Failed ablation

There is such a thing as 'RVR' which is 'rapid ventricular response'. It isn't good having AF, but when the left ventricle contracts in the same frequency, this can be a slow recipe for disaster. The heart is a muscle, after all, and muscles to need to have periods of low activity/low demand. If you're sleeping, but still in AF, and also in RVR, the left side of your heart is getting no rest, and will eventually lead to heart failure due to enlargement of those vessels' walls.
An AV node destruction stops the rapid ventricular response (RVR), but it does not normally also stop any further AF. AF occurs because of a 'leaked' electrical impulse emitting from one or more places inside the left atrium that causes it so contract chaotically. An ablation is meant to place a 'dam', a circular dam, of many small lesions around the 'focus' or reentrant where this extra beat signal enters the left atrium. Those lesions become scar tissue, over which the electrical impulse cannot pass. No passage, no extra beats. AF stops. That's what ablation is meant to do. There is no ablation, no lesions, when doing an pacemaker implant.

Hi Gloaming,
I always appreciate your input. It is obvious that you are extremely knowledgeable, even though - as you say - you are not a medical professional.
You mention RVR as being serious. I have had RVR with each episode of AFib - and I currently have RVR now. Hence, it is imperative that I stop my ventricle contractions.
However (unless I misunderstood you), I respectfully disagree with your statement that "there is no ablation, no lesions, when doing a pacemaker implant." If you are referring to just implanting the pacemaker, I - of course - agree with you. However, if you are referring to the procedure to destroy the AV node, I do not agree with you.
Ablation, by definition is a procedure doctors use to destroy abnormal tissue that can be present in many conditions. such as tumors in the lung, breast, thyroid, liver, spine, etc. Obviously, ablation is also used to destroy heart tissue that's causing irregular heartbeats.
My EP described two basic types of ablations - which he called an "AFib Ablation" or an "AV Node Ablation". The first ablation is, of course, the destruction of the many small lesions to prevent AFib. He (and another EP with whom I had a second opinion) felt that my chance of success with that ablation was very low. The other ablation is often called a "Pace and Ablate". I don't need the "pace" part because I had a pacemaker implanted 4 year ago. However, I will have the "ablate" portion, where he will ablate or destroy the Atrioventricular (AV) node, preventing the electrical heartbeat signal from my atria to my ventricles. The pacemaker will then "take over". I apologize if I misunderstood you, and your saying "there is no ablation" was only referring to a pacemaker implant, not the destruction of the AV Node. Thanks again for all your input; you have been very helpful to many of us.

There is such a thing as 'RVR' which is 'rapid ventricular response'. It isn't good having AF, but when the left ventricle contracts in the same frequency, this can be a slow recipe for disaster. The heart is a muscle, after all, and muscles to need to have periods of low activity/low demand. If you're sleeping, but still in AF, and also in RVR, the left side of your heart is getting no rest, and will eventually lead to heart failure due to enlargement of those vessels' walls.
An AV node destruction stops the rapid ventricular response (RVR), but it does not normally also stop any further AF. AF occurs because of a 'leaked' electrical impulse emitting from one or more places inside the left atrium that causes it so contract chaotically. An ablation is meant to place a 'dam', a circular dam, of many small lesions around the 'focus' or reentrant where this extra beat signal enters the left atrium. Those lesions become scar tissue, over which the electrical impulse cannot pass. No passage, no extra beats. AF stops. That's what ablation is meant to do. There is no ablation, no lesions, when doing an pacemaker implant.

Well, you learn something new every day. I don’t know how with all the reading I’ve done on AFib, I had never read about RVR. Based on bpm, I have RVR. My recent heart monitor showed my AFib went as high as 150 although typically the high is in the 120s. My resting heart rate is mid-50s and sometimes high 40s when lying down.

Until now, I thought all AFib patients have high heart rates. Now I understand why some people have silent AFib. Before, I couldn’t understand how someone could be unaware seeing as I have so many symptoms. Hmmm.

Gloaming - thanks for clearing that up so quickly! So many people do believe that a pacemaker will 'cure' AFib, the same as an ablation. I am a prime example that it doesn't - since I am on my fourth episode of AFib since my pacemaker was implanted - all with RVR ! I really preferred to have PFA because I didn't like the idea of an AV Node ablation (sort of like using the generator as the only power source for the house). However, I also did not want to have multiple ablations, as many people on this site have reported. As you accurately state, "I have accepted" that an AV Node Ablation is the correct course for me. I requested a cardioversion before the ablation, however. I want to start out with my atria not in AFib to compare any differences I feel once I am back in AFib (which certainly will happen).

Zebra - like you, I was confused why so many people "live" with AFib for years without doing anything about it - while my doctors were 'pushing' me to do something! My EP mentioned that my heart rate was over 100 most of the time, but I didn't think that was such a problem. When I saw "RVR" on an ECG report, I started researching and went back through all of my ECG reports and learned that RVR was a part of each episode of Afib that I had. Then I researched RVR to see how my AFib was affecting my ventricles (not good!).

This is all such a learning experience! As you can tell from my "name", I also have CLL (a chronic leukemia). I joined MCC because of that! Then I got distracted by the Heart Rhythm Support Group - and here I am! I sincerely hope I don't have to join too many other support groups!

@bettycll
I’m one of the people living with untreated AFib for years. I’ve always felt for me the risk of treatment was greater than the risk of no treatment. Lesser of two evils. I have a long history of adverse reactions and complications. I just finally had a consult with an EP. He agrees that I have a lot of added risks with DOACs and ablation. He came highly recommended, takes on complicated cases and is willing to treat me. He said I would likely end up having 2-3 ablations overall. I don’t even want one. I do feel he’s the right EP for the job if I decide to move forward with PFA.

Like you, I came to this Mayo site for cancers and rare conditions but I’ve probably found the AFib threads and everyone’s experiences here the most enlightening. I have lung tumor ablations I need to take care of before any heart ablation. The EP agrees.

In the meantime, I need to talk to my oncology teams before I make my decision. I also have so many food triggers, I’m trying a very limited whole foods diet hoping to minimize episodes as afib frequently and duration have become a quality of life issue. I also have dysphagia from a neuro issue so eating fruits and veggies is especially challenging, nearly impossible. Lots of food allergies too. Losing my taste and smell 8 years ago after taking strong antibiotics is an added eating challenge. So far the extremely limited diet is helping but needs to help more. There are so many possible triggers other than food, I’m sure I can’t stop them all. I do appreciate all the real life stories that have been shared. If I ever have ablation I’ll share my experience. Despite all that, I’m still enjoying life in between all the medical stuff. Best of luck to all.

Well, you learn something new every day. I don’t know how with all the reading I’ve done on AFib, I had never read about RVR. Based on bpm, I have RVR. My recent heart monitor showed my AFib went as high as 150 although typically the high is in the 120s. My resting heart rate is mid-50s and sometimes high 40s when lying down.

Until now, I thought all AFib patients have high heart rates. Now I understand why some people have silent AFib. Before, I couldn’t understand how someone could be unaware seeing as I have so many symptoms. Hmmm.

Zebre,
Hello. I have known about my AFib since 2003. There are 4 kinds: you have the same kind as I do with low heart beats. I usually cannot tell when having an AFib session and that can be a higher risk per my cardiologist.
Recommend you read "The AFIB Cure" by Drs. Day and Bunch. Both are cardiologists and EPs. An excellent resource providing guidance, hope and a 5 step plan how to improve your quality of life and put AFib in remission.
All the best...

My comments are not for those who have made dietary changes. But I had severe episodes with only one half cup of coffee. Decaf has some caffeine in it and in the pasty could feel it when drinking one cup. The coffee in the US causes major afib but where I now live, the coffee is pure and with a few sips a day no problem.
My comments are also for those who go to the specialists etc etc and they never even bring up the possibility of being related to caffeine and stimulants. They jump in with their protocols of treatments which as you can read on these posts, often do not work or for only a short time.
I have watched people that had fibromialgia, spelling? and gripe and look for sympathy, and then when the frosted donuts come around, they eat a few. I strongly believe due to my own experiences and watching others that many or most of our health problems are caused by what we throw down the hatch, and many developed after years of abuse, until our bodies scream, STOP, and they run to the doc for a cure of a pill or treatment.
I know people who get SEVERE migraines, but are totally addicted to cups of coffee and sweets and they are more important to them than migraine. It is like a person banging their head with a hammer every day and wanting a cure, when the cure is to put down the hammer. There is a verse in the Bible that reads, there is no curse without a cause. I believe in seeking the cause of the problem and doing what I can to get rid of it.

You make some really good points; I agree that many of us make "excuses" for our conditions and others who seem to say "what the heck!" it isn't going to make any difference anyway so why try! (Remember all the smokers who used to say "we all have to die of something!" but then when they get COPD or lung cancer or esophageal cancer--whatever smoking is know to contribute to--they fight like heck to be "cured." It is also true that some things are just the luck of the draw, or genetic in origin or age related! A-fib in younger folks seems unpredictable; then we get over 65 and all of a sudden the docs say--'well, it is just an aging disease/condition." I looked at the suspected "causes" for A-fib and really had none of them except age! On the other hand, when I try to negotiate with my doc over decisions on what I am willing to risk, I get the same drug "recommended" dosages and choices determined by big pharma! Shouldn't we have the right as patients to decide what is "worth the risk" and what is "prescibed" based on drug companies and their profit margins? My doc says I must stay on Eliquis 5mg twice daily because that is the appropriate dosage; my brother has A-fib and he has never been on Eliquis, just takes a low dose ASA. I currently have had NSR for several weeks and take a drug for rhythm as well as rate. How much poison do I have to take before I can decide to decrease the dosage; I look at the "side effects" of these meds and they scare me to death! I am beginning to think that I will not die of A-fib issues but due to the damage all these drug combinations will do to me.