AV Node Ablation
What is the AV Node?
The AV Node is the normal electrical connection between the top heart chambers (atria) and bottom heart chambers (ventricles). In Atrial Fibrillation, this connection conducts irregularly, often causing fast and/or slow palpitations.
What is AV Node ablation?
This is a procedure that can be used to treat the symptoms of Atrial Fibrillation in combination with a pacemaker. When a pacemaker is present, no AV node is necessary, so it can be knocked out, leaving the pacemaker to control the heart rate in the ventricles. This procedure is irreversible and will make you dependent on your pacemaker. Nonetheless, it is highly effective for symptom treatment, since the heart rhythm will be regular and will no longer race because it is entirely controlled by the pacemaker.
How do I prepare for AV Node ablation?
Preparation is similar to that for an electrophysiology study (EPS); please refer to the section on EPS. You would usually be asked not to stop your Warfarin for the procedure; you should clarify this with your Electrophysiologist, especially if you are taking a different blood-thinning medication.
How is Radiofrequency Ablation performed for AV Node ablation?
This procedure is performed under local anaesthetic. A special catheter is inserted through your vein in the groin area and passed up into your heart. A small burn will be delivered to the AV node through the catheter tip, essentially destroying this part of your heart's natural electrical conduction system. During radiofrequency energy application, patients may feel a transient warm discomfort in the chest.
The ablation procedure will take around 30 minutes.
What is the success rate for ablation of the AV Node?
This procedure carries an almost 100% chance of long term success at resolving irregularity of palpitations. However, this is at the expense of rendering the patient dependent upon their pacemaker.
What are the risks of AV Node ablation?
AV Node ablation is commonly performed and is a low-risk procedure. The worldwide complication rate for ablation procedures is less than 0.5%. Although most patients who undergo ablation of the AV Node do not experience any complications, you should be aware of the following risks:
- Blood vessel problems: bleeding, bruising, damage to the vessel wall, abnormal connections and blood clots can form in the blood vessel in your groin or higher up near the heart. Usually these settle by themselves, but sometimes medications, injections or small operations are required to fix them.
- Perforation: there is a very small chance of causing a leak of blood around your heart. This usually settles without treatment but can also be dealt with by inserting a drain from the chest wall.
What happens after the AV Node ablation?
You will be required to lie flat for 2-4 hours. During this time, your nurse will check on you to see if there is bleeding or swelling at the groin site. Most people can start eating and drinking water within 4-6 hours after the procedure. Most patients stay in the hospital overnight and their heart rhythm may be monitored. Your Electrophysiologist may stop, switch or commence you on new medications after the procedure. In most instances, your Electrophysiologist will advise you to stay on blood thinners lifelong.
You should avoid strenuous physical activity and sports for 2 weeks after the procedure. Most people take approximately 1 week off work. Some patients may experience minor chest discomfort and brief palpitations several days after the procedure. This may be due to the irritation caused by the ablation and will usually settle. If this persists, please consult your Electrophysiologist. You should not drive for at least 48 hours although we usually recommend that you do not drive for a week.
Your groin site might be sore for several days. A small bruise at the groin site is normal but if it starts to bleed, you can contact your local doctor or the Electrophysiologist.