AV node ablation

[Lyn2]

Thanks so much for your service.  I am a 37yr.f.  I have sick sinus for which I have a pacemaker.  Right now I am scheduled for an av node ablation in a wk. for uncontrolled a-fib and other atrial arrythmias. Apparently, I go from one arrythmia to another at various rates.  I take coumadin for the a-fib. My EP made a list of all the meds. I have tried.  I have gone through the entire gamut of anti-arrythmics. Amiodarone was the most successful.  I was on it for 5yrs. Others have given me a dangerous long QT.
I have some concerns about the upcoming ablation I wonder if you can help with. Two years ago I had a sinus node ablation.  As a result my atrial lead would not work due to surrounding scar tissue. It took 3 consecutive surgeries to get it right. Due to that I developed a pacemaker staph infection, for which  the entire pacemaker system had to be relocated. LONG ORDEAL! When I was at the EPs office last discussing this upcoming av ablation he was speaking to the pacemaker rep. They said that they could not currently turn on the v-lead because the av delay was too long.  I was then told that when my battery dies I will need a new v-lead because mine is not in a good spot.
Here is my concern...Because I will be 100% dependant on the ventricular lead, shouldn't it be in the optimum place following this ablation.  I don't want a repeat of last time.  
Do you think I should mention this to the doc. or trust that he knows exactly what he's doing?
He's concerned about loss of atrial kick. What does that mean?  How can that affect me?
Thank you for your time.

[Cleveland Clinic]

cn,

Youve been through a lot. Its really impossible for me to distill and comment on your case in the limited setting of this forum.  My advice though would be to seek a second opinion. If you are at a large tertiary referral center, I would discuss with your physician and one other physician. If not, I would seek opinion at a referral center. At the clinic Dr Patrick Tchou or Dr Walid Saliba are 2 outstanding physians that I would send my family member to if they were having similar problems.

The Atria beat before the ventricles and the electrical communication between the 2 is the sinus node. When this doesnt work properly the 2 can sometimes beat out of synchrony which can cause symptoms in some patients. With an atrial and ventricular lead these 2 leads talk to each other in the pacemaker box and the synchrony is controlled there.

[Bromley]

I am sorry to hear about your troubles.

I think you should gather your health records and go see someone else (in person) --- someone qualified --- with your issues.  For a second opinion.

Good Luck.

[Redbaron]

"Do you think I should mention this to the doc. or trust that he knows exactly what he's doing?"

If you have concerns about any part of your treatment, then definitely make them known to your Doctor.

[Lyn2]

Thanks so much for your comments.  It was hard to fit in everything with the set amount of characters allowed when asking my questions.  There is alot of space but my history is so long it would probably be 10 pages.  The doc. I see is someone I have seen for many years, so I have established a trusting relationship.  I have also been to other EP doctors at other reputable hospitals, as my doc. always refers me.  So I have had many opinions.  
I guess it is just that one thing that is bothering me and I don't see the doc. until the ablation.  Does this make sense? I just woke up so I'm half asleep.  Sorry.  I would love to hear from anyone else on this forum who has had an av node ablation.

[Sunrize]

Yes, I had a AV node ablation along with some "other stuff" in an 8 hour ep study/ablation. One good thing you may have to look forward to: some of the medicines I could not tolerate before the procedure worked great and with no side effects once some of the problems were ablated. Only one spot can act at a time and the medicine acts different on each spot.
Second opinion before was good so I never had to wonder if I was doing the right thing, with the right Doc, with the highest tech equipment.