av node ablation

My mother had a 24 hour halter monitor done.  The doctor had recommended a pacemaker change and av node ablation.  He said the monitor showed atrib. fib w rapid venticular rate (128) . paused 98 times with a max time of 2.5 seconds.  Do you think this would be the right treatment for this?  Also are patients put to sleep for this?  My mother is 74 yrs old and has had her pacemaker since 2000.  She has been feeling very weak and can not walk for with out sitting down and being out of breath and weak.  Just want your opinion.

[Cleveland Clinic]

It is a reasonable approach, but should only be tried once all medical therapeutics have been tried and failed.  Most patients can be well rate controlled during atrial fibrillation with simple meds such as beta blockers or calcium channel blockers.  They work majority of the time.  The times when they fail is if they cause low blood pressure, or the patients develop side effects to them.  If neither is present I would continue to uptitrate those meds until a desired effect is achieved.  I would also recommend checking an echocadiogram because the fast heart rate could cause her heart to worsen at which point chronic pacing may not be a good idea, at least from the right ventricle, and an upgrade to a biventricular pacemaker may be necessary.  The thing that doesnt make sense to me is why your mom is having pauses of 2.5 seconds if she has a pacemaker.  It may need to be reprogrammed.  Also, people who have pacemakers, don't necessarily need to wear holter monitors because almost every pacemaker is a holter monitr.  I would consider getting a second opinion if I were you.  Finally, pts arent put into full sleep during pacer changouts.  They are in what we call a twilight zone.