In cases where heart rate and rhythm medication cannot be tolerated or fail to restore the heart to normal sinus rhythm, a number of medical procedures and interventions carried out in hospital are available for people with atrial fibrillation (AF). These include chemical and electrical cardioversion, catheter ablation, pulmonary vein isolation ablation, and more infrequently, AV node ablation and the insertion of a pacemaker.
Cardioversion
Cardioversion is a procedure which aims to restore normal heart rhythm (sinus rhythm). There are two main types: chemical and electrical.
Dr Tim Holt explains what cardioversion is and when it is used.
Dr Tim Holt explains what cardioversion is and when it is used.
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So cardioversion is a means of restoring the normal regular rhythm of the heart and it can either be done using drug therapy or it can be done by producing an electrical treatment to the heart, which is done with the patient sedated so they’re not aware of it, where the heart is treated electrically to restore the regular rhythm. And sometimes drug therapy is given to make that electrical procedure more likely to succeed. So it can be quite successful. Some people respond to it, other people don’t. Some people need several goes before it’s successful and there is always some reason, some risk of it recurring later.
In what sort of circumstances would cardioversion be used?
Well, it’s used for people who’ve got persistent atrial fibrillation. It can’t be used in somebody who’s got intermittent atrial fibrillation that’s coming and going. You know, it’s, there’s no point in giving it to somebody who is currently in the normal rhythm. So it’s usually given to people who’ve got persistent atrial fibrillation.
Chemical (or pharmacological) cardioversion
This procedure uses drugs such as adenosine and flecainide, injected intravenously (through the vein), in the hope of returning the heart to normal sinus rhythm. David X, who had intravenous flecainide, said that he preferred chemical to electrical cardioversion, after experiencing both procedures. For him, electrical cardioversion was ‘a bit traumatic’, whereas chemical cardioversion was ‘a gentle way of getting back into sinus rhythm’.
After the first attempt at chemical cardioversion failed, Eileen was reluctant to try it again. The procedure was again unsuccessful.
After the first attempt at chemical cardioversion failed, Eileen was reluctant to try it again. The procedure was again unsuccessful.
Age at interview: 63
Sex: Female
Age at diagnosis: 53
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What they call a chemical cardioversion is when they give you an intravenous drug, which slow, which does actually stop your heart, although you’re conscious for it. That, I find, is the most dreadful feeling in the world because you feel as if you can’t breathe but you can breathe. It it’s just horrible.
So you’re awake when they’re doing that?
With the chemical one, yes.
Yeah and you’re on a monitor and there’s everybody standing by, you know but even then it’s quite frightening. In fact, the last time I went in and the little casualty officer, my sister, my daughter took me in, this is just anecdotal, and we went into A and E about eleven o’clock at night and they’re very good. You walk in and you say, “I’m in AF.” Get seen by the triage and then you’re walked straight through. I think they were having a bad night because I was walked into resus and the staff nurse had a go at the other staff nurse, saying, “We’re not doing your ECGs in here blah blah blah.” So I said to my daughter, “If they feel like that, let’s go home.” You know, “Oh no.” So they wired me up in AF, picture’s changed and then they came along, they actually spoke to the cardiology team and they said, “Oh, we’re going to do this IV drug.” And I said to the chap, “Have you ever had it done?” “No.” “Well, it won’t work. I don’t want it done.” I was feeling quite stroppy. Anyway, so we did it. For some reason, my daughter was allowed to stay, probably because she was a nurse and I was grip gripping hold of her hand. She found it the most terrifying experience and it didn’t work and they did it twice. And when I said, and then they said, “Oh we’re admitting you.” So I said, “I told you it wouldn’t work. You could have bypassed all this.”
Jeni, who has supraventricular tachycardia (SVT), readily agreed to having adenosine to stop uncontrollable palpitations. She explained the process.
Jeni, who has supraventricular tachycardia (SVT), readily agreed to having adenosine to stop uncontrollable palpitations. She explained the process.
Age at interview: 41
Sex: Female
Age at diagnosis: 40
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So I had all these doctors milling around me and they were, you know, asking me questions and keeping me calm, as calm as you can be when you’re having a massive attack. And they talked through everything and they explained everything and they wouldn’t do anything, I was given the choice, “Do you want to have the adenosine or not?” My response is, “Is it going to stop my palpitations?” “It should do.” “Well, let’s try it then.” But if I hadn’t of wanted it they wouldn’t have given it to me.
By the time they’d decided to give me medicine I was I had to be given adenosine. I had been going for an hour and a half because they tried every other option. So then it was, “No, adenosine has to be administered.” Which isn’t very pleasant. I was warned that it’s not very nice. Basically, what happens is, you’re injected via a cannula. It’s basically adrenaline, which interrupts the electrical signal to your heart, so it actually stops your heart for a second, so you feel light-headed, you can feel your heart stop. And you can actually taste the medicine. It gives you a metallic taste, which they didn’t know, because nobody has ever told them [laughs]. But I talked all the way through it because that’s what I do when I’m nervous. And, luckily, it worked first time. They didn’t think it would.
Electrical cardioversion
This procedure, which is usually carried out as a day patient in hospital, uses an electric shock to activate the heart and return it to normal sinus rhythm. For some, electrical cardioversion successfully stops further AF episodes, possibly for weeks or even years, and so no further symptom control treatment is needed.
Eileen described what happens in cardioversion.
Eileen described what happens in cardioversion.
Age at interview: 63
Sex: Female
Age at diagnosis: 53
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Cardioversion is when they shock you. They sort of put two paddles on your chest and give you an electric shock. You’re out cold. I mean you’re well sedated. So it’s no problem and it’s like you see them, if somebody has got a cardiac arrest, it’s exactly what they do then because it stops the heart and it restarts it with the hope that it restarts in a normal rhythm and I think they can give you up to three shocks to make that work.
Cardioversion successfully restored Pauline’s heart rhythm.
Cardioversion successfully restored Pauline’s heart rhythm.
Age at interview: 69
Sex: Female
Age at diagnosis: 65
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They could have done it sooner but because I’d had some breakfast, they had to wait, and they came round and said, “Look, you’ll just be out for a few seconds really. It’ll be fine.” And they did say that if it didn’t work then I’d probably have to go to [city name] for something other but, “It will work. It’ll be fine. Don’t worry about that.” And so of course, they came around and put me out and then, of course, as soon as I came round I knew that everything was fine, because my heart wasn’t racing.
Yet while cardioversion can have a good success rate in restoring normal heart rhythm, it does not always work.
Dr Tim Holt explains why cardioversion is not always successful.
Dr Tim Holt explains why cardioversion is not always successful.
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It’s much more likely to succeed if the atrial fibrillation has started recently. In people who have possibly had the condition for years, when they’re diagnosed, it’s less likely to succeed but, nevertheless, it’s still an approach, a treatment, which is worth considering, particularly in people who, in whom the rate can’t easily be controlled with medication.
And can people have multiple cardioversions then?
They can. Some people have many attempts but the more attempts that fail, the more likely, it seems, that this is the wrong treatment for this person. And then there are other ways of restoring the rhythm or controlling the rate.
People we spoke to were not always convinced about the value of having a cardioversion, or were disappointed in the results. Janet, recently diagnosed with AF, was unsure whether to go ahead after finding out the procedure had only been successful in 1 of 3 friends with AF; Mary decided against it when told cardioversion would involve ‘stopping the heart and then restarting it artificially’. For others, who underwent the procedure, the results were disappointing. Dot said she had ‘got away’ with not having cardioversion after her heart reverted to normal sinus rhythm of its own accord.
Dave explained why he refused cardioversion.
Dave explained why he refused cardioversion.
Age at interview: 61
Sex: Male
Age at diagnosis: 50
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He [consultant] did offer to stick electrodes in my heart and try and knock it back into sinus rhythm. But when I asked about, you know, “What’s the chances of it staying like that?” I found out that because it was more than three months since I’d had the onset and because I was over forty five, the chances of it even reverting to normal rhythm were less than fifty per cent and then, even if it did revert, there was a very strong probability, probably about ninety per cent it was going to go back to atrial fibrillation within two years.
Nuala had over 20 unsuccessful cardioversions before reaching a decision with her cardiologist to remain in AF and regulate her heart rate rather than rhythm.
Nuala had over 20 unsuccessful cardioversions before reaching a decision with her cardiologist to remain in AF and regulate her heart rate rather than rhythm.
Age at interview: 60
Sex: Female
Age at diagnosis: 48
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It was me that was pushing for them in a way and I would have said, you know, I wanted it because I so much wanted to be in sinus rhythm and I suppose they were going along with me as well, although the last time, after three episodes both the doctor had said to me and I said I’d thought about it as well and I thought I really don’t want to keep doing this.
Did they discuss it with you much in previous times and so on?
They would have done I, you know, and talked about long term and said to me that I probably will go into AF and I suppose again I was in denial and didn’t want to hear it and I really pushed for it not to happen. And, at the same time, was thinking, if you keep doing the same thing, “If you if you keep doing what you’re doing, you’re going to keep getting what you get.” And all that was in my head but there was still this drive in me to keep in sinus rhythm.
Eileen underwent a number of cardioversions over the years, none of which worked for more than six weeks. She described the worst of these.
Eileen underwent a number of cardioversions over the years, none of which worked for more than six weeks. She described the worst of these.
Age at interview: 63
Sex: Female
Age at diagnosis: 53
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I think the worst time for me, was when the cardioversion didn’t work. And not only that, I it left me with burns on my chest, not full thickness burns but I was in agony and that was that was awful.
Coming to and thinking I’d had a stroke, because my mother had had a big stroke, although she’d died by then but she’d still had the stroke, because I couldn’t move my arms and I hurt. Oh, I did hurt all over. And it turned out they’d given me whatever the maximum number of shocks were and then I think one extra for luck, if they were allowed to. And to wake up for that and then find that it hadn’t worked and it never occurred to me that a cardioversion wouldn’t work.
Ablation
Ablation is a way of controlling AF symptoms and heart rate. Ablation procedures include catheter ablation, pulmonary vein isolation ablation, and AV node ablation and the insertion of a pacemaker.
Catheter ablation
With the exception of athletes, catheter ablation is not usually a first line treatment for people with AF. It may be offered, however, when a person experiences side effects or does not respond to medication, or when cardioversion has been unsuccessful. As Dr Tim Holt explains, although the aim of catheter ablation is to ‘control symptoms and heart rate, it is not yet clear whether these procedures will reduce the lifetime risk of having a stroke in the future’. Usually performed in hospital by an electrophysiologist, catheter ablation involves destroying (ablating) faulty electrical pathways from the heart by freezing or burning the heart tissue. As Jeni described it, ablation involves ‘getting rid of the damaged or problematic tissue in your heart that sends the electrical current the wrong way’. This is done using a long wire (catheter) threaded into the heart. Once the tissue is treated in this way it forms a scar which can no longer conduct the abnormal impulses.
Glyn, who has had two unsuccessful ablations after medication failed to control his AF, described his experience.
Glyn, who has had two unsuccessful ablations after medication failed to control his AF, described his experience.
Age at interview: 64
Sex: Male
Age at diagnosis: 56
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Back in May of two thousand and ten, sorry, two thousand and eleven I had the first of my ablations. Six hour*, horrible operation where you’re awake the whole time and it’s very, very painful because they’re putting rods in your groin up to your heart and it’s burning trying to stop the electrical signals from causing the atrial fibrillation, which in my case failed the first time. And so three months later they decided to start all over again in August and do the same. Again, another painful six hour operation and again, it failed again.
[*Note: Glyn’s experience is unusual as this procedure does not usually take this long].
Ginny, whose passion is mountaineering, explained her decision to have a catheter ablation. Although successful so far, she is unsure how long it will last.
Ginny, whose passion is mountaineering, explained her decision to have a catheter ablation. Although successful so far, she is unsure how long it will last.
Age at interview: 49
Sex: Female
Age at diagnosis: 45
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I was pretty fit and it wasn’t necessarily, hampering me. You know, people would say, “Well, why, why, why go in for an ablation?” But, you know, you are at the risk of stroke and, you know, I wanted to be free of heart problems, you know, so I could I can carry on a very, very active life. And, as I say, he did the ablation and, to all intents and purposes, you know, one month went by, two months went by, three months went by, summer went by and everything has everything, as far as they can tell, is okay now.
I mean my cardiologist said to me, the guy who did the, the specialist said to me, “Some people have one ablation and then that’s it for the rest of their life. No more AF ever.” I suppose for them, the jury is probably out on that because if I’m right, I think this is still considered to be in its infancy because it’s fifteen years research or something into it and there are a number of things they need to research as it like after the ablation on the left hand side of the heart for fibrillation, you do get headaches for two up to two weeks afterwards and they can be really quite, quite debilitating and quite, for me, they were and that that that I did not know before I went in for the ablation and that that was a bit of a surprise. But the arrhythmia nurse told me that that was the case, that the jury is out on that one. They really don’t know exactly why that happens. They think it might be alteration in blood pressure in the heart because of the hole they’ve made in your heart or it could be anything. They’re not really sure. So I I’m not worried that it’s going to necessarily come back but there is a possibility that it could come back within seven years.
Well, I am aware that ablations might not last forever and that AF can come back. I am also aware that, you know, that that, as I say, that that it possibly, that it can it can come back, anybody can get AF at any time. So I’m not I’m not going to worry about it. Once I am, you know, fairly sure, and I am more or less fairly sure now that it that it’s gone, I, you know, I, you know, I want to just get on with the rest of my life and move on and I think yeah, there is that that in the back of your mind that maybe when you get to fifty five or sixty, you could be looking at this problem again. And then you’ll just have to assess where you are, whether you’re fit enough to go through another ablation, whether you actually want to go through another ablation or whether you just want to stay on tablets, you know. Life is a lottery.
Bob, who had two unsuccessful ablations, was delighted when the third attempt proved successful.
Bob, who had two unsuccessful ablations, was delighted when the third attempt proved successful.
Age at interview: 66
Sex: Male
Age at diagnosis: 59
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I had my first ablation in 2006. Unfortunately, as is often the case with the first ablation, it didn’t do the trick. It in fact, in in some respects, it made the situation slightly worse.
We did a second ablation in, just after Easter in 2007 and that was very good. It was very positive. I came out of hospital thinking, “That’s it. I’m cured.” And for about eight or nine months, I had virtually no AF at all, a few little bumps and grinds occasionally, little bit of flutter but no debilitating atrial fibrillation. And then, towards the end of 2007 I started to get occasional times when I have a little bit of an attack and, I was still under the [general hospital]. So we talked about it and, in fact, I had a third ablation, I think it must now have been early 2009 and, since then, I’m delighted to say I’ve not had atrial fibrillation at all.
So it is quite common that it sometimes takes two or three ablations to actually get on top of it. But it’s a very effective for those people that can have it.
But we did discuss it with the medical profession. I discussed it with my GP, and my wife and I discussed it at home and, as I said, there comes a point when you think, okay, there is a risk, but as much risk feeling ill like this all the time and having had one ablation, I never thought twice about having a second or third, and if I’d have needed it, I’d have gone for a fourth as well.
Bob reported that AF symptoms can take a few months to ‘settle down’ after a catheter ablation. He now takes a small dose of flecainide and has not had AF for 18 months. He asked the surgeons not to ablate to such an extent that he might need a pacemaker, as he said that being an engineer, he did not trust technology to keep him alive. Chris X initially rejected having an ablation procedure, but when he later changed his mind, found that his specialist and nurse were happy to discuss it in detail and then allow him to decide in his own time.
James, who had a stroke due to AF, had three ablations and said he felt a little better after each one.
James, who had a stroke due to AF, had three ablations and said he felt a little better after each one.
Age at interview: 63
Sex: Male
Age at diagnosis: 59
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Well, when my… when they tried to kick-start my heart and it failed, we went to we were told to go and see this electrophysio physician, I think we were told. And so we decided, Jenny decided it was far best to go to find the best man we could, which we believe we did. But that’s not, I’m not decrying any other hospitals or anything like that, but it was him that told us that I was a suitable candidate for the ablation and it was… I mean we just I just put my faith in him and just carried on and went for it and said, “Yes.” And a few months later I called down for the operation, and I was so tired after my stroke and I was so tired until I had the first ablation. I felt much better. Second one I felt better still, and the third I really did feel quite good. I’m not saying I’m as fit as I was, but I’m a few years older now and I’m not quite as active with golf and things as I was because I’m too busy working, and I just haven’t got the energy to do both at the moment. But I intend to retire at the end of this year and then I can get back to my golf and things.
Jenny, James’ wife, recalled how she found it ‘absolutely petrifying’ when her husband had the ablations but after the third ablation proved successful acknowledged that ‘He was right that his quality of life was non-existent really. And if that is the case, you just do whatever it takes to get you back on track’. Geoff spoke of breaking a record in his hospital in having four ablations, where the final one was successful. He planned to start reducing his medication soon. He noted that the need to come off his medication prior to each procedure sent his AF ‘haywire’. David Y, who had a triple heart bypass, had an ablation conducted ‘while the surgeon had me open’. Six clots were found during the procedure, so he reported feeling very lucky that his surgeon had been able to remove these.
Gail was pleased that her second ablation appeared to be working. The procedure left her feeling traumatised.
Gail was pleased that her second ablation appeared to be working. The procedure left her feeling traumatised.
Age at interview: 62
Sex: Female
Age at diagnosis: 44
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After the second ablation, which was apparently a difficult procedure, took four hours and I was sort of semi-sedated so that was fine. But I really felt kind of battered and physically kind of traumatised afterwards. I mean it’s not physically that traumatic but I did, and I don’t know whether it was partly, I don’t know, something happens to you on kind at a deep unconscious level, but I just felt like I’d been battered [laughs] somehow.
I was very sick afterwards and the, because of the sedatives, and the, I had a bit of a bleed from the where they’d put the catheter in. Presumably when I was being sick something kind of popped and that was, you know, mildly alarming and, but the nurse was so kind of, it’s very routine for them probably people bleeding a bit afterwards, so, and that was good in one way, but in another way, it was not so good because you thought, “[aaagh] Just acknowledge that this is a little bit scary would you please?” [Laughs].
So that might have added to my sense of having been a bit traumatised after that, after that second ablation, and I feel I just don’t want to go through that again. I mean that’s why I’m so pleased that it might be getting better.
Catheter ablations are not always successful. Elisabeth X, who turned down an ablation over ten years ago when she was in her sixties and ‘didn’t think the odds of success were too good’, now believes she is ‘past the age’ to have the operation. Martin has been told that if his symptoms worsen, he can increase his dose of sotalol or consider an ablation. Aware that ‘the longer you leave it before having an ablation, the less successful it is deemed to be’, he has decided to take medication while it continues to work rather than ‘risk having an ablation’. Glyn believes that his ablations may have failed because his medical team ‘left it too late’ to decide ‘on some really serious action’. They carried out the first ablation seven years after his diagnosis, which he felt made it harder to treat. David X had a haematoma in his leg after both of his ablations, which he found ‘alarming’. He said he was reluctant to have a third ablation as he felt his heart had been ‘horribly abused’, and decided to wait and see if his AF would settle down. He continues to take medication for his AF.
Marianne decided to go ahead with an ablation, although her consultant warned her that it may not be successful and she may need to repeat the procedure.
Marianne decided to go ahead with an ablation, although her consultant warned her that it may not be successful and she may need to repeat the procedure.
Age at interview: 72
Sex: Female
Age at diagnosis: 54
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I joined the local organisation for AF and the AFA [Atrial Fibrillation Association]. They have annual meetings which include patients in London. I went to a few of those and I realised that I probably could have an ablation and where I could go to find out about it.
I said [to my GP], “I’d like to see this particular consultant at this particular hospital in London, because that is a centre of excellence for ablation and I want to find out whether he thinks I can have it done. Because I am now in AF permanently, and they don’t always think that the outcome is going to be very good.”
So I went and I saw this particular consultant who was very good and talked to me about it and he said, “I think you’d be perfectly alright. It probably won’t work first time because for about eighty per cent of people it doesn’t and you would have to have it done again, maybe even a few more times, but at the end of that, you should be free of AF, if that’s what you want.” And I said, “Yes, that’s what I want.” Because I’m not used to being ill. I don’t like it. I was due to have an ablation but then I broke my hip so it’s been postponed, I went to the hospital and saw the nurses and it was all set up for a particular day, which I couldn’t go to. I had to ring them up and say, “Sorry. Can’t come. I’m in another hospital.” So that’s it. That’s where we are at the moment, in a nutshell.
Roger has had three ablations. Despite initial success in bringing the heart back into rhythm, they have all been unsuccessful long-term.
Roger has had three ablations. Despite initial success in bringing the heart back into rhythm, they have all been unsuccessful long-term.
Age at interview: 60
Sex: Male
Age at diagnosis: 50
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So then we started the long trawl of treatments and different medications in an attempt to control the fibrillation and flutter. I’d previously had at the onset of my conditions, two cardioversions with the previous cardiologist. They both worked on the day. One lasted twenty four hours and the other one lasted about ten days. With the new cardiologist, we started a new round and he referred me to an electrophysiologist, and to look at a form of ablation procedure, which was in but it was becoming more popular. I underwent two of those in 2005 and a third one in 2006. Once again, they were all successful on the day but they didn’t last. When I say successful, they were all successful in bringing the heart back into rhythm, and everything appeared fine but it takes a while to settle down. And what happens with an ablation is they burn out some electrical pathways. What happens in the following two to three months is some of those electrical pathways can reform as the scar tissue heals, so they reconnect. So you go back out of rhythm again.
Pulmonary vein isolation ablation
Pulmonary vein isolation is another form of ablation used when medication fails to eliminate symptoms of AF caused by an irregular heartbeat, or in cases where people cannot tolerate medications. Performed under local anaesthetic with sedation, the procedure uses radiofrequency energy (heat energy) to destroy tissue around the four pulmonary veins. The resulting scar tissue, which takes from 2 to 3 months to form, blocks abnormal signals reaching the rest of the atrium (one of the two blood collection chambers of the heart). The procedure is not always successful and may need to be repeated. Eileen had the procedure carried out privately. Despite its initial success, she went back into AF six weeks later.
After many failed cardioversion procedures, Nuala went on to have a pulmonary vein isolation ablation. She was disappointed when she went back into AF a few weeks later.
After many failed cardioversion procedures, Nuala went on to have a pulmonary vein isolation ablation. She was disappointed when she went back into AF a few weeks later.
Age at interview: 60
Sex: Female
Age at diagnosis: 48
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That involved again fasting from the night before and then did all the blood pressure and ECG and everything first and then looked like an operating theatre, laid out on the table. I was given some valium to just to check my anxiety but I was awake for through the procedure and they put a needle up through the groin and up and I could see it see it on the screen as well where they went up to ablate the veins around the, isolate the pulmonary veins around the pulmonary artery and it was okay.
And they talked away, the people in the, the doctor and the nurses and the other staff that were there, the ECG technicians all talked away to me and probably that it was because I had been given valium, I felt settled. So it was about, I think it was about four, maybe four hours to six hours. Of course it didn’t seem like that length of time when it was being done and that was okay.
Just immediately after the pulmonary vein isolation, [doctor] had said to me that he felt my left atrium was badly scarred and he didn’t think it would work, which was very disappointing. However, I left with hope that it would and within a few weeks, it went back into AF again.
AV node ablation and pacemakers
In some cases medication or an ablation procedure are either not appropriate or are unsuccessful in restoring regular heart rhythms and people continue to experience AF symptoms. A third alternative is either to have a pacemaker fitted, or to have an irreversible AV node ablation and a pacemaker implant to prevent the heart rate falling too low. In this procedure the AV node is destroyed, leaving the person dependent on a pacemaker to take over their heart rhythm for the rest of their lives.
Some of the people we spoke to had had a permanent pacemaker fitted. This is a small metal box weighing 20-50g attached to one or more wires that run to your heart. The device uses electrical impulses to regulate the heartbeat. Fitting a pacemaker is a day surgery procedure and takes about an hour under local anaesthetic. It can have a positive effect in reducing the symptoms of AF and improving quality of life. After having a pacemaker implanted, people need to attend regular check-ups to make sure it is working properly.
Glyn, who had a pacemaker fitted after two failed ablations, described his recovery from the operation.
Glyn, who had a pacemaker fitted after two failed ablations, described his recovery from the operation.
Age at interview: 64
Sex: Male
Age at diagnosis: 56
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It did make me housebound for the first six weeks after the pacemaker because they told me I couldn’t lift my arm up above my head and I couldn’t stretch out because there was new leads put in and what they were concerned about, if I stretched or put my hand above my head, I would have moved the leads that was coming from my pacemaker to the heart. They put leads in you see and that would obviously, then maybe occurred of another operation, which I didn’t want to go through.
So I didn’t… I sort of very, you know, if someone had bumped into your shoulder or something like that because it was very sore and still a bit sore now actually. They said it could take another three months because they’ve cut into a lot of muscle on your chest wall and, therefore, your muscle takes a while to mend, if you like, to get back into normal.
Raymond, who had a pacemaker fitted after collapsing several times, was delighted with the result.
Raymond, who had a pacemaker fitted after collapsing several times, was delighted with the result.
Age at interview: 78
Sex: Male
Age at diagnosis: 64
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The heart had stopped for something like five seconds. It’d start up again on its own and then I found out it went as far as ten seconds, it wasn’t the only one. So I had a pacemaker fitted, end of end of subject. I’ve been totally normal since. Travelled, travelled to parts of Africa, where we went on safaris and did stupid things and we went out to Australia.
Eileen had a pacemaker fitted after her pulse rate dropped below 30 and doctors advised her that ‘atrial fibrillation will never kill you but a very slow pulse will’. Despite having to restrict her arm movement so as not to ‘dislodge the wires’ for six weeks after the operation, she described how her life had improved, ‘I can certainly walk upstairs, I can even make a bed without getting out of breath’. However, although she felt better she still experienced palpitations, and after consultation decided to have an AV-node ablation.
Eileen spoke about the psychological impact of having a pacemaker, but admitted that her quality of life had improved since having an AV-node ablation.
Eileen spoke about the psychological impact of having a pacemaker, but admitted that her quality of life had improved since having an AV-node ablation.
Age at interview: 63
Sex: Female
Age at diagnosis: 53
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The AV node ablation was very quick because I was used to the pacemaker, I’d had that in for oh, best part of a year I think, so I was quite used to the pacemaker. So it didn’t really make any difference. There was just the psychological aspect of knowing that I was now dependent on the pacemaker.
And if ever the pacemaker should stop, I haven’t got very long to get to a, well, no, they try and leave, they don’t totally take out the AV node. They try and leave a little bit, so that should anything happen and the pacemaker stops, you’ve got a heartbeat of about thirty beats a minute. You can’t do very much on thirty beats a minute but you can you can call an ambulance.
I still am aware of going into either AF or it fluttering but I can feel it in my chest but it doesn’t get through to my pulse, if you see what I mean, because the AV node ablation stops it doing that. So, although I can feel it in my chest, I don’t have to sit down and I did get breathless. I do get breathless, walking up hill I get breathless. Whether that’s the AF or something else I don’t know. But no, having had the AV node ablation, life is pretty good. To what it was, it’s brilliant because you’re not frightened and although they say, you do get, you know, you’re waiting for the next attack, whereas I’m not because even when it comes on, it doesn’t actually affect me, you know.
Although having an AV node ablation and pacemaker fitted can improve the quality of life for people with AF, they are irreversible procedures. This can have an effect on whether people decide to go ahead with the operation, and how they feel about the procedure afterwards.
Despite having had 3 unsuccessful ablations, Roger is not keen on having an AV-node ablation.
Despite having had 3 unsuccessful ablations, Roger is not keen on having an AV-node ablation.
Age at interview: 60
Sex: Male
Age at diagnosis: 50
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There is another option, which is a node ablation, where I would become a hundred per cent dependent on my pacemaker. Having researched this a little bit more, I find it’s known, or some people refer to it as the “big pill” in that it stops everything completely but it’s completely irreversible. So what it would amount to is the heart would no longer beat of its own accord. It’d be purely on a pacemaker basis. If the pacemaker did fail, which is everyone says they’re very reliable but it’s electronic, then that’s the end. But the other disadvantage I’m reading is that if there’s any further developments in the treatment of AF, I wouldn’t be able to undertake those because the node has gone, and I should say I’m feeling rather cold about that as an option now.
The sense of finality of having an AV-node ablation and pacemaker fitted was a factor in discouraging Nuala from having the procedure.
The sense of finality of having an AV-node ablation and pacemaker fitted was a factor in discouraging Nuala from having the procedure.
Age at interview: 60
Sex: Female
Age at diagnosis: 48
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I just think I’m too young for that, maybe. You know, at the same time, I think if there’s something else that’s going to be developed and I have no AV node, you can’t bring it back again. So I would prefer not to do it, and as well as that, I suppose I know somebody who has had that done and they were taken off all medications. They didn’t need it and that was very attractive to me to me, at the same time, I thought, “Ah, you’re having a machine inside me.” I know at the same time, if I need it then that’s fine. If somebody said to me, “If you don’t have this, you know, you could die.” Then I’ll have it.
Despite having no regrets about having an AV node ablation and pacemaker, Eileen wonders whether she might have ‘jumped the gun’.
Despite having no regrets about having an AV node ablation and pacemaker, Eileen wonders whether she might have ‘jumped the gun’.
Age at interview: 63
Sex: Female
Age at diagnosis: 53
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Well, there’s always a worry that in my situation that the pacemaker might pack up. It shouldn’t. It’s checked but there’s that. The AF probably not great concerns. Side effects of having a pacemaker like going into heart failure or something, you know, that is a possibility. My other thing is, science is making leaps and bounds all the time and sometimes I wonder whether I jumped the gun having the AV node ablation done and that does cross my mind, although it’s improved my standard of, you know, living so much that I probably didn’t. There’s one thing my consultant always says every time I see him is, “You don’t regret having it done.” And no, I don’t.
(For more see ‘
Heart rate and rhythm medication for atrial fibrillation’)
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