning sickness...UGH!  I can't remember if I took Inderal (beta blocker) during my pregnancies, but I know I saw a cardiologist every 3 months for several years. Do you see a cardiologist/EP? What has your OB said?



I'm so sorry to hear about your brother. That must have must very difficult. Do you know what type of CM he had? Given your

family history, are they watching you more closely?  



P.S. Your airline tickets for Thailand are in the mail : )

What area of the country are you in? You may want to consider seeing an EP at one of the major hospitals. Peace of mind can do wonders!



CONGRATS again on the pregnancy. It does get better when the morning sickness goes away. Look forward to brighter days : )

Is this your first baby?