Ablation of the AV Node and Implanting of a Pacemaker

Normal heart - SA and AV Node with four chambers

Location of the AV Node

Ablation or Modification of the Atrioventricular (AV) Node and Implanting a Pacemaker

From a patient’s point of view, this is a procedure of last resort. Each heartbeat normally starts in the right atrium where a specialized group of cells called the sinus node generates an electrical signal that travels down a single electrical road (the Atrioventricular [AV] Node) that connects the atria to the ventricles below. By ablating or eliminating this AV Node, your Atrial Fibrillation signals can’t get to the ventricles which does stop your heart from racing.

But for your heart to beat at all or at the proper rate, you must have a permanent pacemaker implanted in your heart for the rest of your life.

An AV Node ablation is irreversible. What’s worse, you still have A-Fib and have to forever take anticoagulants to prevent stroke. Also, patients with Paroxysmal (occasional) A-Fib often develop permanent A-Fib after an AV Node Ablation.

In addition, when you eliminate the AV Node, there is a risk of sudden death because of the ventricles beating too fast. Another factor to be aware of is A-Fib over time may decrease mental abilities and lead to dementia.

Biventricular pacing is generally preferred over uni-ventricular pacing which potentially can worsen or even cause heart failure by one ventricle beating out of sync with the other.

If you have a bad Sinus Node and would need a pacemaker anyway, this procedure might work for you.

But an AV Node Ablation and Pacemaker does work. Patients report an improved quality of life (being able to golf 18 holes) than when A-Fib made their heart race and they were in symptomatic A-Fib.

Last updated: Sunday, February 8, 2015

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