Apologies if this is an obvious question. I have been reading up on pacemakers and cannot find an answer to a lack of my understanding about their function when the heart is in atrial fibrillation. I know that the atria will continue to fibrillate but ...
Can the chaotic and fast AF signals from the atria overwhelm the pacemaker so that instead of a highest paced rate of, say, 110bpm the ventricles can beat at, for example, 180bpm?
My understanding is that pacemakers regulate the heartbeat during AF if medication is making the heart beat too slowly. When the pacemaker detects that the heart rate is slowing down it sends an impulse to make the heart beat. This way the heart doesn’t drop below what the pacemaker is set for. It doesn’t prevent AF and doesn’t prevent the heart beat from going too fast.
I’ve just been to The Royal for assessment for an ICD or a pacemaker so it was explained in great detail.
As an aside, I was shown various types of pacemakers and their pros and cons explained, then told that I was a perfect candidate for implantation since I am on maximum medication so nothing further can be done from that angle, BUT . . . . .
People who have had endocarditis are likely to have it again, and since the infection/growths attach themselves to the weakest points of the heart, they tend to focus on the places where the wires have been attached. If this happens within three weeks of surgery, fine. They are just whipped out, but after that the removal of them would destroy the heart tissue where the wires are embedded. As the EP said, “It’s just rotten bad luck”. ☹️
Strangely he said, “I’ll do it if you want me to but I wouldn’t advise it”. He’s going to talk to others in his team and bring me back if they think of a solution. Apparently he does this with all “problem” patients 😂
I'm sorry you are having these problems with AF solutions. I had an ablation and now have a pacemaker and am doing well.Off all drugs. One good thing, IMO, you have an honest and upfront doctor.I'll bet whatever solution he finds for you, you can trust it will be in your best interest. Not always the case, IMO. Take care and good luck. irina1975
I had that explained to me as well and told it is a 1/200 possibility - but I have no history of endiocarditis.
Thank you POrtnahapp1e - I’ve sent you a PM.
I have had a pacemaker for 17 years. For sick sinus where you get brady and tachy. I understand it puts in good beats when in chaotic tachy to prevent clots and to maintain a regular heartbeat when in brady. My heart rate now is set to 70 minimum. (Could go down to 20 before and then pass out). My heart since third ablation doesnt go over about 140.
I was very apprehensive before first one but you soon get totally used to it. A real lifesaver literally. Also I used to fall asleep as soon as I sat down but that stopped.
Ask them to put the cut where it will be hidden by bra strap. Thats most annoying thing.
About bras....... can I ask ....any tips for immediately after implantation? I understand that bra straps can be uncomfortable for some time. You can PM me.
Hi CD. It's me again. Just wanted to tell you that for me my incision is very small and now that the redness has faded hardly noticeable at all. And I had no post-op pain. Not even sutures. They just glued the incision closed with a clear surgical glue that slowly peeled off on it's own over a period of several weeks. Usually more little bits came off after showers. They tell us not to help the process along; just let it peel off on its own time. I think it must be designed to not start coming off til the incision is well healed. When I started in the operating room is the 60's pacemakers were the size of a deck of cards and forever sat under your skin like a large bump. Over time they've gotten much smaller. I would imagine icenae's 17 y.o.incision had to accommodate a larger pacemaker and most likely is bigger and much more painful than now. I went into my pacemaker clinic the week before last and the pacemaker tech showed me the very latest. He had it in a little plastic tube and it was no bigger than two pencil erasers one on top of the other. It's designed to fit in the leg and is wireless. Amazing. But I'm happy with mine and I'm hoping you find that right after surgery you will be pleasantly surprised how little pain there is. irina1975
I found I had to wear a very supportive bra 24/7 til wounds healed. Feels a bit sore and bruised but not too bad. I am likely to have a 3rd lead next time as going towards the av node ablation route. Although have been in nsr for 2 weeks after a bad 2 month paf spell. No ryhme or reason to it but it settled down again when I upped my mineral and vitamins and iron supplements. Post 3rd ablation in 2016. Took long while to heal and settle but credit magnesium with major improvement.
Have you tried the magnesium supplement.
Best wishes
It’s great that you have had your life improved Icenae - thank you for the info.
Hi Icenae. I also have tachy-brady and my pacemaker keeps my beats well- controlled. Also set at 70. I got mine in 2016 so it's very small- about the size of a quarter. And my scar is small. It can be seen and I sometimes think about having "PACEMAKER" tattooed above it so I don't need to wear a bracelet. LOL. Never had a tattoo and will be 74 in a couple of weeks. Maybe I should put it on my 'bucket list'. I feel very secure with my pacer and I've named him "SEYMOUR"!! Happy yours is working well too. Take care. irina1975
I spoke to my EP about this as I am about to have pacemaker inserted and then AV node ablation.
Pacemakers are so sophisticated nowadays they can be very, very intelligent. The pacemaker I am having will have 3 leads - one to the atria - I think it was the left atria? and then one to each ventricle. The pacemaker will Pace the ventricles all the time. If AF or Fl occurs - the lead in the atria will sense the out of rythm and the pacemaker will adjust itself to compensate.
I am given to understand that this is different to a pacemaker which would be inserted for something like bradycardia and when the AV node is left intact.
The modern pacemakers can be adjusted to accommodate good heart rate variation to suit individual needs - but only after it has bedded in and wounds healed so my understanding is that for the first few weeks it will be set at a specific rate but later adjustments will allow for variation.
I know my husband’s pacemaker is a simpler 2 lead one and his HR does vary and he does feel AF but he is much less symptomatic when in AF although he sometimes gets a little tired. I think the highest Heart rate I have seen him have is about 140 - which gives an average HR in AF of about 105-110 reading in the Kardia.
The pacemaker paces the ventricles so they don’t get overwhelmed is my understanding but like you, I am struggling to get my head around exactly how it works.
Ah, the modern ones seem to be doing what I imagined a pacemaker might do, CD. I couldn’t quite get it how, in the absence of the AV node, the AF continues to affect the ventricles but your explanation does help. Thank you.
Hi CD, Will be hoping everything goes very well. Mine did in 2016. And welcome to our AF community's "Pace and Ablate" club! Take care. irina1975
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