Ablation/Pace-maker question

Maybe a stupid question, but.... When undergoing a standard RF/cryo ablation, is it a possibility that you will wake up with a pace-maker? Or is this something that they would know before the ablation, if there is a chance or not? Just wondering.

Absolutely not.

Those are separate procedures and would require informed consent beforehand.

Thanks wolfpack. I appreciate it.

Not sure where the question comes from. There is an old, very out of favor procedure, for afib where they ablate the AV node and install a pacemaker. Your atria will still fibrulate, so this does not solve the stroke risk. However the signal from the atria to the ventricles will be blocked and the signal for the ventricles to beat will be provided by the pacemaker. If the pacemaker fails, this signal will stop... If someone offers this to you, IMO head for the doors as fast as you can.



Edited 1 time(s). Last edit at 02/06/2020 01:52PM by GeorgeN.

A significant number of patients with bradycardia or sick-sinus or its variants also have afib. So the heart can beat too slowly when in NSR and too quickly in AF. So even after PVI ablation there might still be a need for a pacemaker to set a floor on NSR rate. There might also be issues with variability that need to be addressed. I would assume this would be discussed and signed off on before the procedure, but I am not as confident as others to say it couldn't happen. You would have to read the details of the permission that you sign, and make sure they coincide with your understanding and desires.

It was just a curiosity. Thanks for your info. You’re always very helpful.

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safib
A significant number of patients with bradycardia or sick-sinus or its variants also have afib. So the heart can beat too slowly when in NSR and too quickly in AF. So even after PVI ablation there might still be a need for a pacemaker to set a floor on NSR rate. There might also be issues with variability that need to be addressed. I would assume this would be discussed and signed off on before the procedure, but I am not as confident as others to say it couldn't happen. You would have to read the details of the permission that you sign, and make sure they coincide with your understanding and desires.

I always hand write additionally instructions to consent forms I sign.

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susan.d
I always hand write additionally instructions to consent forms I sign.

Unless the doctor counter-signs those changes I doubt they would have any legal weight.

But this really just isn't a concern. The only way you might wake up with an unexpected pacemaker would be if something happened during the procedure that made it a lifesaving requirement. That's something I've never heard of happening and it's hard to imagine how it even could happen.

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Carey

I always hand write additionally instructions to consent forms I sign.

Unless the doctor counter-signs those changes I doubt they would have any legal weight.

But this really just isn't a concern. The only way you might wake up with an unexpected pacemaker would be if something happened during the procedure that made it a lifesaving requirement. That's something I've never heard of happening and it's hard to imagine how it even could happen.

Natale knew I didn’t want my AV node ablated because of my autoimmune issue of not tolerating anything foreign even surgical stitches, tapes , ekg stick-on electrodes to anything foreign touching my skin like the blood pressure cup the icu had on me for 3 days. My arm was oozing with blisters from that. My skin bleeds (blisters) with electrodes, internal stitches from surgeries make their way and fester to my incision skin surface (experienced Sloan Kettering surgeon used glue instead of stitches that didn’t react).

My GP though of a great idea. Implant under my arm or thigh the guts of a pacemaker and see how I react. I know all my titanium screws and clips I had to get removed.

Natale though of a way after my ablation to get to the area near my AV node without risk-go behind somehow, if I ever need a touch up. He is the difference from an EP with little experience. He has so many ablation experience to think of plan B.

I think the overwhelming majority of people here agree that Dr Natalie is awesome! I haven’t heard anything negative yet! That’s great.

In addition to his remarkable skills, he is a kind humble man.

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cirenepurzalot
I think the overwhelming majority of people here agree that Dr Natalie is awesome! I haven’t heard anything negative yet! That’s great.

Yes, he is.

And his name is spelled Natale, not Natalie. It's pronounced na-TAH-lay, not like Natalie, nat-a-LEE.

Sorry, don't mean to pick on you. I see this misspelling all the time and just used your post as an opportunity to correct.

Darn iPhone has a mind of its own with spell check. I know how to spell his name. My phone Is Jack.

Yep. Autocorrect. Lol

So is there any need to clarify that you do not want AV node or pacemaker procedure done.

I didn't need to say anything. I fully trusted that Natale would only do exactly what needed to be done. I'm so happy I went to him, especially because I ended up having some non-PV triggers.