Have you ever felt like your heart is beating very fast, out of control? It's like a drum beating fast but without any rhythm. In medicine, we call this condition Atrial Fibrillation . Most of the time, this can be controlled with medication. However, if it can't be controlled with medication, today we are talking about a special treatment method that doctors use.
Simply put, what is AV Node Ablation?
Okay, the name sounds a bit complicated, but the process is very simple. Simply put, AV Node Ablation is a minimally invasive procedure that involves damaging a small area of tissue in your heart called the AV node (Atrioventricular node) with heat or extreme cold, stopping it from functioning.
Now you're probably thinking, "Oh, did you mean disabling part of the heart?" Don't worry, let's be clear about that.
Think of this AV node as a major junction in the heart's electrical system. Electrical signals are sent from the upper chambers (atria) of the heart to the lower chambers (ventricles) through this junction. In atrial fibrillation, the electrical signals coming from the upper chambers are very chaotic and fast. So, to stop these chaotic signals from going to the lower chambers, we close this junction (the AV node).
Then, to control your heart rate, you will be fitted with a permanent pacemaker either before or during this treatment. This means that the pacemaker will take over the duties of the AV node. This will help to maintain the heart rate in a proper rhythm.
Who really needs this treatment?
Atrial Fibrillation is a condition that must be treated. However, AV Node Ablation is not suitable for everyone. Your doctor may suggest this treatment if you fall into one of the following categories:
- If medications are not working: If the medications given to control atrial fibrillation are not able to control your heartbeat.
- If you can't tolerate medication: Some people find it difficult to continue using medications due to side effects.
- If other treatments have failed: If other treatments, such as pulmonary vein isolation, have failed to control the heart rate.
- If you already have a pacemaker: Sometimes this treatment can also be suggested to people who already use a pacemaker for other reasons.
AV Node Ablation treats not only Atrial Fibrillation, but also several other irregular heartbeats that occur in the upper chambers of the heart. For example:
- Atrial Flutter
- Supraventricular Arrhythmias
How the treatment works, step by step
Although this is not a major surgery, it is something that is done very carefully.
What happens before treatment?
If you don't already have a pacemaker, you will have a permanent pacemaker implanted a few weeks before this treatment, or sometimes on the day of the treatment. In addition, your doctor will perform an electrophysiology study of your heart to locate the exact location of the AV node.
When starting treatment:
1. A small cannula (IV) will be placed in a vein in your arm and you will be given medicine to put you into a light sleep (sedation).
2. Tingling on the skin surface in a place like the groin, neck, or arm.
3. Through it, very fine, long tubes (catheters) are inserted into your heart through one of your veins.
What happens during treatment?
After inserting the catheter, the medical team:
- Your vital signs and heart rhythm will continue to be monitored.
- Using X-ray technology, the catheter is guided to the AV node.
- Using the tip of a special catheter, the AV node is deactivated by heat (Radiofrequency ablation) or extreme cold (Cryoablation) .
After treatment?
When the procedure is finished, the doctor will remove the catheters and hold them in place for about 15 minutes. You will then be asked to lie down in bed for a few hours. You will usually stay in the hospital overnight and go home the next day.
Difference between AV Node Ablation and PVI
Some people opt for a treatment called Pulmonary Vein Isolation (PVI) instead of AV Node Ablation. Although both aim to control Atrial Fibrillation, there are slight differences in the methodology and results. Let's look at it this way.
| Feature | AV Node Ablation | Pulmonary Vein Isolation (PVI) |
|---|---|---|
| Main objective | Stopping the chaotic electrical signals from going to the lower part of the heart. | Formation of a barrier around the point where the chaotic electrical signals originate (pulmonary veins). |
| Pacemaker requirement | Definitely needed for a lifetime. | It's often not necessary. |
| Success rate | Very high (more than 90%). | Quite low (between 60% - 80%). |
What are the benefits and risks?
Benefits of this
- A good heart rate: It is possible to control the heart rhythm without medication (however, you may need to continue taking blood thinners).
- Good quality of life: Symptoms are reduced, life becomes more comfortable.
- Exercise can: The body's ability to work harder increases.
- Reduced hospitalizations: The number of emergency hospitalizations or visits to the Emergency Treatment Unit (ETU) is reduced.
Are there any risks?
As with any medical treatment, there are very small risks, but these occur very rarely.
- Problems with the implanted pacemaker.
- Ventricular arrhythmias (irregular heartbeats in the lower chambers of the heart).
- Decreased function of the left ventricle of the heart (this can also be corrected by inserting an additional pacemaker lead (biventricular pacing).
The most important thing is that AV Node Ablation is a permanent treatment that cannot be reversed (irreversible) . That is why a pacemaker is required for life. This is something you should think about carefully before making this decision.
When do you need to see the doctor?
After having a pacemaker, you will need to see your doctor regularly. Usually after the first month, and then once or twice a year. However, if you experience any of the following symptoms, see your doctor right away.
| Opportunity | Symptoms to look for |
|---|---|
| If you suspect an infection at the pacemaker site: | |
| Signs of infection | Fever |
| Shivering due to cold | |
| Pain, redness, or swelling where the pacemaker is located | |
| If you think your pacemaker is not working properly: | |
| Performance issues | Dizziness (vertigo) |
| Going without a watch (old age) | |
| Difficulty breathing | |
Deciding to have AV Node Ablation is not easy. Because it is irreversible and you will have to live with a pacemaker for the rest of your life. However, the success rate is very high. Therefore, discuss all your questions and fears with your doctor. The most important thing is to know everything and make the decision that is right for you.
Take-Home Message
- AV Node Ablation is a highly effective treatment for severe atrial fibrillation that has not been controlled by other treatments.
- This is a permanent, irreversible treatment, and after treatment you will need a pacemaker for life.
- This treatment has a success rate of over 90% and can significantly improve your quality of life.
- This is a big decision. So, make an informed decision by openly discussing the pros, cons, and any concerns you may have with your doctor.
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