longterm outcome after sinus node ablation

[snitch]

Hey there!
I would like to know, if there are any studies on the longterm outcome of sinus node ablations. I have had several ep studies and ablation procedures, starting with three studies + ablations of my sinus node. i have had two ectopic atrial tachycardia, av-nodal-reentry and atrial flutter afterwards. in addition to that, i needed surgery for superior vena cava occlusion which was also caused by the ablations of my sinus node.

I do not know a single patient who has not developed further arrhythmia after having had the sinus node ablated.

I have heard that many hospitals do not perform these ablations any longer because of the poor outcome.

What do you know about all this?
Thanks a lot & warmest regards from Germany,

Inga

[Inspira8]

Hi, I too have IST and after my first ablation for it, they found out I also have Atrial Flutter, but it was masked from the IST. I had since had 2 additional ablations and the Atrial Flutter has since been cured, but I still have IST. My EP has suggested that I undergo a 4th ablation, with a more powerful cathedar, but he said the risk of pacemaker is as high as 60%. I don't know why I am so afraid of a pacemaker (maybe because I'm only 25 yrs old?), but I do not want one. However, I need to make some sort of decision soon as my symptoms were much much worse when I was preg, and because the dr's at that time told me beta blockers were unsafe, I terminated the pregancy. My husband and I would very much like to become pregnant again, but I am afraid of my IST becoming much worse, as it did my last preg, and that they can't control it. My resting heartrate was 150 during preg, and went up significantly if I walked up a few stairs or did minimal activity. Currently, my resting hr is about 100-110,and triples if I walk up a few stairs or other similiar activities. I have taken all beta blockers and calcium channel blockers and only one has somewhat "worked", but it brought my resting hr down to 43bpm and blood pressure was 80/40 so that can't be too good, right?  I am confused about how to proceed.

[CCF-M.D.-RCJ]

Inga,

Thanks for the post, and Gutentag (I hope I got that right?).

The long-term outcomes after sinus node modification or ablation largely depend on why the procedure was done in the first place.

Innapropriate Sinus Tach (IST) can often be successfully treated with an ablation procedure provided a firm diagnosis of IST has been established.  POTS patients, as an example, frequently derive little benefit from a sinus node modification.

Developing AVNRT or aflutter after an ablation of the sinus node would be uncommon.  It is more likely that these arrhythmias were always present, but just masked by the IST.

Lastly, in specific answer to your question about long-term studies, the Mayo clinic has published several smallish series.  Most of their published work shows benefit for very specifically treated/targeted patients.

We still do 2 or 3 IST ablations per month at the CCF.  I can't speak to other hospitals' patterns.

Hope that helps.