3rd ablation

[heartofgld]

This question is about a post made last week regarding the return of AVNRT after 2nd ablation. I met with the Doc at Brigham and Womans last Thurs. Needless to say he was quite baffled with what I have been through in such a short time. He susspects that I may have a 3rd pathway going from the AV node through the coronary sinus. He also suspects that I may not even have SVT based on the failed RF ablations with the multiple burns that were made in the last procedure, and that what I have may be resembling. He knows that I definitely have an Atrial Tach based on the last tracing with HR 300+. I will be having another EP study with hopes to finally rid myself of this nucience.

My questions are:
1. How common is it for someone to have a 3rd accessory pathway?
2. Given the difficulty sometimes to ablate atrial tach, how common is it to have an AV nodal ablation and pacemaker implantation?
3. Having also had Afib and Aflutter, after having a flutterline ablation, would a pacemaker resolve this from coming back?

Thanks for any info you could offer.

[Cleveland Clinic]

heart,

thanks for the post.

Its difficult to tell you specific answers since you have such a complex case. You may have more than one pathway or a pathway that was incompletley ablated. Also, you have other underlying rhythm issudes with your atrial tachycardia. You are doing the correct thing by seeking an opinion at an experienced tertiary care center.  The requirement for pacemaker is best answered by the electrophysiologist performing your procedure. A pacemaker will have no effect on the recurrence of flutter/fib. It is used to control your rate if there was significant damage to the AV node.

good luck

[BABlocker]

A pacemaker will not stop the afib/flutter from recurring; however the settings that your EP prescribes may help to limit or stop the episodes from perpetuating themselves.

I had an av node ablation and pacemaker implanted after 2 ablations, cardioversion and 4 antiarrythmics failed to stop the arrythmias with hr in the 180-250+ for sometimes days, accompanied by plummets in the heart rate when I would convert (into the 30s). Today, almost 1 1/2 years later, I still have afib (feel it less) and occasional aflutter, but the pacemaker is very helpful, along with meds, to greatly curtail the length and severity of the episodes. It has taken an emotional and physical adjustment to live with my heart that is now dependent on the pacemaker, but I am moving along.

I have many good days, some challenging ones when I have many ectopics that lead to runs of flutter/or fib, but for the most part I am doing well. I work strenuously and am much improved clinically, although it took patience and time to allow my heart to settle down after the surgery.

Good luck with whatever occurs. Whatever that is, you will live through it, adjust and embrace a new normal if that is to be.

[heartofgld]

Thanks for your comment. Why did you have an AV nodal ablation? My EP referred me to a more experienced EP at the BWH for a consult to see if I was a candidate for a cryoablation. The new doc said that he was sceptical that it would benefit me. With the myriad of arrhythmias that I have presented with, he suspects that if the RF didn't work I may be facing the av nodal ablation and be pacemaker dependent. Do you have to take coumadin? Since the 2nd week of Sept, I have been cardioverted, had 2 EP studies, 2 abaltions, been on and off flecainide, been hospitalized 3 times. During my last stay, I had Nadolol added to my daily regime of meds which has not been seemed to help and has put my bp to daily readings of 70/48. I am simply worn out and need to have something go right for me.:(