Pace and Ablate for Afib 

We are a doctor couple, my wife has been having AFib for several years now, she is on betalockers, flecarite and anti coagulants for several years. Despite treatment her episodes of AFib attacks were increasing and we were seriously considering ablation. She then seriously took up yoga ‘pranayam’ ( breathing exercises) which she believes decreases the sympathetic tone, she also worked to reduce the ‘ triggering’ points which in her case was tea, coffee, heavy meals and stress. Though she still takes regular medication, but those seem to be working now, the episodes are generally not happening and if she feels her heart rate is increasing on her apple watch she takes extra dose of Flecarite, she is also sleeping well due to breathing exercises. I thought I should share , it has worked for her and may do for others

I would just like to say thank you so much for a very informative and easily explained description of Pace and Ablate. I have actually had this done to control my troublesome aFib. I could not tolerate even a small amount of beta blockers and flecanide did not work at all. I'd had a chemical cardioversion (3x bolus administrations, increased each time) which only made my heart beat even faster. After the cardiologist explained the offered PVI ablation had about a 70% chance of success i decided to go the pace and ablate route. I have never looked back and now, nearly a year on from pacer fitting, my AV mode ablation and a few pacemaker tweaks, my quality of life is so much better and I am able to exert myself cardiovascularly as I used to. I am so grateful.

Thank you Sanjay. Now 81 and still very active, I have recently had a pacemaker implanted and due for the ablate to follow shortly. You have certainly cheered me with your very helpful summary. It will be good to be free of the pills which do give rise to side effects. You always describe matters so clearly……much appreciated.

Dr. Gupta I have been dealing with afib for 9 years and at 65 years of age it is getting worse. I am now on max dosage for betablokers. It is still very unsettling. I listen to your calm voice which helps me during my episodes. Please continue to share. Your knowledge and insights.

I am having pacemaker inserted in four days time and 2 or 3 months later ablate with Dr Affolter in Aberdeen. That was a stunning, clear and brilliantly pitched presentation. You answered all of my underlying questions. Thank you SO much.

Thank you so much for your informative videos. Earlier this year my general cardiologist recommended a Pace and Ablate procedure for me. It wasn't explained to me nearly as well as you did in your video. Luckily, the Electrophysiologist I consulted with didn't feel it was indicated at this time and instead, performed a more traditional ablation procedure, the third one I've had in seven years. I'm happy to say that so far I've remained in normal sinus rhythm. I realize that nothing lasts forever and that the possibility of a pacemaker still remains in my future. Meanwhile, I take my meds, monitor my rate and rhythm, and do my best to live a healthy lifestyle. Your videos give my great peace of mind and reassurance. Keep up the good work.

I am scheduled for a pacemaker due to a racing irregular heart beat. My cardiologist had explained the procedure but this video has put my mind more at ease.

Great content, keep sharing the wisdom! ❤️❤️❤️Short hair, long hair, it doesn't matter, you are still very handsome! 😊😊😊

I’m an RN in America and received a pacemaker and AV node ablation last week for tachycardia 135-140. Before the procedure my husband and I were surprised that the cardiac RN told us we had the best questions of any patient. I attribute this to watching your very clear and well paced RU-vid videos. Thanks so much from across the pond. ❤

Forgot to mention after I got carried away with my last comment. You videos are very helpful and imformative. Thank you Sanjay

Again thank you so much for this. Am about to have this procedure in a couple of weeks and so this video is so timely. Can't thank you enough for all you do. No words can describe how grateful I am for what you are doing. You are in my prayers every day! Sincerely Di

Thanks for a very informative explanation of how a pacemaker can help with Afib

So informative as always! We all appreciate you!!

Really good content and great communication ability.

I appreciate this video it has given me all the info I needed. You put my mind at ease

Excellent explanation of the procedure

Thanks, Dr Gupta for this informative and clear explanation of Pace and Ablate. I found your clarification of what you call the 'escape' mechanism very reassuring. I am listed for Pace and Ablate this summer in Nottingham and was worried a good deal about the "What if....." scenario. Knowing that my heart won't actually stop but continue beating, albeit very slowly is, as I say, very reassuring. You don't need me to tell you this, but you really are an excellent communicator!

Thank you for you video. I have my pacemaker in situ and I’m booked for an AV node ablation next week 🙏🏻

Awesome informational video doctor.

Thank you so much for sharing this information - you really helped put my mind at ease :) My mother needs this procedure, and I was worried about the pacemaker failing! God bless you brother

Thanks for the explanation. I had an A/V node ablation and a pacemaker inserted back in 2017. I understood some of the procedure. Was so scared at first, but was glad I had it done. Could not tolerate many of the cardiac meds. I was diagnosed with A-Fib with RVR.

You rock!! I’m having a pace and ablate this November.

I will send back my heart monitor after 14 days of wearing it to see what it reveals - been through 2 cardioversions in 50 days - 1st one last 38 days the second about week and half - had the heart attack over the 2020 Thanksgiving holiday and had 3 stents put in - so we will see what happens from here on - your videos are uplifting and informative - thanks for what you do!!

Thank you.... for talking to us. Many doctors will not do this....they won’t or can’t communicate.

Had AV node ablated and dual chamber pacemaker implanted last week. Feeling so much better and sleeping better with my heart at a slower steady beat.

Great video Sanjay. I am being scheduled for a THIRD ablation after reverting to afib after seven months in sinus following a second ablation. Rate has been @125-135 and 50mg. Of Atenolol doesn’t seem to do much. I will raise the issue of “pace and ablate” with my docs at Mt. Sinai. Thanks for your excellent videos!

Ah,you look fine. I did not even notice your hair. I had this procedure in late Sept. and it has been amazing!

Thank you for all this information! You have a very calming voice ! I am going to have an ablation in 3 weeks…

TY sir I follow you closely,and appreciate your calming affect you give me always..your hair is fine no matter what♥️🙏🏼

Another informativr vidoe.. thanks dr

Superb explanation 🙏

Are you taking new patients, honestly I would love you as my Cardiologist, you'll definitely cure my anxiety

Wow the heart is fantastic! This video totally aligned with the cross road I'm currently at, and further educates me, allowing more sound decisions in my future! Thanks Doctor!!!!!! 😊

I just had a leadless pacemaker and node ablation. Feel much better.

So well explained thank you so much 👏👏

You are such a God send! Bless you.

I’ve had AF since my 40s started at 250 bpm allergies to so many drugs, had to be resuscitated once, then had ablation then two cardioversions then another ablation didn’t control for long ended up in heart failure I’m nearly 70 now just had a pacemaker fitted due for AV node ablation in a month. Thanks for explanation made me feel less anxious.

Great video, very informative. I always wondered what might happen if the pacemaker fails after the AV node had been ablated. I've never heard about the escape rhythm. Thank you

You help me alot to understand my situation.

This was so useful and wonderfully explained. I may eventually require this procedure as my ablation and two attempts at cardioversion have been unsuccessful. I am also currently taking metoprolol which doesn’t seem to be controlling my heart rate. I am in persistent AFib.

Very helpful.

I love your informative videos! Perhaps we could have another video about PSVT/SVT? I'm tired of hearing about it from big pharma mouths.

Thank you for all the information you share. I have been dealing with a-fib since the age of 14. It has never been serious.Over the last 6-7 years I have had a few episodes that have been bad. Ending up in the emergency. Because of covid, I have not been able to see a Dr. in person. We have talked over the phone.. The medication they have me taking, do not agree with me, and I have been wondering what else might be done. This has been very insightful and has given me something to think about. Thank you for what you do. Janet.

Thank you. I'm still dealing with the after effects post covid and had my first possible Afib last weekend. I had recently bought the Kardia (not for a particular reason or concern, just as a way to monitor) and I was able to take the printout to the GP on Monday, which was handy as their ECG came up fine. Off the back of that, they emailed a cardiologist and they advised referral and a prescription of bisoprolol. Whilst waiting for that cardiologists reply I had a second arrhythmia, this time I went to A&E for a check up (Blood's, Xray, ECG all ok) but they also referred me, off the back of the Kardia's readings. Both arrhythmias happened while in bed, with the second starting and finishing pretty much to the minute of closing my eyes and until getting up to start my day proper.

Informative and helpful, thank you.

Hi, I am going for an Ablate and Pace in 2 weeks time, I think your video was very informative, I never thought that I would be pleased that someone would destroy my heart but 14 Meds a day make me feel so bad, after the Op I will only have to take my anticoagulants.

Informative and useful. Many thanks to you for sharing your knowledge with doctors like us! And as I always keep saying, there's so much to learn from you.

thanks Doc

I have had a ablation and a pacemaker for over 12 years, keeps me out of hospital better quality of life. But I have background A/F and I am always frightened and very nervous. But much improved life I can go for walks, go out for meals, but have to be careful not to over do if. Before I had my pacemaker I was in hospital over 60 times and house bound. Numerous heated blockers most of them made me I'll, but one thing that helped me was anti-histarmines

Great video and very informative but a little difficult to hear.

Thank you doc. Very informative. What about slow beating heart. How is that regarding fibrillation?

Hello Doctor!! Thank you for alqays uploading informative content!! Can you make a video pertaining to anemia and palpitations. I am just curious how long they should last after you corrected the anemia. Also... a video on skipped heart beats while under anesthesia. Can this happen and just be a fluke and the patient need to not worry about it after being advised that it was likely a side affect of the anesthesia?

thanks so much god bless u for helping people how long pacemaker last ?

Hi Doc. I had an ablation because of persistent af about 11 yrs ago which worked till 2 yrs ago when I once again went into af. I've had two electrocardioversions since, the first one put me in rythm for six weeks and it was decided I should go on amiodarone before the next one whilst waiting for another ablation. I was cardioverted again last September and everything was good until January when I had to come off the amiodarone because of side effects. In the mean time I'd been looking at taking a supplement called berberine hcl for unrelated reasons and did a google search for amiodarone and berberine contraindications. Its then I found a study on pub med for the efficacy of berberine compared to amiodarone in the treatment of af. This study concluded no statistical difference between the two which was a huge surprise to me. I started taking the Berberine hcl when I came off amiodarone in January and I'm very happy to report ive been in rock solid sinus rythm since ( I feel every wrong beat but also has been confirmed by my gp ) . I am now reconsidering the ablation as taking berberine is well documented to have very few side effects even when taking long term. Please could you look at this and let me know your thoughts as for me it has been a total game changer. Thank you.

Thank you for addressing this. I have been paced (bundle of HIS) but not abated yet. I”m doing well, with beta blockers, diltiazem and digoxin and maintaining 83 bpm. I just hate the side effects of the meds. So I guess my next step will be the a/v node ablation.

Thank you you make it so easy to understand have been on Sotalol for 20 years, now Digoxin as well plus Rivaroxaban after an arrhythmia when got pneumonia.. all good now but love your explanations as can be a bit disconcerting on occasions.. Great work.

I take Pine Bark extract every morning with plenty of water. It helps with circulation. And then I take DHEA and melatonin in the evening, which helps with palpitations.

Thank you for explaining this in layman terms.

Thank you for your video, always informative and helpful. Can you advise if there is a normal age at which Pace and Ablate would be done, as one cardiologist said it was usually done in 'older' people? Also I'd read in some information that a) mortality was increased and b) AF can become permanent - if that is the case - what then? This looks like my next option, and b) is my main concern. I've had 4 ablations, at least a dozen cardioversions.

Doctor can you please make video on bounding pulse ! I sometimes see pulses between the color bone and left side of the neck for few seconds , it gives me a lot of anxiety .

Your a doll just like you are~!!!

Hello Dr. Gupta, if you are worried about getting a haircut you can buy a Flowbee that attaches to your vacuum cleaner and cut it yourself, I have cut my own hair for years with a Flowbee. You mentioned 3 or 4% of ablation patients have to have another ablation. I have had an ablation and was told the number of repeats is much higher. I hope your number is the correct one. Thanks for all you do.

Amazing, and you don't need meds w a ventricular or bi-ventricular pacemaker?

I have just listened to this. It's excellent as I can't deal with anything graphic. Had the pacemaker a couple days ago (Bristol Heart Institute) AV Node Ablation in 6/8 weeks (hopefully) Really hoping to get quality of life back. No idea if they fitted a bi ventricular or single chamber pacemaker. Will ask. Does the NHS always insert catheter via the groin or do they also use shoulder or neck? Is the ablation a day procedure? Thanks.

Dr: just watched your excelent & enlightening video on AF. Do you have any experience on the credability & accuracy of the Apple watch Series5, which purports to offer a reasonably accurate ECG & alert you to any period of AF or Low Pulse Rate? After some intermittant instances of AF alerts on my Apple Watch, I raised this with my Doctor, who was very sceptical & had not seen any data on the Watch's accuracy. A single ECG did not show any problems, which was to be expected. In these CV19 times, seeing a Cardiologist is nigh impossible! Thanks

Can pacemakers be fitted in someone with level 2 mitral valve regurgitation, level 3 aortic regurgitation and pulmonary hypertension (rvsp of 45)?

Dr. I have developed a uneaven rhythm to my heartbeat and a heaviness to my chest. Please tell me is it that I have afib? It is scary.

Dr. Gupta. Am currently in afib and have has previous cardio ablation for SVT. My heart seems to have weakened as i had crap insurance for quite some time and was being controlled by meds....cardia and metrpolol. Wpnow i have Medicade, am 65, was always very active and want to continue with my life! I am fortunate enough to be near Tx Med center in Houston. Aalthough I will have to wait longer now due to Covid, which hospital do you suggest? Methodist?

How would you compare the outcomes, in terms of quality of life, of pace and ablate versus cox-maze?

I have taken your tip of exercise for two reasons one for my general health and a artherick knee My heart problems started whilst walking home after a very large meal My doctor ignored my problem ,& said it was caused by the blood going to my stomach to digest the food I had eaten, The next day after my attack I walked the same hill and distance over 10 times walking very fast instead of the Slow way the night before, also during the attack the pain between my shoulders was very bad The next attack I experienced was taken more seriously by a different Doctor , who sent me for tests on the treadmill, their opinion was that high blood pressure was to blame, 2 years later I got a sever attack with very severe back pain, I was in hospital 4 days, & put on medication, One year & four month later I experienced another attack ,this was put down to the stress of my youngest sun dying , p,s both attacks happened when i was in bed, the first one I was awakened by a noise I have experienced breath problems for some time before all of the attacks, and find if I become excited e,g, going to hospital see the doctor etc I get the breathing problem ,I was unaware of was unaware of what it was, the best way to explain it was , it was similar to what we used to have a choke in our car & if you left it out the car engine would start to lose power, when I got this feeling I felt that I was going to die and had to stoop to regain my composure, so I believe that if I exercise as you have pointed out it should possible increase my fitness levels etc I am 6 foot & weigh 14 stone, I have been of the option that my breathing is effected if I have eaten and don’t feel Confident to walk any distance , also getting worked up / worried also has an effect on my breathing

You missed talking about the Bradycardia induced by AFib. Would you recommend pacing if it is asymptomatic?

It's a useful information. I know a person who's heart palpitations go up so much that the body starts shaking.Please tell me is heart rate/pulse the same as palpitations? ?

Hello Dr. Sanjay can you explain us how Arteriovenous Malformation occured? is this curable or fatal?

Doc does my heart rate affect my 2d echo? I get anxiety in clinic my blood presure shoot up and my heart rate is fast. I have a sched of 2d echo test.

Hello sir,I am from the Netherlands and from mri scan was shown cerebral infarction small ones 5times without knowing en recently a big one which i had symptoms,couldn’t talk and no feeling from one side leg up to my arm.Had a mri scan and this was the result.For medication i have pradaxa twice a day 150 and sotalol also twice 80.I used to have the afib all the time for years but didn’t realize the danger.Pulse was mostly around 70 but irregular now I have the sotalol my heartpulse is 50 and it’s regular most of the time.Sh

if a patient did this proceedure, and prior to the procedure, their left atrium was enlarged, would this allow the atrium to reduce in size, hopefully to a normal size?

Ok, but how about the rate of atrium, if it will beating fast for a long of period of time will not weaken them or will not dilate them more?

Dr Sanjay - I once had a doctor in Kent who looked just like Dr Zhivago... I couldnt concentrate then either!!!

I have a left bundle branch block and have a fast rate I I feel on my left shoulder! It makes me tired but I wake up all night long. Very discouraged!

Thank you for your very helpful updates. What happens when you have multiple arrhythmias and have already had an ablation. The symptoms are reduced but some arrhythmias are still there. Can you advice?

Could you talk about Vitamin D and PVC's together with unsustained VT? I had 5k PVC's / day with episodes of unstained VT because of my lack of Vitamin D3. Ever since I started taking 2k UI Vitamin D3 per day, my symptoms went away about 90+%. It was a miracle, I really though I was done for...

I get chest flutters for the past 2 to 3 years I went to the ER got a cardiac and pulmonary scan with contrast and EKG and blood work and everything looked normal. Even when I got the chest flutters the machine couldn't pick it up they said my electrical is fine even my cardiologist said that part was ok. I do have high blood pressure it goes up and down a lot so maybe that's the problem or my hormones could be off idk. I do have anxiety as well but I haven't had any flare ups for a long time

I had an afib episode 6 months ago and they said I am a good candidate for an ablation. They never mentioned ablation and pacemaker. Is there such a thing as a stand-alone ablation without pace?

Do we have to take blood thinner with this pacemaker

Don't fancy pace and ablate. Prefer to keep my AV node and put up with the occasional afib episode. However, for bradycardia what about single pace to the ventrical? Would that have the side effect or reducing afib episodes that occur during sleep when hr drops very low?

How can I get in touch?

Fast heart beat since childhood, about 90 to 96 per minute. Scared all the time, height phobia and also driving phobia. Perspirate too much. High blood pressure about 140/96 if not taking magnesium supplement. With jogging and magnesium it will come to 130/90. But still won't be able to drive. My heart is normal and not worried about it but the only thing that has made my life hell is that I can't drive. I am 41 now. When I first knew about high blood pressure and palpitation I was a teenager. Can anything can help me with driving phobia. Please help if possible. Thanks

New pacemakers fit inside the ventricle the nhs of course have shed fills of the old ones

Oeps pressed the wrong button,my dilemma is should i have an ablation or just stick with medication.I think that would be for live.i am 49 and female.thank you

I had A-fib at 180 bpm for about 8 hours or so before I was cardioverted. What is the "long period of time" before the Cardiomyopathy begins to develop?

I've been short of breath with extreme fatigue and even pulse is visible in palm of hand!

does lorazepam 2mg helps in palpatation and sleeping sir?

My hubby has persistent AFib and just had a ablation we won't know for 3months if it worked.He is on eliquis and plavix as he had a stent also as well as sotalol and cardizem.If he has to do the pace and ablate can he get off all these medications as they give him nose bleeds and make him very fatigued?? Also if he has pace and ablate can he exercise will his heart rate increase when he jogs?? Like your explanation of this.

What about Atrial Flutter?

What are your feelings on a nuclear stress test having on next week 7/23 and I have a aorta aneurysm 5.6

My concern with pace makers is how does the body compensate for exertion since heart rate is fixed?

ve pstv 4 de past 3year now getting better wit Amodrone i ve been taking it for de past months now hp am save

Sympathetic and parasympathetic disturbances?

My pulse is consistently 94 - 98 with or without beta blockers then suddenly it's 36 but totally asymptomatic. What's going on?

can'r hear