AV Node Ablation Pros and Cons

Posted by dalewhit @dalewhit, Feb 4, 2024

I am scheduled for AVNode Ablation early March. Has anyone had one?
I have had 2 cardiac ablations and am on sotalol and metoprolol. I have had no afib for 9 months but continue to have intermittent episodes of tachycardia at rates in the 120's and 130's. I already have a pacemaker - since 12/22 for bradycardia probably caused by amioderone which also elevated my liver enzymes.
This is a "last resort" procedure and I am concerned that I will continue to have symptoms of afib (which AV Node ablation does not cure).
I am an almost 83 female and am otherwise in good health except for arthritis. Another question: Will having this procedure make for complications in the event I have a knee replacement.
All thoughts and experiences much appreciated!
Dalewhit

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@treeman1942

I'm a soon-to-be 82-year-old male. I've had A/Fib for the last several months and one cardioversion last November, which worked for four days; it was performed at the Meijer Heart Center in Grand Rapids, MI. I'm slated for an on-site review of my records and additional tests at the Mayo Rochester Clinic on 15 February. I'll be fitted with a heart apparatus for a day, echograms, etc. I'm curious as to how many ablations are okayed after the pre-exams.

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You are in good hands at Meijer Heart & Mayo. Follow your path it sent me there.

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Hi—very similar situation, 83F with 20 year history of afib. Tried all treatments to no avail and now Dr proposing AV node ablation with pacemaker. Not convinced. How has yours worked out since March? Thanks in advance for your time.

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@applesforall5370

You are in good hands at Meijer Heart & Mayo. Follow your path it sent me there.

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You are in good hands at Mayo. I am 80-year-old female. I presented with persistent Afib with rvr in March of 2023 and was referred to the Mayo hear rhythm clinic by my cardiologist in the HCM clinic at Mayo. At my consult with the EP in the heart rhythm clinic I was offered either antiarrhythmic meds or ablation (already tried rate control which didn't work). I asked which he recommended and he said meds as ablation is irreversible. So, I went with Dofetilide (Tikosyn) which took a three day stay in hospital to be "loaded," So have now been in sinus rhythm for 13 months except for one 7 day breakthrough which self converted. Good luck.

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@emo44

You are in good hands at Mayo. I am 80-year-old female. I presented with persistent Afib with rvr in March of 2023 and was referred to the Mayo hear rhythm clinic by my cardiologist in the HCM clinic at Mayo. At my consult with the EP in the heart rhythm clinic I was offered either antiarrhythmic meds or ablation (already tried rate control which didn't work). I asked which he recommended and he said meds as ablation is irreversible. So, I went with Dofetilide (Tikosyn) which took a three day stay in hospital to be "loaded," So have now been in sinus rhythm for 13 months except for one 7 day breakthrough which self converted. Good luck.

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Thanks for your reply. The 2 ablations I had left me with episodes of tachycardia. No afib since Sotalol (also in hospital to start) prescribed in April ‘23. The AV Node would eliminate the tachycardia but cause other structural heart issues. A dilemma!

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@fucci

From the 6 different doctors that I have spoken to, Afib becomes permanent over time after the AV node Ablation. I had the AV ablation 7 weeks ago.
Found out afterwords that the AV node can grow back.

My first 30 days were great. Had high energy, 80 bpm heart rate, and good blood pressure… under 140/90 even when in Afib. After 30 days I had a pacemaker check and when they tested the pacemaker leads I grew very very dizzy. Since then I’m in Afib multiple times per day and have to rest after walking a very short distance.

I’ve had 4 ablations over the course of 20 years. I’m 75 and
my heartbeat was from 145 to 165 for a week at a time. I had Afib for a few days and then a week or two without Afib.
I have hade a pacemaker for 20 years.

Please make sure that you know what your chances are of going into Afib permanently.,,
And how long you can expect before the Av Node grows back.

And any risks for Pulmonary hypertension and other conditions that could develop if you do go into Afib permanently…

GOOD LUCK with the procedure!

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Hello Fucci, We've had similar experiences. I'm a 74 yr. old man , that had an A V Node ablation Oct. 21 2024, after 6 ablations over the years. I too can't walk long distances without feeling I'm going to faint. My heart rate and blood pressures are always normal. I'm very depressed that this is as good as it gets. Doctors keep saying give it time, but I'm not gettin that much better.

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@dalewhit

I have recently been diagnosed with Pulmonary Hypertension. I never went through with AV Node ablation as tachycardia symptoms were infrequent and manageable with meds.
I think PH was caused by my enlarged left atrium and possibly amioderone which I was on for almost a year. Amioderone also caused bradycardia and I now have a pacemaker. Beware of amioderone. It is an effective anti arrhythmic but can have lethal side effects particularly if you are an elder. I am 83.
Thank you for your post. I hope your symptoms quiet down.

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Interested in your PH diagnosis - this was a finding on a recent routine echo ordered by my EP prior to to the ablation I just had a week ago. The EP said nothing about it but I was concerned and self-referred to a pulmonologist. He first thought maybe I had asthma but then a 6 minute walk test and determined it wasn't asthma but that I needed supplemental oxygen! I was shocked to say the least. I know I have had increasing shortness of breath probably for about the last year but have attributed it to AFib which had gotten worse (thus the choice for ablation). I had been on amioderone for 8 months but now discontinued it with EP's OK. I fear that amioderone did this to me but I can't prove it. Will the PH get better now I'm off the drug (and when it's out of my system)? I had paroxysmal Afib so was not in it all the time. Looking forward to feeling much better as I progress in recovery from my ablation but am very worried about the PH condition.

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@carculmer

Interested in your PH diagnosis - this was a finding on a recent routine echo ordered by my EP prior to to the ablation I just had a week ago. The EP said nothing about it but I was concerned and self-referred to a pulmonologist. He first thought maybe I had asthma but then a 6 minute walk test and determined it wasn't asthma but that I needed supplemental oxygen! I was shocked to say the least. I know I have had increasing shortness of breath probably for about the last year but have attributed it to AFib which had gotten worse (thus the choice for ablation). I had been on amioderone for 8 months but now discontinued it with EP's OK. I fear that amioderone did this to me but I can't prove it. Will the PH get better now I'm off the drug (and when it's out of my system)? I had paroxysmal Afib so was not in it all the time. Looking forward to feeling much better as I progress in recovery from my ablation but am very worried about the PH condition.

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Hello Carculmer:
I, too, worry about PH diagnosis. I had right heart catheritzation (sp) which is gold standard for determining exact level of PH. My echo revealed PH but at higher level. The right heart procedure revealed that it was mild and pulmonologist recommended tadalafil which is cialis! I am on it with no side effects. The other test was a sleep study which revealed mild sleep apnea which can cause PH. Who knew. I will probably have to be on CPAP - will know when I talk to pulmonologist.
The docs say amioderone was not cause. They say my enlarged left heart is the culprit. I was also on that nasty drug for about 8 months and I think it did cause the PH but can’t prove it either.
I have not had a fib for almost 2 years thanks to Sotalol but the ablations left me with tachycardia events. I am in consultation with my EP about what is next.
I am sorry you got bitten by that PH bug but there is treatment now that can be effective keeping it at bay. Good luck!
Dalewhit

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@jamesgallenstein

Hello Fucci, We've had similar experiences. I'm a 74 yr. old man , that had an A V Node ablation Oct. 21 2024, after 6 ablations over the years. I too can't walk long distances without feeling I'm going to faint. My heart rate and blood pressures are always normal. I'm very depressed that this is as good as it gets. Doctors keep saying give it time, but I'm not gettin that much better.

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Hello James:
I hope your situation improves. They say that AV Node procedure does not cure A fib but that most people don’t experience symptoms.
And that it eliminates tachycardia which I have every now and then and which interferes in quality of life.
I have opted out of the procedure for now but it may be in my future.
Good luck!
Dalewhit

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@dalewhit

Hello Carculmer:
I, too, worry about PH diagnosis. I had right heart catheritzation (sp) which is gold standard for determining exact level of PH. My echo revealed PH but at higher level. The right heart procedure revealed that it was mild and pulmonologist recommended tadalafil which is cialis! I am on it with no side effects. The other test was a sleep study which revealed mild sleep apnea which can cause PH. Who knew. I will probably have to be on CPAP - will know when I talk to pulmonologist.
The docs say amioderone was not cause. They say my enlarged left heart is the culprit. I was also on that nasty drug for about 8 months and I think it did cause the PH but can’t prove it either.
I have not had a fib for almost 2 years thanks to Sotalol but the ablations left me with tachycardia events. I am in consultation with my EP about what is next.
I am sorry you got bitten by that PH bug but there is treatment now that can be effective keeping it at bay. Good luck!
Dalewhit

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Thank you for your comments - it's helpful. I have been using a CPAP for mild sleep apnea since 2018 and it didn't stop me from getting this problem with the PH. Since I just had an ablation a week ago, the EP won't let me be off my blood thinner for 2-3 months so I guess I can't have that right heart catheratization for a while. There has been no mention of drugs for this - just that he said I needed to "be on oxygen" for exertion. (boy that's a problem!) Since you've been taking the med have you gotten over your shortness of breath problem or did you not have that symptom?

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I have shortness of breath if walking uphill or exerting myself similarly. I exercise in pool and on recumbent bike with no shortness of breath - yet. Sometimes anxiety will make me feel short of breath.
I did not have to stop blood thinner for right heart procedure. It was painless and over in 20-30 minutes.
The meds apparently open the pulmonary artery to allow more blood flow. Don’t know if it’s helping slow down progression- have an appointment in April.
I am almost 84 so aging also obviously a factor.
Discouraging that CPAP not helpful for PH!

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