Pacemakers and AF

[ralft]

What are your experiences out there with pacemaker's ability to prevent AF? In my case, I got a Pacemaker in late September and except for 3 very short episodes in the days immediately following the surgery, there have been NONE! In the weeks before the PM implant, I was having episodes several times a week. My pacemaker has the designed capability to prevent AF but it is not programmed for that and will not be for several more months of healing. And, Medtronics (the manufacturer) says that it is effective only 50% of the time.

[aika]

Yes I would love to hear people's thoughts on this matter. I myself have a medtronics AICD which is supposed to be a combination pacemaker and defibrolator. I have had it for 1.5 years. The defib portion does work for it had fired 6 months ago 3x in one evening and I was able to make it to the ER. But what confuses me is that I have daily arrythmias in which the HR can fluctuate as low as the 30's/40's and can even go up to 120's. Maybe my understanding of how a pacemaker is supposed to work is wrong, but WHY DOES IT FLUCTUATE???? I have spoken with friends that have pacemakers and they do no seem to have such noticeable issues. My EP says to not worry about it, but will only give an explanation of PVC's occurring and this is nothing of concern. I should explain that the device was originally implanted because of an ventricular tachycardia episode 1.5 years prior. Anyhow, I am just trying to get a better understanding of this whole matter along with "ralft", whom I wish only the best as for everyone on this website

[cassie46 in reply to aika]

I do not know a great deal about pacemakers, I am learning at the moment as I have been advised to have a pace and ablate, I have permanent AF and very irregular heartrate. I will have a pacemaker inserted and then my AV node will be ablated (this is your bodies normal pacemaker) the pacemaker will then be activated to take over and control my heartrate at a normal rate. I will be totally depended on the pacemaker to keep my heart beating. Once the AV node is ablated there is no way of putting it back, If anything went wrong with the pacemaker my hr would drop to about 30 and I would have to seek emergency medical attention immediately.

I have been told by my EP that I will still have AF but with my HR controlled this should improve QOL.

I think the majority of people with pacemakers have problems with HR dropping to low and making them feint or pass out. The pacemaker is thereto kick in to stop the HR dropping below 60.

I know of some of the other types but not much knowledge on them. I donn't think any of them actually stop AF. Sure there will be more people along with more knowledge soon.

Cassie

[CDreamer in reply to cassie46]

I think you have been given good advice by your doctors - it helps some people as it has my husband who was given a pacemaker for brachycardia-tachycardia - slow then fast HR which triggered AF. After pacemaker the AF mostly disappeared for several years but returned recently but episodes are infrequent and he is not a symptomatic and takes no meds for AF.

No-one can predict if any particular treatment will be helpful for you as all statistics ar based on crowd or herd % on how effective they are for the majority.

Pace and ablate is a very different procedure and my understanding is will not stop AF BUT as it will control pace the ventricles you will not be as symptomatic because Heart will perform more efficiently.

Pace and ablate is my next option but I am holding off until AF because more prevalent as episodes are intermittent and mostly Vagal these days.

[seasider18 in reply to aika]

The pacemaker must be set to kick in when your heart rate goes below 60 so you should never go down to 30/40. Where are the low readings recorded?

[cassie46 in reply to seasider18]

Are you replying to me Cassie, if I have a pace and ablate I am sure it will be set to not to go down below 60 (at the moment I never go anywhere near that normally 80-100). My point was is that anything went wrong with the pacemaker I would have no heartrate, I understand that it would still keep going for a short while but at a level of around 30 - which means I would probably have passed out. So urgent medical attention would be needed to get the pacemaker working again. Thats why a few of us on here who are being offered this treatment it takes a while to get your head round it is such a final decision to have you body's natural pacemaker stopped and no reversal is available.

Cassie

[seasider18]

Is this a new type of pacemaker as all I have read tells me that they do prevent episodes of AF?

webmd.com/heart-disease/atr...

[ralft in reply to seasider18]

I do not know if my PM is a new design but guess that it is. In general all such devices are frequently upgraded

[Jong1945]

ralft what was the reason for your pacemaker? Did you have bradycardia (slow heart rate)? (the article linked above by seasider18 is quite good)

[ralft in reply to Jong1945]

My PM was implanted almost immediately after my electro physiologist discovered that my heart had stopped for 14 seconds almost a month previously. I was lucky that my Medtronic Reveal Linq was still working when I went to see him because of a frequent AF episodes that started a few weeks earlier. I say that because the battery is only designed for 3 years and I was at 3 1/2 years. It did fail just a few weeks after my PM was implanted.

[Jong1945 in reply to ralft]

OK, thanks. Intersting

[JonathanPittsCrick]

I think that your experience is not unusual. Many of my patient with attacks of AF, especially when they mainly start at night, have a tendecy to slow heart beats or pauses which can trigger the AF. So a pacemaker, by maintaining a heart rate of 60-70 at night can be extremely edffective in preventing attacks, especially if combined with the heart-stabilising drug like flecainide.

Unfortunately the problem of slow heartbeat (bradycardia) is made worse by many drugs used to control AF, especially beta blockers (any drug with a name ending in -olol) so pacemakers can be even more necessary if those are being used.

It doesn't have to be a special kind of pacemaker – the anti-AF systems don't make much difference – but they do have to be programmed with a minimum rate at least 60.

[Beehive1]

I had a PM fitted in August for brady/tachy/sss and although I had episodes of AF in the first few weeks, I have mainly been AF free since. The only episodes since have been triggered by stress caused by a couple of long journeys and a lack of sleep. It is set at 60. I take Bisoprolol 2.5 and rivaroxaban.

[ralft in reply to Beehive1]

And is your PM programmed to prevent AF? Also, what is SSS?

[Beehive1 in reply to ralft]

Hi ralft

PM is not programmed to prevent AF. I was advised that if my AF was triggered by bradycardia it would help. My PM is not programmable to prevent AF as far as I am aware. SSS is 'sick sinus syndrome' which I was advised was caused by the Bisoprolol in the first place!

[Garybaldi]

Pace maker won't stop af I got full ablate & pace, no problems since. Best move I made, af only weakens the heart.