AV Node Ablation

[bcat]

Has anyone had an av node ablation? I have long-standing, permanent afib which is pretty well controlled with cardiezem and digoxin, but several different doctors have recommended an av node ablation. I already have a pacemaker because the drugs caused dangerous pauses in my heart rate. Is there any advantage to the av node ablation? What effect would it have?

[007dude]

I am a 74 year old male. I have had A-fib a big part of my life, but it had got worse the last three years. so, finally I had AV Node Ablation done four months ago and the A-Fib stopped. However recently I am having these weird feeling of painic and waves of nerviousness. It sounds like I'm not the only one that is experiencing this.

If so has anyone found an answer, and or treatment for this problem?

Jimmy In Prescott

[ksig]

Well we are very similar in medical history.  I had a pacer implanted a year prior to the AV Node ablation and I still suffered through too many AFib events.  When one lasted 60+ hrs, I was fed up and agreed to the procedure.  I was scared to death but I was not willing to continue fighting the AFib events like I had been doing.  The AV Node ablation is very quick and I was home int he afternoon of the same day.  I had relief almost immediately.  I am off all meds except Pradaxa and atenolol.  It was the best decision I ever made.  I still have AFib but I cannot feel it and it does not incapacitate me like it used to.  There is a great life after the AV Node ablation.  Its a tough decision and one you should not take lightly.  Good luck to you.
ksig

[smialc]

Your circumstance is identical to mine. 3 PVI ablations + 1 atrial flutter and no relief. I have a pacer implanted (3 days ago), but no AV node ablation ... yet. I've been under drug therapy for 8 years, so I'm pretty-much tapped out there. The first surgeon I saw, 8 years ago, suggested an AV node ablation and pacer and I've fought that tooth-and-nail until now. I'm at a point where the AV node ablation is about all that is left. I may try pacer + drug therapy about 6 months and, if nothing, proceed with the AV ablation. My current doctor (6 years now) understands my desire to avoid the ablation and has not "pushed" the procedure.

[ksig]

bcat,
I agree with Tony.  If you do not have to have the AV node ablation and it is a choice, don't do it.  If you are tolerating the meds, stick with that plan.  In my case, I was running out of options as AFib was running too much of my life and the QOL was not so great.  I was at the maximum levels of several drugs and the AFib was not being controlled.  I had already had 3 PVI ablations and one for atrial flutter with no relief.  If either the ablations or the meds took care of the AFib, I would not have considered the AVJ ablation.

Good luck to you.

ksig

[va_tony]

bcat

I personally would resist having the AV node ablation as it would make you pacemaker dependent for life. If your present meds make life bearable I would stay with that. I too am in permanent afib but hardly notice bcause the meds I take (cardizem and altace) keep my heart rate at about 70 at rest. I too have an enlarged atrium (LA diam. of 5.2 cm) and have been told that an ablation would likely not be successful. In my case, I experience few to no symptoms and am able to work out at the gym daily (3 miles on treadmill at 9 % grade as well as free weight and nautalus machines).

The deciding factor should be if you are symptomatic to the point of the afib disrupting your life or if the afib poses a further health threat. If not, then why go through an av node ablation? With an av node ablation, you will still be in atrial fibrillation and your ventricals must be paced by the pacemaker.  You would still have to take warfarin for anticoagulation and stroke prevention.

JMHO

Tony

[bcat]

Thank you for being so helpful. My left atrium is enlarged to 5 cm. (One doctor said it was "humongous.")  The afib has been going on for years--I kept telling my doctor about the fast heart rate, and he patted me on the head and said I'd just been rushing around a lot. Now I'm told it's too late for the pulmonary ablation. So I need to decide whether to keep taking the meds or to have the av node ablation. I really wasn't told much about the pros and cons, so I do appreciate your input. I feel like I just fell through the cracks (at Mayo Clinic, no less).

[PikaPika88]

Hi. "I am 100% pacer dependent.  There is no turning back." = I have a turning back during my heart block.  That's why I'm not a pacemaker dependent.

[ksig]

Hi to both of you.

bcat, yes, I am on coumadin but I am off all other meds. At the time of the AVJ (AV Node junction) I was on Tikosyn, diltiazem and atenolol. I had a pacer inplant two years ago so I was ready for the procedure. At the time, I was paced about 20% of the time.

Yes, the electrophysiologist keeps and eye on the atrium size.  I do not have an enlarged atrium at this point.  Pros and cons of the AV node ablation:
]Pro: I really have had a significant reduction of AFib events that I feel although I still have them.  Many of them do not bother me at all.  I am off all meds except for coumadin.  I feel phenomenally better with more energy and QOL is significantly better.
Cons:  I am 100% pacer dependent.  There is no turning back.

After weighing the pros and cons, and discussing it with my family, I decided to go ahead with the procedure.  It took 30 min and then I waited on the table for an additional hour and they tested to make sure I could no longer conduct. There was only one cath for the procedure.  After a couple of hours to recoop, I was on my way home.  Because I already had the pacer I did not have to have one implanted.

All in all, I feel really good and do not regret having the surgery.  I make sure I have my pacer interrogated at the scheduled times.

ksig

[PikaPika88]

Hi bcat, I have my His bundle ablated in 1985 (sometimes cardio used/said AV node ablation).  I think the his bundle is just a little bit below the av node.   How come he said the same?

If you have a pacemaker already, why your doctor not programme to VVIR and permanently paces the ventricle?  If he do this, you won't feel any a-fib symptom but your Atrial still fib though.  Even you've the av node ablated, your A-fib remain in fib..... Just the fib or any activity won't get to the ventricle only.  Plus additional risk is, permanent pacing the right ventricle can cause heart failure.  You'll have it paced permanently after the av node ablation.  You'll become a pacemaker dependent.  Did your doctor give you a choice of Pulmonary Vein Isolation or some kind of ablation (NOT av node ablation)?  Take care.

Hi ksig, did your cardio keep an eye on your Atrium size?  What is the pro and con that he told you before the av node ablation?  Could you share with us?  I'm not the pacemaker dependent.  I got A-fib but it last from few seconds to less than 2 minutes only so I don't need to take blood thinner.

[bcat]

I'm not sure what AVJ stands for. Does it involve destroying the av node and becoming dependent on the pacemaker? I thought it was necessary to keep on taking coumadin after this procedure.

[ksig]

I, too, have AFib and I recently had the AVJ ablation (March 5).  I have found that it was a great decision as I do not experience the "rocking and rolling" of AFib nearly as much.  That is a great thing but the best thing is I am med free.  Once I had the AVJ, I was taken off all meds.  I feel great and make sure that I make all pacemaker  interrogations.  Good luck to you.
ksig