JulieLynn
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JulieLynn, January 31,  2019  11:37pm EST
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Help with knowledge on A V node. Ablation

I am a 56 year old female ,with chronic A fib from having mitral stenosis for having reumatic fever as a child . Started bothering me in  88 “” in 89 “ had a valvular plasty done did good for 30 years . Then started having a fib had another valvulaplasty in 2011 didn’t help have had a cardio version twice  kept going out of rhythm been on numerous meds to try to control had a ablation,then finally had a mechanical mitral valve placed in 2012  still going into a fib finally found med that controlled the a fib   but had rate going to low so had pace maker put in  2017  .been on  this med now for 6 years taking  highest dose allowed now going back into a fib but with chest pains , light headed ,dizzy, anxious, scared ,and head ache ,sometime wakes me up from a sound sleep chest pain heart racing  these symptoms are new . Dr now says only thing left to do is a A V Node Ablation would like to hear the pros and cons of this procedure from any one who is living with this type of ablation. Please and Thanks .

8 Replies
  • Thumper2
    Thumper2, February 1,  2019  10:34am EST

    JulieLynn, I'm sorry to hear of your heart problems.  I can suggest two things:  (1) see if you can get a second opinion on your problems -- have you been seeing an electrophysiologist who specializes in AFib?  (2)  I have had a special procedure which involved an AV Node Ablation, and it made all the difference in the world!  It is called AVNA (Atrial Valve Nodal Ablation) + PDHBP (Permanent Direct His Bundle Pacing).  A special lead was screwed into my His Bundle and attached to my pacemaker, which then causes both ventricles to beat properly without the need of signals from the atria.  I went from all-day napping and no energy to an essentially normal lifestyle.  My procedure was done at the Guthrie Clinic in Sayre, PA, by Dr. Pramod Deshmukh, who specializes in this area.  You would have to see a specialist to know if this procedure would work for you, given your valve problems.  But is has been wonderful for me, over the past 3 years!   Keep us posted!

    Thumper2 (Judy)

  • MellanieSAF
    MellanieSAF, February 1,  2019  11:40am EST

    Is there a reason you can't have surgery for your afib? Of course, I'm not sure why they didn't do a maze procedure for your afib during any of the times they went in to fix your valves.

    Mellanie

  • JulieLynn
    JulieLynn, February 1,  2019  6:00pm EST

    Melanie, did have surgery for the a fib a ablation , what is a maze produce. ?

  • Larkspur
    Larkspur, February 2,  2019  2:09pm EST

    Hi JulieLynn,

    Is there a reason you can't have surgery for your afib? Of course, I'm not sure why they didn't do a maze procedure for your afib during any of the times they went in to fix your valves.

    Mellanie

    I am also interested in Mellanie's question as I will soon be having surgery to repair/replace my mitral valve and will discuss a maze procedure with the surgeio as well as asking him to clip the left atrial appendage. I am failing on flecainide and was preparing for an ablation when the valve problem was discovered. I am wondering if adding a maze procedure to the valve surgery has added risk? I'm sure it would add to the time on the table but I'd be very interested to hear more about Mellanie's experience than the information in the link she provided. 

    Thanks, Mellanie and best wishes JulieLynn.

     

  • MellanieSAF
    MellanieSAF, February 2,  2019  2:22pm EST

    Larkspur,

    I had mini maze, not classic maze, so I can't provide much insight. I have heard from surgeons that adding maze and AtriClip to valve repair or bypass adds about 30 minutes.

    Unfortunately, only about 25%-30% of those with afib who are having valve repair or bypass ever get a "concomitant maze" for their afib. You have to ask specifically to be referred to another surgeon if your's doesn't do it. 

    Mellanie

  • Larkspur
    Larkspur, February 2,  2019  4:43pm EST

    Thanks so much Mellanie,

    I had mini maze, not classic maze, so I can't provide much insight. I have heard from surgeons that adding maze and AtriClip to valve repair or bypass adds about 30 minutes.

    That is very helpful information. I will be seeing Dr. Alfredo Trento at Cedars-Sinai in Los Angeles and his surgical scheduler did tell me that he has experience doing a maze procedure and the AtriClip. He seems to specialize in a minimally invasive approach (often using robotics) but I won't know what is suitable in my particular case until I have the consult with him.

    Have you ever had any contact with Dr. Trento or do you know him by reputation? He seems to have very good reviews. This came up suddently so I hope that I am moving in the right direction.

    Thanks for any guidance,

  • MellanieSAF
    MellanieSAF, February 2,  2019  4:52pm EST

    I do not know Dr. Trento, but do know Dr. Ali Khoynezhad at Cedars, who is very highly regarded. 

    Oops, just looked him up and it appears that Dr. Khoynezhad has moved to MemorialCare Long Beach Medical Center.

    Mellanie

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