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AV Node Ablation
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AV Node Ablation

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?
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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
21 Comments
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Avatar_n_tn
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.
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Avatar_n_tn
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.
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Avatar_n_tn
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
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Avatar_n_tn
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.
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21064_tn?1309312333
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!
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Avatar_n_tn
>>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
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21064_tn?1309312333
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
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21064_tn?1309312333
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
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Avatar_n_tn
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
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21064_tn?1309312333
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?
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21064_tn?1309312333
Sorry, I forgot to include the website for the article I mentioned.

http://www.jstage.jst.go.jp/browse/circj

Go to "Available Issues"
Vol 66 (3003)
No 11
Page 1065

It is a very small journal article from a Japanese journal, but I found it interesting.

Have a GREAT day!
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Avatar_n_tn
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?


Hi Connie, thanks for your reply.  Yes this is my first pregnancy and my partner and I am very excited about having a little baby but not so keen on the pregnancy so far! the nausea is horrible but the palpitations are the worst.  Thankfully they have settled down a bit today so I can work (I am trying to finish my thesis before the baby arrives), I am even thinking of going to a ballet class tonight so I must be feeling better.  My OB said that palpitations including sinus tachy and PVCs/PACs often increase during pregnancy due to the increased blood volume and hormonal irritation of the heart.  I used to really notice that my pvcs were worse just before my period and my mum is having a tough time with them right now as she is going through menopause.

The death of my brother was terrible - even though it was over 10 years ago we are still trying to get over it.  He was only 17 and we were told that his arrythmias were common and benign so it was an awful shock.  He had idiopathic dilated cardiomyopathy - a form of CM that is usually not inherited although some studies are now suggesting that up to 50% of cases have some genetic basis.  No-one else in my family have ever had any heart problems (except pvcs) but we are super-vigilant.  I have had echos, ecgs, tilt-table tests and even an EP study so I have had the works. Everything always comes back normal.  I am lucky that I only get about 50 pvcs/pacs per day but its the runs that bother me. Of course i worry that i have V-tach which is the reason for the EP study.  It was normal even though I went into VF during it - due to the EP doc really giving my heart a BIG workout.  My cardiologist thinks I am having really short runs of PACs or SVT.  Of course I have never been able to document one of these runs on a holter.  The next step is an event monitor I guess.  I try to stay happy and busy but I must admit sometimes the pvcs get me down sometimes - I HATE THEM!!!

anyway thats my longwinded story,
BTW I am actually in Australia and I love this site, so many times its been a lifesaver for me.
cheers
Penelope



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Avatar_n_tn
oops I didn't mean to leave your comment in the box, sorry everyone!
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21064_tn?1309312333
Hey 20-30 per month!! That's awesome!! I was wondering, do you notice the 20-30 more because they hit you out of nowhere? It's strange because when I had thousands per day, I noticed them, but not each one. Now, when I get one I REALLY notice them. They dont' scare me, but they do feel weird...and these do sometimes hit me with the characteristic "thump". Have you noticed that when they are less frequent you really NOTICE each one?

Thanks for the great discussion on pvcs!
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21064_tn?1309312333
Hi Penelope!!
Welcome to the boards!! It's great to have a visitor from Australia! You guys must be thrilled about the baby, despite the crummy morning sickness.  Remember, that will pass...lol! Sounds like maybe you are headed on the upturn since today was a bit better. Keeping my fingers crossed for you.  

You are working on a thesis?  I am graduating in May with my MBA and I cannot wait to be done!! Ballet sounds like a great way to relax and work out some stress. My OB said the same thing about the increased blood volume and palps. At this stage of my life, I am probably more like your "mum"...lol! The best and worst of hormones...hahaha!

Again, I am so so sorry about your brother. I have an 18 year old son, and I cannot imagine losing him. Please stay vigilent as you have been and take good care of yourself.  Just curious if you don't mind, did your brother have the arrythmia or the CM first? What type of arrythmia, do you know? There is SO little research on this topic, and I am always trying to learn. I've had pvcs for years (always benign), but ended up developing CM as a result of VERY frequent pvcs (24% of all beats) about 15 months ago. I am fortunate ablations were a successful treatment at reversing the CM. Now, I am enjoying a much improved left ventricular function.

I'm glad to see you have been thoroughly "checked out". Stay informed and take care of that little baby : )

I understand your frustration over the runs...those are definitely attention getters. I used to have 10-15+ in a row...ugh! I cannot believe you went into VF during the study..did you feel that? I think my doctor said they were not able to induce SVT. Fine with me!! The event monitor is a great idea for capturing what you feel.  

Staying happy is good! You have a lot of wonderful times ahead of you! Try to stay busy and try not to let the pvcs get you down.

Thanks for sharing your story! Get some rest and take care of yourself : )
connie
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Avatar_n_tn
Hi again connie,

yeah we are really happy about having a little bub, I can't wait to get the pregnancy "glow" I can tell you I'm not looking my best at the moment! lol but everyone says it gets better in the 2nd trimester so here's hoping :)

I am in the writing stage of my PhD, after 3 long years I can finally see the finish line, I am a cancer researcher focusing on prostate and breast cancer.  My partner is a med student so between the two of us there is a lot of self diagnosis going on which is not always for the best!

I am so glad your ablations worked - what a wonderful feeling, I bet you have a lot of energy back.  If only all of the pvc sufferers on this board could have the same result.  Even though I don't have too many pvc/pacs I sure can feel every single one of them.  My partner has them too (I can feel them at his pulse) but is blissfully ignorant of them - so jealous!  My doctors (I have a team of them!) are aware of my family history so they watch me very carefully.  My cardiologist always looks for ventricular hypertrophy (above the reference range for active people as I was a dancer)  because he says this can be a marker of early CM.

Unfortunately they only found out my brother had DCM after his death at autopsy, he had absolutely no symptoms of CM before his death, no oedema or breathlessness at all - probably because he was an amateur athlete and extremely fit.  He did have echos and had one 6 months prior to his death which was normal, thats how fast the CM developed.  The arrhythmias he had were bouts of SVT, multiple PVCs and PACs and very occassional atrial fibrillation, we were told that he would probably "grow out" of these and that they were common and benign.  We will never know the true cause of his CM (was it there before the arrhythmias in a subclinical form?? maybe) - it could also have been due to myocarditis but there was no microscopic evidence of this.
Oh well, its not healthy to dwell but i do get myself checked for my own piece of mind.

Thanks for your comments and concern, I'm sure you will go from strength to strength now,
penelope
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21064_tn?1309312333
Penelope,

Ahhhh, the "glow" will be around soon..lol! 2nd trimester is usually awesome!

Wow!! Congrats on working on your PhD...3 years is GREAT! I've given it some thought, but I am taking a break after the MBA...I am looking forward to doing something other than work, study, work, study...Wow...a PhD candidate and a med student! Must make for interesting dinner table discussions...haha!! Thanks for being a cancer researcher!! What a wonderful field!

Yes, I have much more energy than I did about 6 months ago. I was dragging. But, that's behind me now, and I'm enjoying my renewed sense of well-being. Isn't it weird how some people are hyper-aware of pvcs, while others as you say are "blissfully ignorant"?  

Sounds like you have a great team of doctors and they are keeping a good eye on you. Yes, keep an eye on those echo readings. My EF dropped quickly also. But, fortunately, the doctor caught it right away (luck of the Irish maybe...lol).

Again, I'm sorry about your loss. That is an amazing story! Thank you for sharing!

Please feel free to email me if you would like. It's been fun and informative chatting. The best of luck with your "bub" AND with your thesis!! Hope tomorrow morning is good! You are fast approaching the 2nd trimester and the morning sickness should be diminishing. Keeping my fingers crossed. See you on the boards.

Connie (***@****)  

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Avatar_f_tn
You made a comment that you would never go on Tambacor.  I hope that's the way it's spelled.  I also take 25mg Atenolol twice a day, and the doctor recently prescribed Tambacor.  She does not want me to stop the Atenolol as it keeps my blood pressure and heart rate low.  Why do you not want to take Tambacor?  I'm very nervous about going on it and to date have not taken my prescription to a pharmacist.  Also, my cardiologist wants me to have an EKG a week after I'm on the new medication.  Thanks.
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Avatar_n_tn
To Hankstar, Connie, Fred, Doggybeats and all,

In reading your comments, I just want to say, that no matter what your challenges, you all have a good sense of humor and GOOD HEARTS no matter what your challenges in life.  It's hard to be happy when you feel like you are a heartbeat away from keeling over all the time, but I'll bet you all make the best of it.  I know I try to.  Have a great day.....and P.S.  Thailand vacation?? Let's all go!
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21064_tn?1309312333
Thailand!!  I'm booking my flight!!  My shorts are packed...and I'll meet you guys at the airport!

Sunnygirl, thanks for your very thoughtful comments! This is a terrific place to gather information, make friends and find comfort. I truly know the frustration of living with pvcs. They are indeed a challenge! I used to refer to myself as a frequent flier not because of accumulating miles, but because I had SOOO many pvcs! I was platinum for sure...Hey, about that ticket to Thailand...Hmmmmm

Thanks to the ablations, I have turned in my "wings".

Thanks again!  Have a 'sunny' day!  connie
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