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Drugs vs Ablation for Atrial Fibrillation (AF)
Heart Rhythm Conditions | Last Active: 1 day ago | Replies (58)Comment receiving replies
I'm 84 years old and have had a-fib for 12 years. Initially medication (diltiazem) was key to maintaining normal sinus rhythm. But after a few years I had an ablation which was effective for about 8 years. From the inception of a-fib I took the anticoagulant, Zarelto. At 81 years of age I had a GI bleed. I had to stop the anticoagulant and had a watchman placed. The difficulty that my cardiologist and I struggled with was the rapid heart rate. Between diltiazem, metoprolol and another I could maintain NSR for indeterminant lengths of time. The rapid heart rate always returned, anywhere from 5-80% of the time. Last week metoprolol was increased again which means I have to monitor my blood pressure closely. My heart rate is now between 110-130 about 60% of the time. When it drops to 85 I pray that it stays, but it never does. So on Thursday, September 3rd I am going to have a procedure, AV Node ablation. I am so worried and angry because this a-fib is so prevalent and defies a cure or solution. I think about what this ablation means. It will keep the atrium separate from the ventricles - no communication between the two chambers of the heart!!! I'm very frightened, but have been assured that it is the only way to go with a heart rate so high for most of the time.
Replies to "I'm 84 years old and have had a-fib for 12 years. Initially medication (diltiazem) was key..."
@bforester1
I have a similar history to you, although I do not have a Watchman, as I am taking Xarelto without problems (so far, anyway!). Tomorrow you will have your AV Node Ablation. I had one last year. As gloaming indicated, you will have to have a Pacemaker. You stated that you understand that communication between the atrium and ventricles is severed (I generally use the term that they "burned the bridge"). Consequently, the pacemaker is needed to keep the heart beating at a 'normal' rate. I resisted for a long time (I told my EP that he wanted me to turn off all the electricity in the house and rely on the generator!). I watched several videos about AV Node Ablation. Here is one that you might find helpful: https://www.youtube.com/watch
Now - a year after the AV Node Ablation, I am grateful that I had it. Unfortunately, my atria are back in AFIB (and my cardiologist says that they will be for the rest of my life). However, it is not an issue for me. My heart beats fine; do be aware that you probably will have to have your pacemaker "tweaked" a few times, so that it works for YOU the way it should. I wish you all the best! Please report back after your procedure.
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@bforester1 I feel for you. I'm not in your boat (maybe 'yet'), but I would say your progression is not atypical, not by any means. I know people reading don't like to see me post this, but the stark fact is that most ablations have a limited lifetime. Remember, it's a progressive disorder once you have it. Maybe slow, maybe dead slow....but it progresses. So, while an ablation might last 8-10 years, I'd say you did very nicely. That first EP did a great job of buying you time out of AF, which would be the one condition that would hasten heart structural changes like enlargement and valve deterioration.
Your elevated HR is worrisome in that it imposes an unnatural burden on your heart that 'should' relax into a typical 50-58 BPM when asleep. Most adults who are otherwise healthy and active, even if advanced in age. Nuking your AV node prevents the irritable circuit that wants your ventricles to beat quite a bit more frequently than they need to....or should need to. If your ejection fraction (LVEF, in the left ventricle) is decent, then the high rate is a problem because it should be unnecessary. You're not climbing a long flight of stairs, so an HR running above 100 BPM is a distinct problem.
I'm guessing that you have a pacemaker ahead of you if they are going to destroy your AV node. Something now has to pace your two ventricles, and the AV node won't be able to do that any more.