More on pacemaker question-posted incorrectly!

Thanks to you all for responding but I am still in the dark with all this. in my simple way of thinking I imagined once your heart was put back into rhythm then all good - isn't that what Flecainde or similar tabs supposed to do? Whereas the beta blockers just slow down the rate but the heart rate can still be irregular. So if your take tabs like Flecainide which supposed to make u regular (like a pacemaker) then that must mean the AF Is still having a party in the background and many people seem to do okay with Flecainide so...,? It never worked for me though.

Sorry to appear so dumb but it's a hard one to get my head around. Patx

8 Replies

  • Hi Pat. As I understand it the flecanide works to block whatever it is that makes the atrium excitable so there is no fibrillating but with the A.V. node ablation the fibrillating continues but the elecrical impulses cant reach the ventricles, the beating of which gives us our pulse. The pacemaker then makes the ventricles beat regularly and at a predetermined rate. Although you can still feel fluttering in the atrium surely you should feel better with a regular pulse and lowish rate. It is irregularity and high rate that make me feel so bad when in A.F. ALso, it is much better for the hearts health if the ventricles are beating regularly. If all medication has failed surely this alone is a reason for consideration.

    These are only my own rambling thoughts as someone who may need to consider this option sometime in the future as cant have moreP.V.I.ablations. Thankfully flecanide and bisoprolol still doing the trick for now. X

  • Hello Pat, I can comment as a non medical person on what I know (or think I know) about the role of Flecainide in the suppression of AF, having questioned my EP like a prosecuting attorney in trying to understand what is happening. Briefly he told me:

    Taking Flecainide does not stop the rogue signals but makes the heart less responsive to them, so the party invites are there but the party doesn't happen, so to speak.

    The signals usually 'progress' and become stronger but this progression is poorly understood and varies from person to person. He felt that natural ageing is a factor for me - I'm 72.

    Flecainide (like other antiarrhythmic drugs) is capable of organising the rogue signals into tachycardia or flutter. When this happened to me, it was my first proof that the rogue signals are still active, just not causing AF.

    I hope this is of some help regarding Flecainide. I have often wondered about a PM too, but are the rogue signals capable of increasing the ventricular rate in spite of the PM? Don't know the answer to that one.

  • Yes these anti arrhythmic drugs merely slow down the speed at which the electrical impulses can pass through the cells and the speed at which they recover to send the next signal. Think of flushing the loo. You flush it once and then can't again till it fills up again. If you had high pressure water it would fill much faster and you would be able to flush it a lot more often but by restricting the flow then it takes even longer to fill. Get it?

    Pat, anti arrhythmic drugs don't stop the AF they control it (one hopes --but not always) and this may help the heart to go back into normal sinus rhythm (NSR) at least until the next time the AF starts up.

    Studies have shown that ALL treatment of AF is about control of symptoms not controlling AF. This applies with rate control where hopefully by keeping heart rate at a manageable level the patient is not too distressed as well as rhythm control where the aim is to maintain NSR. There is apparently no best approach, rather what works for each patient. Ablation can stop the signals at source and has the best chance of leaving the patient with a drug free better QOL but is not suitable or available for everybody.

    Hope you are getting the picture but do read all you can form AF Association website.

  • Further to BobD's comments I think that Professor Schilling did a video on this and certainly Dr Mark Earley, one of PS's top team, did a presentation on this at patients day last October. The conclusion is often rate control is more important than rythym control.

  • Ok then. I get that ultimately ablation is the only treatment that could possibly cure AF but we all know that it can take multiple ablations before successful and even then some people still have to take the tabs and it can come back some time in the future too. Pacemaker would put you back in rhythm and the party still going on in the background but would you be aware of it .....mmm. So I'm still unsure really which is best option but thanks everybody for your input - lots to think about. Patx

  • AV node ablation does not cure af, it simply blocks transmission of af signals to the ventricles , hopefull relieving symptoms. In practice success is variable. My recent AV node ablation still leaves me with erratic heart rate and rhythm which my dual chamber CRT-D does not seem to control for about a third of the time despite optimisation.

  • That is disappointing to hear Bionic but it is good to get the honest low down from folk who have had it done. I guess if nothing else works this may still be the only option but I would like to think I was reaping significant benefit from it. Thanks for your honesty. X

  • Unfortunately, as you may have gathered, nothing is simple! We are all different and all react differently to both drugs and ablations. There is no certainty with anything in life but particularly AF!

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