This page is courtesy of Florida Electrophysiology Associates; The leader in the Southeast United States in complex catheter ablation procedures
AV nodal ablations are used to control someone's heart rate who has incessant atrial fibrillation. In some patients atrial fibrillation results in very rapid pulses. Patients such as this tend to become out of breath easily, are easily fatigued and are on a number of medications to keep their heart rate under control. Many complain of feeling their heart flopping around in their chest.
In these patients, the electrical connection between the abnormal fibrillating upper chambers and the lower pumping chambers can be interrupted by an ablation called an AV nodal ablation. Once an AV nodal ablation has been performed, any abnormal impulses originating in the upper chambers are no longer transmitted to the lower chambers. Since the electrical connection to the lower pumping chambers of the heart has been interrupted, in order to keep the patients heart beating at the correct rate this procedure must be combined with a pacemaker insertion.
Catheter position for a typical AV nodal ablation
All patients who undergo AV nodal ablation require pacemaker insertion. Once a patient has had an AV nodal ablation and pacemaker insertion all rhythm control medications for atrial fibrillation can be discontinued. Patients still need to take coumadin as atrial fibrillation continues but patients can no longer feel atrial fibrillation. Patients who have had this procedure always have stable regular pulses afterwards. Generally patients energy levels and exercise tolerance improves after an AV nodal ablation.
Patients who undergo AV nodal ablation become pacemaker dependent for life. If atrial fibrillation can be cured with catheter ablation or treated medically, then this is generally preferred to AV nodal ablation and pacing. Still for certain types of patients, AV nodal ablation and pacing is the best approach. These patients generally have a marked improvement in lifestyle and daily symptoms once their pulse is brought under control.