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gingersnap1932

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  1. I see that you had an AV ablation and pacemaker recently....sounds like you did well.  I am scheduled Jan25 for the same only they are using the Medtronic Micra Pacemaker, installing in the ventrical with no leads.  Very new approved by FDA 2016 after a ten  year study.  I was not aware of the AV ablation procedure when we met with the EP but was startled to learn that this is permanent deal, if the pacemaker fails--that is it, you are done, kaput.

    This has me very concerned, do you have any positive info to offer.  Negative is ok, of course, if I need to really consider it.

    I am calling my EP office tomorrow to discuss this with them.  I am 86, have had AF and AFL since 2011, controlled with Sotalol and Xarelto until this past November when it seems to be pretty consistent.  I have Kardia program so that help identify issues.

    1. AgentX86

      AgentX86

      Hi Ginger,

      Not sure I'm doing this right - didn't know there was a "profile message" until I saw the email saying it was there.

      Yes, I had an AV ablation last February.  I've done well, generally, but a few months ago I started having bigeminy PVCs that felt awful. My EP up'd my pacer to 80bpm, which isn't good either but we'll see where this goes.  Overall, I wouldn't go back for a second.  It was a good choice for me but more information would have been good at the time.

      Yes and AV ablation is a one-way street but it's usually not as bad as you imagine.  Most have an "escape rhythm" that would take over if the pacer completely stopped (highly unlikely).  The problem is that the escape rhythm is usually quite slow and may not be enough to remain conscious but is usually enough to survive.  They test this periodically, during pacemaker "interrogations".  Mine doesn't kick in when they run my pacemaker down to 30bpm, the lowest they're allowed to test, so they don't know if I have one or not.  A little disconcerting but not the end of the world, either.  As I understand it, most will have an escape rhythm around 40bm.

      The "pacemaker dependent" issue did make me think hard before going with it.  My EP had been sorta pushing me that way for about a year but I wanted to make sure there were no other alternatives, first.  When I started having pauses (8-seconds recorded), which my EP says was caused by sotalol, a pacemaker became an immediate necessity so it wasn't a large leap from there to the AV ablation too.  It did "fix" my flutter.  I put "fix" in scare quotes because it isn't.  I'm still in flutter 100% of the time but it doesn't matter (much).  If I understand your situation, you'll have no atrial function (AV dyssynchrony) - I don't either.  The Micra can't sense the atrial beat so can't time the ventricles to coincide with the atrial pulse.

      I'm a little concerned about your EP recommending the Micra with an AV ablation.  As I mentioned in one of my postings, the Micra precludes CRT pacing which, according to my EP and cardiologist, will prevent pacemaker induced cardiomyopathy.  My pacemaker is biventricular so both ventricles beat together, normally, rather than a small delay between the left and right that can cause cardiomyopathy.  I would ask your EP about this.  I would also make sure you understand the dyssynchrony issue above.  I sorta missed this when I had mine done.  It wouldn't have changed anything and it does make sense but I don't like surprises.

      Good luck with your surgery and if you want to talk further, please don't hesitate to reach out again, before or after.

       

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