Atrioventricular (AV) Node Ablation

You must have a pacemaker before undergoing an AV Node Ablation

What are the goals of the procedure?

The goal of an AVN (Atrioventricular Node) ablation is to help you with certain heart problems that can make the heart beat fast and out of control, such as atrial fibrillation, atrial flutter, or other types of supraventricular tachycardias. During the procedure, doctors use heat (radiofrequency energy) to ablate the AV node. The AV node is a small structure in the heart which transmits signals between the atria and the ventricles (top and bottom) like an electrical check point. When the AV node is ablated, the atria and the ventricles no longer communicate electrically. As a result, the atria (top part of your heart) remain out of rhythm, but these electrical signals cannot affect the ventricles (bottom part of your heart). Since the communication center is ablated, you will be dependent on a pacemaker and it will completely control your heart rate. However, since the atria and ventricles are no longer communicating electrically, the goal is that you will no longer feel poorly with your racing heart, and your symptoms associated with your arrhythmia will improve.

What are the risks?

An AVN (Atrioventricular Node) ablation is generally considered a safe procedure, however like any invasive procedure, there are risks associated with it. Risks include bleeding, infection, damage to the blood vessels, damage to the heart structures/valves, stroke, blood clots, and in very rare incidences death. Some of the major risks associated with an AVN ablation are described in more detail below:

  1. Bleeding: during the procedure, there is a risk of bleeding, both at the catheter insertion site and within the heart. In rare cases, significant bleeding may require blood transfusion or surgical intervention.
  2. Infection: There is a risk of infection at the catheter insertion site or within the heart. Precautions are taken to minimize this risk, but it can still occur. Infections may require antibiotics or, in rare cases, additional procedures to address the infection.
  3. Damage to blood vessels or heart structures: The catheters used in the ablation procedure are threaded through blood vessels to reach the heart. In rare instances, there is a risk of injury to the blood vessels or heart structures during the catheter insertion process.
  4. Stroke or blood clotting: Manipulating catheters within the heart can occasionally dislodge small blood clots, which may then travel to other parts of the body, potentially causing a stroke or other complications. Medications are typically given to reduce the risk of blood clot formation.

It is important to note that these risks are generally low, and most patients experience successful outcomes after AVN ablation. However, the specific risks and their likelihood can vary depending on many factors including your age and other medical comorbidities. Your provider will discuss your risks with you prior to the procedure.

Why should I have this procedure with South Denver Cardiology?

Dr. Dan Alyesh, Dr. William Choe, Dr. Sri Sundaram, and Dr. Nick Palmeri  routinely do this procedure. Our specialized electrophysiology doctors perform a large number of AV node ablations annually. Our center has consistently maintained a lower rate of complications compared to the averages reported in the literature.

What happens during the procedure?

The atrioventricular node is a small cluster of specialized cells in the heart responsible for conducting electrical signals between the atria and ventricles. During an AVN ablation, the atrioventricular node is intentionally destroyed or ablated using heat (radiofrequency energy).

Where is it done?

The procedure is done in an Electrophysiology Lab  at Porter Adventist Hospital or Swedish Medical Center.

How long does it take?

Approximately 1-2-hours

What type of anesthesia is used?

Moderate sedation

What happens right after the procedure?

Your heart rate will be programmed higher at 80-90 bpm while your heart gets used to the ablation. You will then visit the device clinic to reduce the heart rate by 10 bpm per week until you reach the target basal rate of approximately 60 bpm.

Anticipate same-day discharge or staying the night?

Depending on what time your procedure starts, you typically can go home that same night. However, if your procedure starts later in the day, or if there are concerns from your doctor, it might be recommended to stay in the hospital 1-2 nights after your procedure.

Will I need someone to drive me home?

Yes, you will need someone to drive you home. After receiving sedation driving is not recommended for at least 24 hours.

What about traveling home if from out-of-state?

We recommend staying in the local area 1-2 nights after discharge from the hospital.

 How will I feel after the procedure?

Everyone’s experience varies, however some common and expected symptoms after an ablation include soreness, fatigue, and chest discomfort.

Soreness and discomfort: You may experience some soreness, bruising, or tenderness at the catheter insertion site, typically in the groin area. This discomfort should subside gradually over a few days.
Fatigue: Feeling tired or experiencing fatigue is common. The body needs time to recover from the procedure and to adjust to the changes made in the heart’s electrical system.
Irregular heart rhythm: You may experience episodes of irregular heart rhythm or palpitations after the procedure. This is also a normal and expected part of the healing process.
Chest discomfort: Some individuals may have mild chest discomfort or tightness for a few days following the procedure. This typically improves within a few days.
Improved heart rhythm: In many cases, patients experience a significant improvement in their heart rhythm following the ablation procedure. However, it is common to have a return of irregular rhythm or a-fib during the first three months.

Remember that everyone’s experience can differ, and it’s essential to communicate any concerns or unusual symptoms to your healthcare provider. They will be able to provide            personalized guidance and support throughout your recovery.

 What is my expected recovery course?

After the procedure you will be taken to the recovery area where you will be continually monitored until you are OK for discharge. Your medical team will provide you with specific aftercare instructions. You can drive 24 hours after your procedure.  However, you may be sore and may want to wait longer to drive, especially long distances. Your medications might be adjusted before you go home. It is imperative that you continue to take your blood thinners to decrease your risk of stroke. Your activity restrictions aim to prevent groin incision bleeding. Any activities that involve a lot of movement in the groin region, or those that increase pressure in the abdomen, will put pressure on the blood vessels where the incision(s) were made. Therefore, during the first 4-7 days after the ablation, avoid heavy lifting (more than 10 lbs), straining during bowel movements, excessive bending over, stooping, walking long distances, running, or climbing many flights of stairs. You may resume normal activity 1 week after the ablation. You will follow up with both the device clinic and your medical team after an AVN ablation; specifics will be discussed with you prior to discharge.

Note on Pre-Op and Post-Op instructions:  The most up-to-date pre- and post-operative instructions will be the ones provided to you during your pre-op visit & on your hospital DC instructions given to you when checking-out of the hospital.

Helpful Resources


Preoperative Instructions

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Postoperative Instructions

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