Atrial Fibrilation ablation surgery or Pacemaker

Thanks, Annette - it sounds like they are proposing an AV Node Ablation for you. My doctor referred to it as a "simple ablation". I will look forward to hearing about your experience. Good luck!

I understand completely, Betty. That's why we at afibbers.org, a free forum site for anyone needing help managing their AF or just dealing with it emotionally, routinely insist that people gather some courage, and their other necessary resources (including $$$), and find the very best EP their money and energy can buy. Those experts are very busy, in high demand, have been practicing for at least ten years (you DO want experience because that teaches in a way you can't in the classroom), and are doing between 6-12 ablations every week. However, asking the EP, when face-to-face, what his/her success rate for index ablations is will help to put you at ease. If they say 90%, don't believe them! Not even the vaunted Dr. Andrea Natale or Dr. Pasquale Santangeli would claim such a level of success. My own EP, the Canadian Cardiac Association's Student of the Year for 1991 was the EP who did my two ablations, and he calmly told me his success rate was about 75% for a first crack at anyone's heart.
I would try to encourage you to be more optimistic than you seem to be, and to educate yourself about what is involved in an ablation. It's straightforward, day surgery (you're home that night just as you would be for a colonoscopy), and if it doesn't work, like it didn't for me, get right back into line and hope for the best. Worked for me. Some take three, four stabs at it before some bright bulb figures out where to make the lesions and block the electrical impulses that are causing the chaos.

Hi Annette - thanks so much for your message. They are also proposing an ablation for me that will burn the node in the middle of the 4 chambers (the AV Node). However, according to my EP, this will still go up a vein through the groin to the heart. He refers to it as "simple". I don't have any paperwork, so I would very much appreciate hearing what your paperwork says. He feels that I have too many complicating factors to have a successful regular AFib ablation; the success rate expected for me is less than 60% , while the AV node ablation should have a 100% success rate. I expect that my pacemaker will keep my heart beating. I am concerned that I will always have AFib, even though he says that I will not have any symptoms.

If anyone has had an AV Node Ablation, I would love to hear from you. Are you in constant AFib? Is that harming your heart? Do you have any AFib symptoms?

I converted before with a cardioversion. However, my doctor says that I can't shock my heart every few months!

Looking forward to hearing from you, Annette! Cheers, Betty

Thanks, Gloaming - I did go to afibbers.org. I do believe that I have an experienced excellent EP; he has a great reputation. He believes with my other issues that I would not have a success rate better than 60%. This was confirmed by another EP with whom I had a second opinion. So, he is recommending an AV Node Ablation. I have to decide if I want to take the risk of an ablation that does not have a good success rate or have the ablation that some doctors refer to as a "last resort". I appreciate your input. Thanks, Betty

Betty, an AV node ablation does NOT offer a 100% chance of eliminating AF. It may in some cases, and it looks like it is highly likely in yours ( I don't know all your particulars, but your advising EP would). But I know at least one person for whom the AV node 'nuking' didn't work. What it does do is to reduce to essentially 'zero' the chances of getting RVR (rapid ventricular response, which is somewhat more dangerous than SVT and AF are) since the AV node passes on the SA node's original impulses down the Bundle of His and then on two the two bundle branches, left and right, and into the Purkinje Fibers (you may have heard of 'left bundle branch block', another heart rhythm defect). RVR encourages the left ventricle to begin to thicken in response to the extra work when it is cycling rapidly in consonance with a rapidly cycling atrium above it.
The way it works is this: the SA node sends out a 'beat signal', which travels outward, down to the AV node, but also through the septum and out into the inner endothelial lining of the left atrium, which causes the atrium to beat first (filling the left ventricle below it via the mitral valve). The same signal, moving away from the SA node, passes to the AV node which can actually re-signal the atrium to beat again, so that's one potential cause for AF. But normally the signal continues down the Bundle of His and ends up splitting and causing each ventricle to contact a fraction of a second after the atrium (the signal takes longer that way, so that beat comes later). If AF is formally diagnosed, and if the sustained rate is higher than 100 BPM, it is deemed to be 'AF with RVR', or atrial fibrillation with rapid ventricular response. This can lead to a tired heart muscle in time, and that is why instructions to ablation patients, or just plain AF patients waiting for treatment, to get to an ER if their rate is at 100 or higher for more than 24 hours.
I expect that you understand that an AV node ablation means a pacemaker as this is needed to do what the AV node does, and that is to pass on the beat instruction signal to both ventricles.

I had a complete heart block and had an emergency pacemaker One at midnight, one at 3am then a permanent one next day works great set at 70

Annette,
I just completed the Node ablation at Mayo last week(Dr Dai).
My program is to reduce bpm in three stages: 80-70-60 or a three month period.
This of course is controlled by my pacemaker.
The major issues I have been dealing with( serious shortness of breath, balance, fatigue ), have not been mitigated or improved.

Hi Gloaming - thanks for your detailed response. I have RVR with any incidence of AFib; just sitting here, my heart rate is over 100. Hence my doctor's decision to ablate. I also have moderate mitral valve and tricuspid valve regurgitation - contributing to a poor success rate for an AFib ablation.

Of course I understand that an AV Node Ablation requires a pacemaker. I had a pacemaker implanted 4 years ago when amiodarone put me into bradycardia, so I am a candidate for AV Node Ablation for several reasons.

Thanks again - you are very helpful.

Thanks for your response. Since I have had a pacemaker for 4 years, I have not discussed staging the bpm, I will ask about that.

My major issue is shortness of breath. I am sorry to hear that your symptoms have not been mitigated or improved. Hopefully, that will come in time - since you are only a week out from the surgery.

Hi Dixie May
I have had Node ablation and a Pacemaker. I am 4 weeks post surgery. My shortness of breath is still occuring and night sweats. I'm still fatigued but I have started walking my dog around the block every day when weather allows we have winter in Western Australia. My BP is still high.