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Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4469
Experience:  MBBS/FCPS(R)/MRCP U.K(R), Senior Registrar Cardiology
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I had two failed ablations and then, a year ago, an AV node

Resolved Question:

I had two failed ablations and then, a year ago, an AV node ablation and dual chamber pacemaker. I did have very symptomatic AFib and flutter alternating before the implantation. I had one further episode afterwards of feeling all the symptoms early on and an adjustment was made to the pacemaker and for almost a year, no symptoms at all. On pacing checks since, although this revealed there were one or two episodes of AFib, I had no symptoms of this. Last week however, I had about an hour of full symptoms, my pulse became irregular as it always used to and I felt strong palpitations and chest discomfort. I did just have a further pacing check which showed all is as it should be and I felt I was being disbelieved over the irregular beat (although my husband confirmed it at the time) as I was told I should only ever feel (or hear, as I can always hear my heartbeat in my ears) the ventricular steady paced beat. The printout showed about an hour of intermittent AFib, with undisturbed ventricular paced beat.
When the tech said the pacemaker would stop the heart from going too fast, I think this is not true and that it will only prevent a too slow heartbeat, so I haven't a lot of confidence in what I was being told. My beat had not exceeded 100bpm, so that aspect is not a problem since the ablation.
I write to ask whether this breakthrough on the pulse steady beat means that somehow the signals are finding a way through from the atria - or what can it signify? I just don't know what to expect as the AFib becomes more frequent (as it probably will). I thought the AV node ablation would prevent symptoms being as severe as they were this time. I took a Flecainide 100 mg and don't know whether this was the right thing to do? I find my GP and even some at the hospital, don't understand what an AV node ablation means in terms of outcomes. I just don't know what to expect!
Jo Kelly dob 16.06.1942 UK
Can an AV node ablation fail and need redoing?
What does it mean if my pulse becomes irregular now despite the pacemaker?
Should I take any medication during an episode (eg Flecainide)?
If my AFib became permanent, will I always feel ill if symptoms persist or is there something else which could be tried?
Submitted: 2 years ago.
Category: Cardiology
Expert:  Dr .Saeed ahmed replied 2 years ago.
Hello,
Thank you for your question.
I will try my best to assist you with your queries.
Av node ablation with dual chamber pacemaker has a problem. That is it only isolates the ventricles from effect of fibrillation which in fact continues. Dual chamber pacemaker has a problem that it tried to follow the fibrillation whenever it happens.
Now what can be done ???
Only options are to ask your doctor to use pacemaker which has mode shifting capability and Ir shifts to VVImode wwhenever atrial fib happens.
Second is that you use high dose flecainide or amiodarone.
I hope this helps. No one was willing to answer this question because it is a high tech question and low price. Do rate as positive to credit the answer. Thank you
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