In some patients with atrial fibrillation, or an irregular heartbeat, medications are not effective in controlling the heart rate or rhythm. Patients who have a rapid heart rate during atrial fibrillation are often troubled by uncomfortable palpitations, shortness of breath during exertion, dizziness or exercise intolerance. In rare cases, rapid heart rates from atrial fibrillation can also eventually weaken the heart muscle.
For patients whose atrial fibrillation is not well controlled with medications, our first line of treatment is catheter ablation, a minimally invasive technique intended to control atrial fibrillation without major surgery.
For patients in whom catheter ablation and medications are not effective, AV (atrioventricular) node ablation can be considered for eliminating the rapid and irregular heartbeat that may accompany atrial fibrillation. The AV node is a nerve that conducts electrical impulses from the top chambers to the bottom chambers of the heart, controlling heart rate.
Patients who undergo an AV node ablation are also implanted with a pacemaker to help maintain a normal heart rate.
AV Node Ablation Procedure
During the procedure, a catheter is inserted into a vein in the area of the groin and guided up to the AV node. Radiofrequency energy is passed through the catheter to destroy the node. This eliminates the rapid and irregular heartbeats caused by atrial fibrillation.
Because the pulse rate typically drops to a very slow rate as a result of the procedure, a pacemaker is implanted to increase the heart rate at rest and during exertion or exercise, simulating a normal heart rhythm.
The pacemaker is an electronic device made up of a pulse generator and leads (wires). The device is implanted in the upper chest, under the skin. It is connected to one or two leads that are inserted through a vein into the heart, delivering painless electric pulses that stimulate the heart to beat faster when necessary.
The AV node ablation procedure (including implantation of a pacemaker) takes about three hours to perform and the patient typically spends two nights in the hospital before going home.
Advantages of AV Node Ablation
AV node ablation with pacemaker implantation has a very high success rate and low risk of serious complications while being effective in alleviating symptoms caused by a rapid and/or irregular heart rate. The procedure also eliminates the need for medications aimed at preventing atrial fibrillation and controlling heart rate.
Because AV node ablation does not cure atrial fibrillation, the patient is dependent on a pacemaker for the rest of his or her life and will have to continue taking a blood thinner to prevent strokes.
Complications of AV Node Ablation
There is a 1 or 2 percent risk of a complication during the pacemaker implantation procedure, including:
- Puncture of a lung
- Displacement of one of the pacemaker wires, which requires another procedure to reposition the wire in the heart
Make an Appointment
The Arrhythmia Program at the University of Michigan has been a national and international leader in the treatment of arrhythmias for more than 30 years and focuses exclusively on these patients. Working in tandem with our research department, we are on the cutting edge of new procedures and therapies with many of our physicians among those who help set national standards of care for these patients. To schedule an appointment to discuss AV node ablation, a heart arrhthmia, or any other cardiovascular condition or treatment, call us at 888-287-1082 or visit our Make a Cardiovascular Appointment page, where you may fill out a Patient Appointment Request Form and view other details about making an appointment.