pacemaker recommendation

[Guest guest]

Hi everybody,

After reading lots of messages for the past few weeks, I've decided to

jump in and ask advice.

I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

have been on meds ever since. I've been fortunate that meds have

controlled things pretty well and each time a med no longer worked,

another medicine (typically combination of meds) was found to take its

place. I underwent an ablation (2001) but it was not successful.

Since then, my doc put me on sotalol and metoprolol. He put me on

sotalol when he felt I had no other drug options left (anyway no other

options he wanted to prescribe). In many respects, I've done better on

sotalol/metoprolol than any other combination in the prior five years,

but the side effects have become increasingly difficult. Side effects

generally have bothered me more and more over the past ten years.

So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

opinion made the same recommendation ~five years ago). If I pursue

this option, I will be pm dependent - they would ablate my natural

pulse. But the doc thinks I'll have less need for meds and get away

from those risks and side effects.

I'm wondering if anybody else has received a similar recommendation?

If you took the recommendation, how did it work for you? Also,

thoughts about the changes in ablation technologies over the past five

years? I guess I wonder if I might try that again before a pm.

Sorry about the length of this and thanks. Brent

[Guest guest]

Brent, There are so many questions that come to mind. Are you maintained in NSR

pretty well? What are the side effects you are having? Are you having problems

related to bradycardia? How active do you like to be? It sounds the doc is

considering ablating the AV node, and then you will have a venticular pacemaker,

is that the case?

There are two basic types of pacemakers. On basic type is called a demand

pacemaker. An atrial demand pacemaker provides electrical stimulus if your SA

node fails to send its' signal whithin a specified time. Another demand

pacemaker, a ventricular pacemaker, is attached to the ventricular pathway. It

sends a signal to the venticles if no signal comes from the atria within a

specific time.

The other type fires regularly at a set rate to make the ventricles contract.

This seems to be what the docs have mentioned to you. My guess is that they are

suggesting an ablation of your AV node. Ablation of this node means that all

electrical signals from the atria would be blocked. This would mean that the

only signals for the venticles to contract would have to come from the

ventricles themselves. The ventricles have automaticity and thus are able to

generate their own signals to pump, but their inherent rate is about 40 /

minute. Since 40 is not fast enough to do the boogie, a medical venticular

pacemaker must be inserted and set to a fixed rate - say 70.

Sometimes pacemakers are helpful or essential. The drawback with a fixed rate

pacemaker such as I think your doc has mentioned, is that it can effect your

exercise tolerance, and tolerance to some stresses as well. You loose the

responsiveness of having your natrual pacemaker, the SA node. Brent, I assume

your SA node is pacing your heart currently, which is another way of saying I

assume you're in NSR most of the time.

The beauty of having your hearts SA node pace the heart, as apposed to a fixed

rate pacemaker, is the your SA node responds to your bodies needs in a more

adaptive way than a fixed rate pacemaker. When you exercise, or have a fever, or

any other stress, the sympathetic nerves stimulate your SA node to fire faster,

and your increased heartrate help to meet your bodys needs by pumping blood

faster to the body to meet its' need for increased oxygen, glucose, etc. When

you are at rest and your body has less need for O2, glucose, etc. , the

parasympatetic nerves stimulate the heart rate to slow down. With a fixed rate

pacer you lose this fine tuning of your heart rate to your metabolic need, and

consequenty this does effect you tolerance for a lot of activity.

Brent, I really don't know all of you particulars and beyond that I am not a

physician. Your decision regarding a pacemaker is a big decision. In some cases

pacemakers may be helpful or even necessary, but as I suggested above there are

some serious down sides to consider. I suggest that you get another opinion or

two or three before making a decision. I would try to seek out advice of

Electrophyiologists(EPs), because they specialize in heart rhytms, and I would

ask lots of questions about all of your options for medications and procedures

such as additional Pulmonary Vein Ablation, Mini-Maze etc. There has been a lot

of progress made in treatment of AF since you last had a second opinion five

years ago.

If you could tell more about your health, rhythms, side effects, and

activity, I'd appreciate it, and I'm sure others in this group could offer more

advice as well. Please excuse this long, poorly organized response. Please

post further,

Brent wrote>

Hi everybody,

After reading lots of messages for the past few weeks, I've decided to

jump in and ask advice.

I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

have been on meds ever since. I've been fortunate that meds have

controlled things pretty well and each time a med no longer worked,

another medicine (typically combination of meds) was found to take its

place. I underwent an ablation (2001) but it was not successful.

Since then, my doc put me on sotalol and metoprolol. He put me on

sotalol when he felt I had no other drug options left (anyway no other

options he wanted to prescribe). In many respects, I've done better on

sotalol/metoprolol than any other combination in the prior five years,

but the side effects have become increasingly difficult. Side effects

generally have bothered me more and more over the past ten years.

So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

opinion made the same recommendation ~five years ago). If I pursue

this option, I will be pm dependent - they would ablate my natural

pulse. But the doc thinks I'll have less need for meds and get away

from those risks and side effects.

I'm wondering if anybody else has received a similar recommendation?

If you took the recommendation, how did it work for you? Also,

thoughts about the changes in ablation technologies over the past five

years? I guess I wonder if I might try that again before a pm.

Sorry about the length of this and thanks. Brent

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

............ Sometimes pacemakers are helpful or essential. The

drawback with a fixed rate pacemaker such as I think your doc has

mentioned, is that it can effect your exercise tolerance, and tolerance

to some stresses as well. You loose the responsiveness of having your

natrual pacemaker, the SA node. Brent, I assume your SA node is pacing

your heart currently, which is another way of saying I assume you're in

NSR most of the time.

The beauty of having your hearts SA node pace the heart, as apposed to

a fixed rate pacemaker, is the your SA node responds to your bodies

needs in a more adaptive way than a fixed rate pacemaker. When you

exercise, or have a fever, or any other stress, the sympathetic nerves

stimulate your SA node to fire faster, and your increased heartrate help

to meet your bodys needs by pumping blood faster to the body to meet

its' need for increased oxygen, glucose, etc. When you are at rest and

your body has less need for O2, glucose, etc. , the parasympatetic

nerves stimulate the heart rate to slow down. With a fixed rate pacer

you lose this fine tuning of your heart rate to your metabolic need, and

consequenty this does effect you tolerance for a lot of

activity.................

[Guest guest]

I had a node ablation 7 weeks ago. It was not what I had gone in to have done,

it was something new the EP found and ablated it. As there was no consultation

about doing this I was not given any say on having it done. He has not found the

problem I went in to have investigated because he ran out of time doing this

ablation. I am now worried because I didn't realise that what I have had done

was riskier than other ablation. Have I got this correct?

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Thanks for the responses and thanks for a lot of great

information. ine, you are right on target with your comments.

When you said, " I may not feel any better but have to live with it, "

you encapsulated my fears in just a few words.

On the details: I am fairly active - almost daily exercise; have

always been fairly thin and have been getting thinner in recent

months. I am in NSR most of the time with a few brief episodes of AF

each day and lengthier (couple of hours) every few months. I have not

had an episode of AF which lasted 12 hours or more since going on sotalol.

Side effects are: insomnia (my doc gives me ambien to deal with this

one), lightheadedness, achiness, and feeling just " blah " or kind of

disconnected(?). I know that last one is weird, I obviously don't

know how to describe it. Finally, I fight constipation and my

appetite doesn't seem as good as it used to. On the flip side, I

really don't know how much any of these things are truly caused by my

meds - and what might be the heart meds vs. ambien.

The procedure would include ablating the AV node and make me pm

dependent. As I understood it, the pm is designed to have some

responsiveness to activity - - though obviously a poor substitute for

the real thing. My doc is an EP and the other two who examined me are

EPs as well (one in Austin and the other at Baylor Medical in Dallas).

I guess that's about it. Thanks again for your long, well

worded and very appreciated response. Brent

>

> Brent, There are so many questions that come to mind. Are you

maintained in NSR pretty well? What are the side effects you are

having? Are you having problems related to bradycardia? How active

do you like to be? It sounds the doc is considering ablating the AV

node, and then you will have a venticular pacemaker, is that the case?

>

> There are two basic types of pacemakers. On basic type is called a

demand pacemaker. An atrial demand pacemaker provides electrical

stimulus if your SA node fails to send its' signal whithin a specified

time. Another demand pacemaker, a ventricular pacemaker, is attached

to the ventricular pathway. It sends a signal to the venticles if no

signal comes from the atria within a specific time.

>

> The other type fires regularly at a set rate to make the

ventricles contract. This seems to be what the docs have mentioned to

you. My guess is that they are suggesting an ablation of your AV node.

Ablation of this node means that all electrical signals from the

atria would be blocked. This would mean that the only signals for the

venticles to contract would have to come from the ventricles

themselves. The ventricles have automaticity and thus are able to

generate their own signals to pump, but their inherent rate is about

40 / minute. Since 40 is not fast enough to do the boogie, a medical

venticular pacemaker must be inserted and set to a fixed rate - say 70.

>

> Sometimes pacemakers are helpful or essential. The drawback with a

fixed rate pacemaker such as I think your doc has mentioned, is that

it can effect your exercise tolerance, and tolerance to some stresses

as well. You loose the responsiveness of having your natrual

pacemaker, the SA node. Brent, I assume your SA node is pacing your

heart currently, which is another way of saying I assume you're in

NSR most of the time.

>

> The beauty of having your hearts SA node pace the heart, as

apposed to a fixed rate pacemaker, is the your SA node responds to

your bodies needs in a more adaptive way than a fixed rate pacemaker.

When you exercise, or have a fever, or any other stress, the

sympathetic nerves stimulate your SA node to fire faster, and your

increased heartrate help to meet your bodys needs by pumping blood

faster to the body to meet its' need for increased oxygen, glucose,

etc. When you are at rest and your body has less need for O2,

glucose, etc. , the parasympatetic nerves stimulate the heart rate to

slow down. With a fixed rate pacer you lose this fine tuning of your

heart rate to your metabolic need, and consequenty this does effect

you tolerance for a lot of activity.

>

> Brent, I really don't know all of you particulars and beyond that

I am not a physician. Your decision regarding a pacemaker is a big

decision. In some cases pacemakers may be helpful or even necessary,

but as I suggested above there are some serious down sides to

consider. I suggest that you get another opinion or two or three

before making a decision. I would try to seek out advice of

Electrophyiologists(EPs), because they specialize in heart rhytms, and

I would ask lots of questions about all of your options for

medications and procedures such as additional Pulmonary Vein Ablation,

Mini-Maze etc. There has been a lot of progress made in treatment of

AF since you last had a second opinion five years ago.

>

> If you could tell more about your health, rhythms, side effects,

and activity, I'd appreciate it, and I'm sure others in this group

could offer more advice as well. Please excuse this long, poorly

organized response. Please post further,

>

> Brent wrote>

> Hi everybody,

>

> After reading lots of messages for the past few weeks, I've decided to

> jump in and ask advice.

>

> I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

> have been on meds ever since. I've been fortunate that meds have

> controlled things pretty well and each time a med no longer worked,

> another medicine (typically combination of meds) was found to take its

> place. I underwent an ablation (2001) but it was not successful.

> Since then, my doc put me on sotalol and metoprolol. He put me on

> sotalol when he felt I had no other drug options left (anyway no other

> options he wanted to prescribe). In many respects, I've done better on

> sotalol/metoprolol than any other combination in the prior five years,

> but the side effects have become increasingly difficult. Side effects

> generally have bothered me more and more over the past ten years.

>

> So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

> opinion made the same recommendation ~five years ago). If I pursue

> this option, I will be pm dependent - they would ablate my natural

> pulse. But the doc thinks I'll have less need for meds and get away

> from those risks and side effects.

>

> I'm wondering if anybody else has received a similar recommendation?

> If you took the recommendation, how did it work for you? Also,

> thoughts about the changes in ablation technologies over the past five

> years? I guess I wonder if I might try that again before a pm.

>

> Sorry about the length of this and thanks. Brent

>

>

>

[Guest guest]

Hi

Did you have a pacemaker fitted (the ablate and pace procedure)? The

main risk is the fact that you are pacemaker dependant, and if something

should go wrong with the working of the pacemaker. Having said that

your medical team should be aware of these risks and keep a close eye on

your pacemaker performance. I have had a PM for 3.5 years and

absolutely nothing has gone wrong. All is well I am going to the clinic

next week for a check. Try not to worry, many people have the procedure

done and are absolutely fine, I am sure that the doctor was acting in

your best interest.

ine

RE: pacemaker recommendation

I had a node ablation 7 weeks ago. It was not what I had gone in to have

done, it was something new the EP found and ablated it. As there was no

consultation about doing this I was not given any say on having it done.

He has not found the problem I went in to have investigated because he

ran out of time doing this ablation. I am now worried because I didn't

realise that what I have had done was riskier than other ablation. Have

I got this correct?

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

[Guest guest]

>

> Hi everybody,

>

> After reading lots of messages for the past few weeks, I've decided

to

> jump in and ask advice.

>

> I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

> have been on meds ever since. I've been fortunate that meds have

> controlled things pretty well and each time a med no longer worked,

> another medicine (typically combination of meds) was found to take

its

> place. I underwent an ablation (2001) but it was not successful.

> Since then, my doc put me on sotalol and metoprolol. He put me on

> sotalol when he felt I had no other drug options left (anyway no

other

> options he wanted to prescribe). In many respects, I've done better

on

> sotalol/metoprolol than any other combination in the prior five

years,

> but the side effects have become increasingly difficult. Side

effects

> generally have bothered me more and more over the past ten years.

>

> So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

> opinion made the same recommendation ~five years ago). If I pursue

> this option, I will be pm dependent - they would ablate my natural

> pulse. But the doc thinks I'll have less need for meds and get away

> from those risks and side effects.

>

> I'm wondering if anybody else has received a similar

recommendation?

> If you took the recommendation, how did it work for you? Also,

> thoughts about the changes in ablation technologies over the past

five

> years? I guess I wonder if I might try that again before a pm.

>

> Sorry about the length of this and thanks. Brent

>

[Guest guest]

I tried to post this earlier, but I must of done something wrong.

Hi Brent.

You have already received some good information, but no one has

mentioned the main one you should at least check on and consider.

I am talking about the maze procedure. It is a well established

that the Maze III procedure provides about a 95% cure rate for

all types of atrial fibrillation.

I have been cured of AF since April 10, 1998 and free of AF and

medications ever since.

You are a very young person to consider the AV node ablation and

pacer, and coumadin for the rest of your life.

I will later mail you this information also. Many here do not like

to hear of the maze procedure being discussed.

This is a subject that you need to research completely and that is

all I am suggesting.

Best wishes Jack

> >

> > Brent, There are so many questions that come to mind. Are you

> maintained in NSR pretty well? What are the side effects you are

> having? Are you having problems related to bradycardia? How active

> do you like to be? It sounds the doc is considering ablating the AV

> node, and then you will have a venticular pacemaker, is that the

case?

> >

> > There are two basic types of pacemakers. On basic type is

called a

> demand pacemaker. An atrial demand pacemaker provides electrical

> stimulus if your SA node fails to send its' signal whithin a

specified

> time. Another demand pacemaker, a ventricular pacemaker, is attached

> to the ventricular pathway. It sends a signal to the venticles if no

> signal comes from the atria within a specific time.

> >

> > The other type fires regularly at a set rate to make the

> ventricles contract. This seems to be what the docs have mentioned

to

> you. My guess is that they are suggesting an ablation of your AV

node.

> Ablation of this node means that all electrical signals from the

> atria would be blocked. This would mean that the only signals for

the

> venticles to contract would have to come from the ventricles

> themselves. The ventricles have automaticity and thus are able to

> generate their own signals to pump, but their inherent rate is about

> 40 / minute. Since 40 is not fast enough to do the boogie, a

medical

> venticular pacemaker must be inserted and set to a fixed rate - say

70.

> >

> > Sometimes pacemakers are helpful or essential. The drawback

with a

> fixed rate pacemaker such as I think your doc has mentioned, is

that

> it can effect your exercise tolerance, and tolerance to some

stresses

> as well. You loose the responsiveness of having your natrual

> pacemaker, the SA node. Brent, I assume your SA node is pacing your

> heart currently, which is another way of saying I assume you're in

> NSR most of the time.

> >

> > The beauty of having your hearts SA node pace the heart, as

> apposed to a fixed rate pacemaker, is the your SA node responds to

> your bodies needs in a more adaptive way than a fixed rate

pacemaker.

> When you exercise, or have a fever, or any other stress, the

> sympathetic nerves stimulate your SA node to fire faster, and your

> increased heartrate help to meet your bodys needs by pumping blood

> faster to the body to meet its' need for increased oxygen, glucose,

> etc. When you are at rest and your body has less need for O2,

> glucose, etc. , the parasympatetic nerves stimulate the heart rate

to

> slow down. With a fixed rate pacer you lose this fine tuning of

your

> heart rate to your metabolic need, and consequenty this does effect

> you tolerance for a lot of activity.

> >

> > Brent, I really don't know all of you particulars and beyond

that

> I am not a physician. Your decision regarding a pacemaker is a big

> decision. In some cases pacemakers may be helpful or even necessary,

> but as I suggested above there are some serious down sides to

> consider. I suggest that you get another opinion or two or three

> before making a decision. I would try to seek out advice of

> Electrophyiologists(EPs), because they specialize in heart rhytms,

and

> I would ask lots of questions about all of your options for

> medications and procedures such as additional Pulmonary Vein

Ablation,

> Mini-Maze etc. There has been a lot of progress made in treatment of

> AF since you last had a second opinion five years ago.

> >

> > If you could tell more about your health, rhythms, side

effects,

> and activity, I'd appreciate it, and I'm sure others in this group

> could offer more advice as well. Please excuse this long, poorly

> organized response. Please post further,

> >

> > Brent wrote>

> > Hi everybody,

> >

> > After reading lots of messages for the past few weeks, I've

decided to

> > jump in and ask advice.

> >

> > I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

> > have been on meds ever since. I've been fortunate that meds have

> > controlled things pretty well and each time a med no longer

worked,

> > another medicine (typically combination of meds) was found to

take its

> > place. I underwent an ablation (2001) but it was not successful.

> > Since then, my doc put me on sotalol and metoprolol. He put me on

> > sotalol when he felt I had no other drug options left (anyway no

other

> > options he wanted to prescribe). In many respects, I've done

better on

> > sotalol/metoprolol than any other combination in the prior five

years,

> > but the side effects have become increasingly difficult. Side

effects

> > generally have bothered me more and more over the past ten years.

> >

> > So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

> > opinion made the same recommendation ~five years ago). If I

pursue

> > this option, I will be pm dependent - they would ablate my natural

> > pulse. But the doc thinks I'll have less need for meds and get

away

> > from those risks and side effects.

> >

> > I'm wondering if anybody else has received a similar

recommendation?

> > If you took the recommendation, how did it work for you? Also,

> > thoughts about the changes in ablation technologies over the past

five

> > years? I guess I wonder if I might try that again before a pm.

> >

> > Sorry about the length of this and thanks. Brent

> >

> >

> >

>

[Guest guest]

Thanks Jack - I'd not heard of the maze/mini-maze until reading about

it on this site. Am I understanding correctly, that it's a surgical

solution that is essentially attempting the same " disruption " of the

electrical misfires with a-fib as a radiofrequency ablation? Or is

there more to it? Brent

> > >

> > > Brent, There are so many questions that come to mind. Are you

> > maintained in NSR pretty well? What are the side effects you are

> > having? Are you having problems related to bradycardia? How active

> > do you like to be? It sounds the doc is considering ablating the AV

> > node, and then you will have a venticular pacemaker, is that the

> case?

> > >

> > > There are two basic types of pacemakers. On basic type is

> called a

> > demand pacemaker. An atrial demand pacemaker provides electrical

> > stimulus if your SA node fails to send its' signal whithin a

> specified

> > time. Another demand pacemaker, a ventricular pacemaker, is attached

> > to the ventricular pathway. It sends a signal to the venticles if no

> > signal comes from the atria within a specific time.

> > >

> > > The other type fires regularly at a set rate to make the

> > ventricles contract. This seems to be what the docs have mentioned

> to

> > you. My guess is that they are suggesting an ablation of your AV

> node.

> > Ablation of this node means that all electrical signals from the

> > atria would be blocked. This would mean that the only signals for

> the

> > venticles to contract would have to come from the ventricles

> > themselves. The ventricles have automaticity and thus are able to

> > generate their own signals to pump, but their inherent rate is about

> > 40 / minute. Since 40 is not fast enough to do the boogie, a

> medical

> > venticular pacemaker must be inserted and set to a fixed rate - say

> 70.

> > >

> > > Sometimes pacemakers are helpful or essential. The drawback

> with a

> > fixed rate pacemaker such as I think your doc has mentioned, is

> that

> > it can effect your exercise tolerance, and tolerance to some

> stresses

> > as well. You loose the responsiveness of having your natrual

> > pacemaker, the SA node. Brent, I assume your SA node is pacing your

> > heart currently, which is another way of saying I assume you're in

> > NSR most of the time.

> > >

> > > The beauty of having your hearts SA node pace the heart, as

> > apposed to a fixed rate pacemaker, is the your SA node responds to

> > your bodies needs in a more adaptive way than a fixed rate

> pacemaker.

> > When you exercise, or have a fever, or any other stress, the

> > sympathetic nerves stimulate your SA node to fire faster, and your

> > increased heartrate help to meet your bodys needs by pumping blood

> > faster to the body to meet its' need for increased oxygen, glucose,

> > etc. When you are at rest and your body has less need for O2,

> > glucose, etc. , the parasympatetic nerves stimulate the heart rate

> to

> > slow down. With a fixed rate pacer you lose this fine tuning of

> your

> > heart rate to your metabolic need, and consequenty this does effect

> > you tolerance for a lot of activity.

> > >

> > > Brent, I really don't know all of you particulars and beyond

> that

> > I am not a physician. Your decision regarding a pacemaker is a big

> > decision. In some cases pacemakers may be helpful or even necessary,

> > but as I suggested above there are some serious down sides to

> > consider. I suggest that you get another opinion or two or three

> > before making a decision. I would try to seek out advice of

> > Electrophyiologists(EPs), because they specialize in heart rhytms,

> and

> > I would ask lots of questions about all of your options for

> > medications and procedures such as additional Pulmonary Vein

> Ablation,

> > Mini-Maze etc. There has been a lot of progress made in treatment of

> > AF since you last had a second opinion five years ago.

> > >

> > > If you could tell more about your health, rhythms, side

> effects,

> > and activity, I'd appreciate it, and I'm sure others in this group

> > could offer more advice as well. Please excuse this long, poorly

> > organized response. Please post further,

> > >

> > > Brent wrote>

> > > Hi everybody,

> > >

> > > After reading lots of messages for the past few weeks, I've

> decided to

> > > jump in and ask advice.

> > >

> > > I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

> > > have been on meds ever since. I've been fortunate that meds have

> > > controlled things pretty well and each time a med no longer

> worked,

> > > another medicine (typically combination of meds) was found to

> take its

> > > place. I underwent an ablation (2001) but it was not successful.

> > > Since then, my doc put me on sotalol and metoprolol. He put me on

> > > sotalol when he felt I had no other drug options left (anyway no

> other

> > > options he wanted to prescribe). In many respects, I've done

> better on

> > > sotalol/metoprolol than any other combination in the prior five

> years,

> > > but the side effects have become increasingly difficult. Side

> effects

> > > generally have bothered me more and more over the past ten years.

> > >

> > > So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

> > > opinion made the same recommendation ~five years ago). If I

> pursue

> > > this option, I will be pm dependent - they would ablate my natural

> > > pulse. But the doc thinks I'll have less need for meds and get

> away

> > > from those risks and side effects.

> > >

> > > I'm wondering if anybody else has received a similar

> recommendation?

> > > If you took the recommendation, how did it work for you? Also,

> > > thoughts about the changes in ablation technologies over the past

> five

> > > years? I guess I wonder if I might try that again before a pm.

> > >

> > > Sorry about the length of this and thanks. Brent

> > >

> > >

> > >

> >

>

[Guest guest]

Hi ine

I didn't have a pacemaker, only the ablation. As it was of the node does this

mean I may need one?

ine pj.gilmartin@...> wrote:

Hi

Did you have a pacemaker fitted (the ablate and pace procedure)? The

main risk is the fact that you are pacemaker dependant, and if something

should go wrong with the working of the pacemaker. Having said that

your medical team should be aware of these risks and keep a close eye on

your pacemaker performance. I have had a PM for 3.5 years and

absolutely nothing has gone wrong. All is well I am going to the clinic

next week for a check. Try not to worry, many people have the procedure

done and are absolutely fine, I am sure that the doctor was acting in

your best interest.

ine

RE: pacemaker recommendation

I had a node ablation 7 weeks ago. It was not what I had gone in to have

done, it was something new the EP found and ablated it. As there was no

consultation about doing this I was not given any say on having it done.

He has not found the problem I went in to have investigated because he

ran out of time doing this ablation. I am now worried because I didn't

realise that what I have had done was riskier than other ablation. Have

I got this correct?

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

[Guest guest]

Hi Jack,

You mention that the Maze III procedure has a 95% cure rate for most

types of AF. I have been diagnosed with AF and Atrial Flutter. I am wondering

whether it would be effective for this. Regards Pat

[Guest guest]

, I don't know all of the particulars both all the medical standards when

it comes to cardiac ablation procedures and also of all of the particulars in

regards to your health, cadiac status, and the specific procedure which you

underwent, so it not possible for me to speak with certainty about your

situation. In addition I am not a physician, rather a masters trained Registered

Nurse. It is probable that the best of care was given, so please keep that in

mind as you read my comments

An AV node ablation can be helpful and maybe essential if one has permanent

AF associated with a rapid heart rate which can't be brought under control with

medications or other procedures. An AV ablation could be justified also if one

has a tachycardia driven by abberant conduction involving the AV node, which

can't be contolled by meds or other possibly curative procedures or surgery. I

can't logically imagine other reason for an AV ablation, but there may be

reasons of which I am unaware.

I am surprised that a doc would do a procedure without discussing all of the

risks and benifits of the procedure and receiving a written informed consent by

you. I imagine that a doc who does a procedure without obtaining infomed consent

could be held liable for damages and maybe even held criminally liable, but that

is a legal judgment would need to be made by a lawyer.

I would like to hear more about your situation. If you are feeling

better that is a big plus. Please let us know more, and I'm sure there are

others in this group who will have something to contribute on this.

airhairlair_uk@...> wrote:

I had a node ablation 7 weeks ago. It was not what I had gone in to have done,

it was something new the EP found and ablated it. As there was no consultation

about doing this I was not given any say on having it done. He has not found the

problem I went in to have investigated because he ran out of time doing this

ablation. I am now worried because I didn't realise that what I have had done

was riskier than other ablation. Have I got this correct?

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

ine, I agree with all of you comments. Thanks for the good word.

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

, it just struck me that if you did not get a ventricular medical pacemaker

put in, then they must not have ablated your AV node entirely. If your AV node

were ablated, no messages could travel from the atria to the venricles, and you

would have to have a pacemaker put in. Please alleviate my confusion and let me

know more. Thanks,

PS. Best wishes

airhairlair_uk@...> wrote:

I had a node ablation 7 weeks ago. It was not what I had gone in to have done,

it was something new the EP found and ablated it. As there was no consultation

about doing this I was not given any say on having it done. He has not found the

problem I went in to have investigated because he ran out of time doing this

ablation. I am now worried because I didn't realise that what I have had done

was riskier than other ablation. Have I got this correct?

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

If you needed one they would have had to put it in straight away, it

sound like that your pathway to the Ventricles is fine. Has your

ablation worked and are you out of afib.

ine

RE: pacemaker recommendation

I had a node ablation 7 weeks ago. It was not what I had gone in to have

done, it was something new the EP found and ablated it. As there was no

consultation about doing this I was not given any say on having it done.

He has not found the problem I went in to have investigated because he

ran out of time doing this ablation. I am now worried because I didn't

realise that what I have had done was riskier than other ablation. Have

I got this correct?

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

[Guest guest]

I was told that he had ablated the node but that if he had ablated any

more of it I would have needed a pacemaker. If he had bothered to discuss that

it might be an AV with me beforehand I would not have had it done. Afterwards he

told me it had not been that serious but he had done it to give me a better

quality of life, although I had asked him to only do an ablation if it was

really needed. At the follow up appointment he then told me he couldn't

guarantee that it had worked! After reading the posts on AV ablation I am now

worried that having this sort of ablation could cause problems, such as then

needing a pacemaker. In the meantime the problem I had in the first place has

not been treated. My better quality of life consists of being in pain from my

groin 7 weeks after, getting some odd feelings coming from my chest and worrying

about what he has done. Add to this the way the procedure was done, without any

discussion, sedation or support and I am feeling

totally

traumatised! He spoke of having another procedure done but at the moment I

can't face having it done again.

Van Deusen ceasargracie@...> wrote:

, it just struck me that if you did not get a ventricular medical

pacemaker put in, then they must not have ablated your AV node entirely. If your

AV node were ablated, no messages could travel from the atria to the venricles,

and you would have to have a pacemaker put in. Please alleviate my confusion and

let me know more. Thanks,

PS. Best wishes

airhairlair_uk@...> wrote:

I had a node ablation 7 weeks ago. It was not what I had gone in to have done,

it was something new the EP found and ablated it. As there was no consultation

about doing this I was not given any say on having it done. He has not found the

problem I went in to have investigated because he ran out of time doing this

ablation. I am now worried because I didn't realise that what I have had done

was riskier than other ablation. Have I got this correct?

ine pj.gilmartin@...> wrote:

Hi

WOW thanks for the very informative info on pacemakers and I am sure

that Brent will find it useful. I personally would decline any offer of

an AV node ablation because of the implications of being pacemaker

dependant and the risks should there be a problem with the PM. As you

know I have a PM and I think that doctors may consider this an easy

option as they would consider the job half done already.

Not having that natural pacing from the SA node could affect your

general well being. When faced with a stressful situation you need that

rush of adrenaline, what the psychologist call the flight or fight

theory, giving your body the physical energy to cope with the situation

(eg. when exercising).

What also concerns me about the AV node ablation is that it is final and

once done you have to live with the consequences. I would worry that I

may not feel any better and I would then have to live with it.

As I say this is my personally opinion and I would avoid having one

unless the afib became completely intolerable and it was the last

possible option.

ine

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

, I am wondering if they ablated your entire AV node. If they did, then

they would have had to put in a pacemaker or your heart rate would have been

about 40/min or lower.

ine pj.gilmartin@...> wrote:

If you needed one they would have had to put it in straight away, it

sound like that your pathway to the Ventricles is fine. Has your

ablation worked and are you out of afib.

ine

RE: pacemaker recommendation

Hi ine

I didn't have a pacemaker, only the ablation. As it was of the node

does this mean I may need one?

Nothing in this message should be considered as medical advice, or

should be acted upon without consultation with one's physician.

[Guest guest]

Brent, the maze procedure was developed by Dr. , while he

was in St. Louis in the mid 1980's. He refined it from the

maze, to the Maze II, the Maze III, and now some call it the

Maze IV. The Full Maze has always had a very high cure rate

for AF, with the patient being off all medication and free of AF.

Some times it is as soon as the surgery is done, but it can take time

for the lesions they make in the heart to heal before it stops the

errant impulses. I was cured as soon as I came out of the O.R. and

have never looked back. It was 8 years April 10 since I had the

maze.

The maze now consist of at least 3 different approaches to the full

maze procedure.

One is the full maze pattern, through open heart, where they open the

sternum as in open heart by pass surgery.

Another is the full maze pattern, through the chest, but they don't

open the sternum all the way. Without splitting the sternum it

helps with a faster recovery rate.

Another is the full maze pattern, through a opening between the

ribs. I don't think to many surgeons are doing this type now.

There are several variations of what they call the Mini Maze. They

provide a similar lesion pattern as some of the PVI ablations. they

are done by working on the outside of the heart where the ablations

are done using catheters from the inside of the heart.

Several people have been cured by the mini maze and the ablations

both, but the success rate is not as good as the full maze

procedure.

Dr. Dale Geiss that did my maze in 98 is now doing a lesser invasive

maze using robotic assisted surgery and he still does the full maze

pattern, but he does not remove the LAA with this procedure. This

Robotic Assisted Surgery is done using about 5 small openings in the

chest, but it still requires being on the by-pass pump.

I have a lot of this information posted on my web site. The

address is

http://health.groups.yahoo.com/group/A-fibcures/

I have a list of many of the maze surgeons, and hospitals and also

some information on the different ablation procedures.

You can also write me. You need to educate yourself about all the

different options you have, and learn all you can about each one of

them.

Except in special cases, the AV node ablation and pacer procedure is

considered the last choice when all else fails.

Best wishes

Jack

>

> Thanks Jack - I'd not heard of the maze/mini-maze until reading

about

> it on this site. Am I understanding correctly, that it's a surgical

> solution that is essentially attempting the same " disruption " of the

> electrical misfires with a-fib as a radiofrequency ablation? Or is

> there more to it? Brent

>

[Guest guest]

Jack - who doesn't like to hear the MAZE being discussed here? I've never

hear anyone discourage discussion on this and all procedures that may one day

alleviate afib in all of us?

Stef

snip " Many here do not like to hear of the maze procedure being discussed " .

[Guest guest]

Brent - I would definitely get thee to a great heart hospital, and get a second

opinion about another ablation... I'd do that LONG before letting anyone ablate

my AV node and make me pace maker dependent for life. You might also consider

one of the maze procedures which are discussed here from time to time.

There are many people who've had more than one ablation and found success..

sometimes it takes 2 or 3. I was told before mine, that I may very well need a

" touch up " and I would certainly exhaust all other options before I'd agree to

an ablate and pace.. that's so permanent and doesn't really solve the problem.

Stef

jackdrum jackdrum1@...> wrote:

>

> Hi everybody,

>

> After reading lots of messages for the past few weeks, I've decided

to

> jump in and ask advice.

>

> I was first diagnosed with A-fib/tachycardia in 1984 at age 24 and

> have been on meds ever since. I've been fortunate that meds have

> controlled things pretty well and each time a med no longer worked,

> another medicine (typically combination of meds) was found to take

its

> place. I underwent an ablation (2001) but it was not successful.

> Since then, my doc put me on sotalol and metoprolol. He put me on

> sotalol when he felt I had no other drug options left (anyway no

other

> options he wanted to prescribe). In many respects, I've done better

on

> sotalol/metoprolol than any other combination in the prior five

years,

> but the side effects have become increasingly difficult. Side

effects

> generally have bothered me more and more over the past ten years.

>

> So, my doc says the remaining option is a pacemaker (a 2nd and 3rd

> opinion made the same recommendation ~five years ago). If I pursue

> this option, I will be pm dependent - they would ablate my natural

> pulse. But the doc thinks I'll have less need for meds and get away

> from those risks and side effects.

>

> I'm wondering if anybody else has received a similar

recommendation?

> If you took the recommendation, how did it work for you? Also,

> thoughts about the changes in ablation technologies over the past

five

> years? I guess I wonder if I might try that again before a pm.

>

> Sorry about the length of this and thanks. Brent

>

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.