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Hylda2 profile image
38 Replies

please could you settle a dispute. Two years ago my husband had a total heart block and was hastily fitted with a pacemaker. Since then we have discovered he has Atrial Fibrillation 1.9%of the time and so takes Edoxaban.

Nurse at surgery yesterday sat for ages clutching his pulse before finally telling him he wasn’t in AF then. Question is, can she actually tell from his pulse or is she just feeling his pm pounding away.

Di

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Hylda2
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38 Replies
Desanthony profile image
Desanthony

Yes you can tell from taking a pulse whether or not you are in AF at that time as you can feel the longer pauses between beats or quicker beats whatever. My Cardio nurse says it is the best way. When in paroxysmal AF my friend quite often went to A&E in an awful state with very high heart rate - sometimes up to200 and over but by the time her hubby had driven her there she was not in AF but just feeling like a wet rag after a particularly bad event. Having said that she was cardioverted several times in A&E as the attack had not passed by the time she got there. Its the nature of paroxysmal AF that it can be hard to catch on examination ECG, EKG and such things.

Hylda2 profile image
Hylda2 in reply toDesanthony

Yes, but did she have a pacemaker?

Desanthony profile image
Desanthony in reply toHylda2

Yes she did but with a high heart rate it wouldn't kick in as I understand it?

JOY2THEWORLD49 profile image
JOY2THEWORLD49 in reply toDesanthony

Hi

So the hospital gives the patient a heart monitor for x amount of time. I had 3 in one year when I had one before change then after every change in meds.

Cheri Joy 74. (NZ)

I know zippo about PM’s but out of curiosity, a friend who has one did try using my Kardia and it produced a spectacular graph. BobD will probably know more and I look forward to seeing your replies…..

Hylda2 profile image
Hylda2 in reply to

So do I John because I don’t see how you can!

CDreamer profile image
CDreamer in reply toHylda2

If you take a kardia trace then you will get a lot of interference from the pacemaker if it is operating but even so mine will pick up AF - I just have to ignore the interference. Does depend upon the pacemaker but if less than 5 years old, should work but kardia do not advertise it and the conditions do state that kardia does not work with pacemaker - but I can show you a graph I did tonight that picked up AF - not that I needed confirmation!

Micorazon profile image
Micorazon in reply to

Well, all I can say is that I had my PM installed three months ago, and I too have a KARDIA , when I didn't have a PM, my Kardia results were AWFUL, ABNORMAL and BRADYCARDIA, but now since my PM, the results are always: NORMAL and the graph looks beautiful!, before, the graph of the EKG, looked like "severe earthquake graph!" :-)

in reply toMicorazon

Mine is one of the original single lead ones. I think the later ones are a bit more sophisticated 😉

Micorazon profile image
Micorazon in reply to

Yes indeed! it has six leads. :-)

wilsond profile image
wilsond

My mum had a pacemaker because of heart failure after a HA. She continued to have AF, as far as I understand it it ( and it makes no sense to me I admit) the PM just stops you sensing the irregularities.

Perhaps someone knows more it's always made me curious, especially now I am in remission from AF myself after ablation.

Hylda2 profile image
Hylda2 in reply towilsond

Thank you for your reply, just interested if AF can be felt via the pulse if you have a pm.

Di

BobD profile image
BobDVolunteer

That wouid depend on PM settings of course. Mine is default at 60bpm so if my HR is higher than that it is not working so should I be in AF (I'm not) with a rate of 90 then that would be obvious. Since my rate is generally around 75-85 the PM only kicks in if the block hits so anybody taking my pulse would know I am not in AF.

Just to confuse people I always offer my right arm first and watch the total shock and confusion spread over their faces. I have no pulse in my right wrist since an angiogram caused arterial stenosis in 2017. I usually add to it by asking if they had ever met a ghost before. lol 😁

in reply toBobD

I always thought you had an evil streak 😂

wilsond profile image
wilsond in reply toBobD

Naughty, Santa's listening 🎶

Desanthony profile image
Desanthony in reply toBobD

Bob! absolutely brilliant!

Peacefulneedshelp profile image
Peacefulneedshelp in reply toBobD

When my boys were very young and we were at the pediatricians office we had an unusually long wait in one of the examining rooms. We practiced over and over the reflex muscle in the knee. So when the dr finally came in and he would tap the left knee my son flexed the right leg and the opposite as well. The dr was totally thrown and the look on his face was priceless, we all laughed out loud. We still laugh about that after all these years.

Camelia23 profile image
Camelia23 in reply toBobD

You're wicked 😅

Hylda2 profile image
Hylda2

Pm just been checked, set at 60 but nurse sat holding his pulse for minutes before stating he had no af at the time. I maintain the pulse she is getting is from his pm so how could she tell!!

Buffafly profile image
Buffafly

Unless he had an AV node ablation his pacemaker is only stopping his HR falling below 60 or whatever the pacemaker is set at. So if his rate was 60 my guess is it was the pacemaker, if above and steady, NSR.

Hylda2 profile image
Hylda2 in reply toBuffafly

He has total heart block. Completely dependent on pacemaker

Buffafly profile image
Buffafly in reply toHylda2

In that case he can’t have AF affecting his ventricles, the same as if he had AV node ablation. His atria might be in AF but it wouldn’t affect his pulse.

Palpman profile image
Palpman in reply toBuffafly

Spot on.

cassie46 profile image
cassie46

Maybe I am being a a bit thick here but my basic understanding of pacemakers is:- Basic pacemaker only kicks in when H/R goes below 60. My Dad had one, did not have AF but low H/R, often caused problems so fitted with one. Then there is the two/three lead one (resynchronising sorry about spelling) CDreamer has this see some of her posts. Finally pace and ablate where AV node ablated and pacemaker is in total control of your H/R. Hylda - is your husband's pacemaker a standard pacemaker, what was his pulse reading when nurse took it - if over 60 pacemaker would be doing nothing.

Cassie

PS - I am looking at the 2nd option at the moment and finding not an easy one to get, as I was told pace and ablate or stay on meds is all that is left for me.

lindat15 profile image
lindat15 in reply tocassie46

Can appreciate how hard a decision that must be Cassie. I’m heading towards similar decision ( amiodarone or av node ablation , although at 64 consultant feels I’m too young for pm atm ) unless I can persuade them to do 3rd ablation. Really hate the whole AF thing .

CDreamer profile image
CDreamer

That’s a very interesting question - depends on many things - competence of the nurse to take an accurate pulse, the settings and the algorithm and the type of the pacemaker and the nature of the AF.

It is possible to be and feel AF and to have what feels like a regular pulse, I know as it’s happened to me. Sometimes my iWatch or my Kardia picks up the AF, sometimes not as the purpose of my PM is to synchronise ventricles.

I have a RST Pacemaker - my clinic tells me exactly when I’ve been in AF and not known it as Pacemaker records the AF episodes so the best way to know is ring your pacing clinic and ask if you can have a report at your next review. If you give them a specific date and time they could check - whether or not they would is another matter. They usually will tell only your ‘AF Burden’ is but if you can charm the physiologist you can often get more information.

Jonathan_C profile image
Jonathan_C

How do you know you are in afib 1.9% of the time?

I wouldn't trust a medical practitioner that told me that.

Hylda2 profile image
Hylda2 in reply toJonathan_C

He had read my husband’s pm report and is a top consultant so I would hope we could take his word at that price’

opal11uk profile image
opal11uk

Yes, A/F is felt in the pulse beat of the heart. Depending on your Pacemaker......... mine ensures that my heart rate does not fall BELOW 60 however it does not stop me going into A/F, I take drugs to help stop it. At my yearly pacing checks the technician can tell when and how often I have been in A/F

Suesouth profile image
Suesouth

I’ve had my pacemaker almost 12 months, it will only kick in if pulse goes below 50; not if it goes high, you can still get AF, my doc could tell last week from my pulse I was in nsr

CDreamer profile image
CDreamer in reply toSuesouth

That sounds as though your PM is only set to pace when your rate drops below 50 - I would imagine for occasional Bradycardia? Hylda’s husband is completely pacemaker dependant so will always have a regular pulse but still be in AF so you would not be able to diagnose AF from pulse but maybe able so feel the AF - I certainly can - but most of the time I would have a regular pulse.

Only an ECG can determine AF - according to NICE.

Suesouth profile image
Suesouth in reply toCDreamer

I have Af which I always feel, atrial flutter, heart block and a CA last year!

helenium75 profile image
helenium75

I have a pacemaker for a total heart block. It takes over the function of the AV node and is set so that my heart rate keeps between 60 and 130. I have had one episode of AF since it was fitted 18 months ago which was certainly felt by me, at my pulse, and recorded on my pacemaker. My apple watch recorded it when I pressed the ECG function too.

Gulmarrad profile image
Gulmarrad

Did they do a ECG.

Nick1957 profile image
Nick1957

Yes that's is certainly the best way to feel that your pulse is out of rhythm when mine was taken by doctors/ consultant etc. You can feel missed irratic beats.

Jimmy37 profile image
Jimmy37

If the pacemaker is doing it job there shouldn’t be a pounding. Has he had an node ablation

Hylda2 profile image
Hylda2 in reply toJimmy37

He had total heart block. Pulse 19! Had to be resuscitated on theatre table!!

2learn profile image
2learn

Hi, I have a pacemaker and have AF, though not at moment. My understanding is pacemaker is to stop HR going too low, it doesn't stop it going high, there's some other insert for that but not called a pacemaker. AF can be felt at pulse by someone who can recognise it. When I go into AF my pulse can go towards 200, I can't feel a pulse, its too fast. PM doesn't stop AF or control it. Careful with kardia's etc cos if too near PM they can mess it up.

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