I have had a mechanical mitral valve for eight years and my atrial fibrillation has now progressed to “persistent”. My cardiologist mentioned a possible AV Node Ablation if my current medication stops working. I would be interested to hear from anyone who has had this type of ablation after receiving a mechanical valve.
AV Node Ablation
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pellicle
Professional Dingbat, Guru and Merkintologist
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I have a mechanical mitral valve (at age 50) and had AFIB a few years prior to that. When my AFIB developed, it never 'turned off' until I had an ablation.
Ablations are generally done through the veins so there is no comparison (surgically) to open heart work.
AV node ablation essentially destroys the heart's pacemaker (the AV node) so a permanent pacemaker is then a requirement.
The first ablation that I had would be called a pulmonary vein isolation. It was explained to me that during early embryonic development, when the heart cells split/fold to form our multi-chambered heart, cells in the vicinity of what becomes the AV node end up in the vicinity of the pulmonary veins. Hence the finding that a portion of AFIB can be resolved by isolating the pulmonary veins.
I would expect an electrophysiologist to be very involved in these discussions. Most ablations are scarring the heart tissue to block faulty flow of the heart electrical signals. (vs AV node ablation which is to stop the hearts electrical signal generator). These signals can be pretty difficult to discern and subtleties may not be evident via standard EKG. A few years after my mitral valve was replaced, I again developed the symptoms of AFIB. It felt just like AFIB to me. My kardiamobile indicated AFIB. Holter monitor indicated AFIB. Standard EKG indicated AFIB. However, when I was in the EP lab for another ablation, as soon as they hooked me up to their 25 lead EKG, they said "flutter". I had several flutter loops including one that had developed around a scar from the mitral valve insertion. So this ablation was actually to resolve some Atrial Flutter(s).
My experience may have little in common with your situation, but I hope it gives you a few more questions to ask or areas to investigate.
Ablations are generally done through the veins so there is no comparison (surgically) to open heart work.
AV node ablation essentially destroys the heart's pacemaker (the AV node) so a permanent pacemaker is then a requirement.
The first ablation that I had would be called a pulmonary vein isolation. It was explained to me that during early embryonic development, when the heart cells split/fold to form our multi-chambered heart, cells in the vicinity of what becomes the AV node end up in the vicinity of the pulmonary veins. Hence the finding that a portion of AFIB can be resolved by isolating the pulmonary veins.
I would expect an electrophysiologist to be very involved in these discussions. Most ablations are scarring the heart tissue to block faulty flow of the heart electrical signals. (vs AV node ablation which is to stop the hearts electrical signal generator). These signals can be pretty difficult to discern and subtleties may not be evident via standard EKG. A few years after my mitral valve was replaced, I again developed the symptoms of AFIB. It felt just like AFIB to me. My kardiamobile indicated AFIB. Holter monitor indicated AFIB. Standard EKG indicated AFIB. However, when I was in the EP lab for another ablation, as soon as they hooked me up to their 25 lead EKG, they said "flutter". I had several flutter loops including one that had developed around a scar from the mitral valve insertion. So this ablation was actually to resolve some Atrial Flutter(s).
My experience may have little in common with your situation, but I hope it gives you a few more questions to ask or areas to investigate.
Thank you for responding with this interesting information. I hadn’t realized you could have a regular ablation after having a mechanical valve inserted. I now understand an AV node ablation is different. As long as my current medication continues to keep me in sinus rhythm I only see my cardiologist but I guess I would be referred to an electrophysiologist if I have to go the ablation route.
Did the ablation stop the AFib or flutter
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Yes. In my case, cardioversions nor medications had any impact. My recollection is about a dozen shocks and 4 or 5 drugs over about a 4 month period when I first had afib. Nothing had any impact. Once it turned on, it was on . . . . until the ablation. When the flutters showed up a decade later, we did not try any cardioverting nor medications but went straight to the ablation . . . which worked immediately.
Thank you, I had a maze 18 years ago and did good then I started again with a fib a year or so ago. We did a cardio conversion and it did good for about a year then it came back and we started rythomal and it worked then I had a paravavular repair and it came back. So now I’m kinda trying to figure my next move. Where did you have an ablation at?
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My first ablation for AFIB was done at the University of Michigan by Dr. Morady ~15 years ago. Something you are likely aware of, is that is very common for AFIB to return. Ablations often/usually? are not getting to the root cause of the arrythmia .. . i.e. what is causing the abherent signal?. Ablation procedures (for AFIB) usually induce scarring which in turn blocks transmission pathways for the abherent signal. That is also what the maze procedure does.
Yes, I’m actually in the ER right now. Said it maybe atrial flutter and not afib. Running labs and waiting on a echo. Just want to get this straight. Thanks for replying.
AFIBs come from dilation of the heart. Once the chambers bulk up and stretch even if they reverse remodel, new electric pathways have been created.
One solution is to slow the heart down. Beta blockers are pretty good at this but you have to take them for life and they work.
The other side is to treat the arrhythmia itself. Cardioversion if the AFib lingers. These days, so long as my INR is right, I will wait 2/3 days before I call the doctor. If it resolves he will hear about it in our 6 month check up.
Also try to find out triggers. Stress is a big one, coffee, for me if I chug a cold drink or frozen slushy it's on. So no cold water or beer for me.
One solution is to slow the heart down. Beta blockers are pretty good at this but you have to take them for life and they work.
The other side is to treat the arrhythmia itself. Cardioversion if the AFib lingers. These days, so long as my INR is right, I will wait 2/3 days before I call the doctor. If it resolves he will hear about it in our 6 month check up.
Also try to find out triggers. Stress is a big one, coffee, for me if I chug a cold drink or frozen slushy it's on. So no cold water or beer for me.
Going to do a ablation today maybe this will fix my problem.
I wish you the best in your procedure today.
(vs AV node ablation which is to stop the hearts electrical signal generator). The primary pacemaker of of the heart which generate electrical impulses is SA node (sino atrial node), the AV node is a secondary pacemaker (generator) which takes the job when the SA node is damaged or stop working, In addition, the AV node act as a bridge or a station on which the electrical impulse generated by SA node pass across and are conducted to the ventricle, thus when AV node is ablated, the electrical impulses can no more be conducted to the ventricles, so there will be a need for an artificial pacemaker
How did you ablation go?
