Anyone Know?

[JoKelly]

Just been told that I am fairly rapidly in and out of AF lately and I am certainly aware of this.  I have a dual chamber pacemaker and have had an AV node ablation also almost two years ago and have been fine, so was disappointed to feel all the old symptoms.  They explained at the Pacing Clinic check that if my heart goes above the setting of 80bpm then it is still possible to feel an irregular pulse as my own partly working heart has bypassed the 80, although I am told it hasn't exceeded 90 bpm up until today.  The pacemaker can only speed up the heart but not bring down a faster beat.  So I am digesting that fact, unpalatable though it is as an outlook

However, I am now feeling chest pain on exertion and suspect this is stable angina as my father had this quite severely.  Is it possible to have both these conditions?  Anyone?

[JoKelly]

Thank you for your reply.  I was under the impression that an AV node ablation following pacemaker was the final thing to try.  I do take daily dabigatran and know this is for life now.  Previous to the AV node ablation I had two failed routine ablations.  My two lower chambers are paced but the upper chambers are left to their own devices now and obviously have decided after almost two years, to dip in and out of AF.  I went to the Pacing Clinic yesterday and was told that I had had eleven AF episodes in three days, so no wonder I am feeling not too good.  They gave me the impression that there was nothing left to be done and I would just have to put up with it.

If there is anything else which will help either medical or surgical, I would be willing to try.  I cannot take Bisoprolol as I have a bad reaction to this.  

[researcher09]

Hi Jo,  Unfortunately, there are plenty of inexperienced centers out there that don't do a good job once they have to go into the left side of the heart.  AF ablation requires that and the learning curve is long (a few hundred AF cases) so if a doctor doesn't have the AF volume, he never gets good at it.  The best centers in the UK are in London, Royal Brompton and Imperial college.  I would take your doctor's word that his skill set for your case has reached his limits.  In a skilled center, your first two ablation attempts should have resulted in greater than 90% success.  This happens a lot in the USA as well.  80% of the AF ablations are done at centers doing less than 25 AF procedures per year so a lot of people end up with pacemakers that don't do anything for their AF.

[researcher09]

Hi Jo, sorry to hear of your AF problems.  AV node ablation and pacemaker implant doesn't get rid of the AF.  It is called a rate control strategy.  You would still need to be anticoagulation therapy since the underlying AF never goes away with this strategy.  Some people are asymptomatic and can tolerate rate control.  You are unlucky in that respect since you are symptomatic.  At the AF forum, we tell people that were told by their doctors who offer the pacemaker option for AF to go find a new doctor that wants "rhythm control".  Rhythm control is what is needed to get rid of AF over the long term.  You can still do that by requesting an EP study for an ablation.  Having a pacemaker doesn't preclude you from getting an ablation and most centers that do a decent volume should be able to do a reasonably good job for you.  Your chest pains could be a symptom of the AF as well.