Treatment for Atrial Fibrillation

[Johnno333]

Can a pacemaker stop your heart going into AF?

[BobD Volunteer]

NO but it can ensure that your ventricular rate remains in good rhythm. The AF will continue and even after AV node ablation can remain although the symptoms should b e less.

[Johnno333 in reply to BobD]

Thanks for your reply.

So the AF would still kick in but the PM wouldn’t let the HR go over the PMs set speed and the HR would be irregular?

I am not in a position to have an ablation unfortunately.

[BobD Volunteer in reply to Johnno333]

If you have pace and ablate where some weeks after the PM has been implanted the AV Node is ablated then the atrium and ventricle are no longer connected electrically so the ventricle will be paced by the machine and your pulse will be that of the PM leaving the atrium to do what it jolly well feels like. For what reason are you not able to have ablation? The AV node ablation is quite different to one to isolate the pulmonary veins to try to stop AF by the way.

[Johnno333 in reply to BobD]

I didn’t mean a pace and ablate just pacemaker if that is doable. Too young to have P&A don’t fancy a machine running things, knowing my luck the battery would go duff lol.

My heart is on its side making if difficult to get into chambers apparently.

My cardiologist said that an ordinary pacemaker with two wires may be able to be used to help control my AF.

[BobD Volunteer in reply to Johnno333]

To my knowledge no pacemaker alone can stop AF. . It may enable stronger drugs to be used which might control it better but without breaking the chain with AV Node ablation the atrium will still be connected to the ventricle..

[Johnno333 in reply to BobD]

I think that increasing my drug level is perhaps the route he wants to go. St present I cannot tolerate any more than 2.5 bisop and 200 Amioderone it makes me feel so sluggish I can’t function.

So this PM option is my only real hope unfortunately.

Thanks for your input.

[Norm in reply to Johnno333]

Sorry about this but I see that word in your reply to BobD above.

Amioderone

I assume you are aware of the possible side effects of this drug.

If not you can do a search.

[Johnno333 in reply to Norm]

Yes the sideffects have been explained and I have blood tests every three months for LFT and a breathing test every twelve months.

Unfortunately I have tried the most popular tablets without much success so Amioderone is the last chance saloon so to speak.

My dose is only 200 mg and I can tolerate the side effects at this level. The bisop is the worst for me anything over 2.5 in one dose just knocks me sideways.

[Teignfisher in reply to BobD]

Hi Bob

I had a pacemaker fitted nearly 3 years ago because of repeated AF attacks .Ablations failed (3) so I was offered pace and ablate but the pacemaker worked very well with only 2 event in 6to 12 months. I believe that because my AF only occurred at night when perhaps my heart rate was to slow that was the trigger. Often after one of my frequent visits to AandE the AF stopped but then I would be braddicardic. We are all different and one day I might need the AV node ablated but for now it’s good.

[BobD Volunteer in reply to Teignfisher]

Lucky you. There are always exceptions and since your AF was likely vagal I can see how it helped. !

[Hidden]

Short answer yes. Early enthusiasm for this approach seems to have waned, unless there are other reasons for pacing like heart block or bradycardia with rate or rhythm meds.

sciencedirect.com/science/a...

[CDreamer in reply to Hidden]

I am so suprised that this isn’t researched more. Thanks for the link p.

[IanMK]

I don't think that drugs will be an answer for the long term. They tend to become less effective as the body gets used to them. Some also have risks of significant side effects. I'm presently on 200mg Amiodarone and 7.5mg Bisoprolol (plus other medications) and I expect to have a P&A within a couple of months. I really can't get off the medications quickly enough. I understand your reticence about undergoing this non-reversible procedure at a young age but pacemakers are very reliable and your cardiologist would not recommend one if it was not in your best interests. It is important that you have complete confidence in your cardiologist.

[Johnno333 in reply to IanMK]

I understand about the side effects they can be harsh at times, it would be great to get off meds I agree.

Your procedure wasn’t spoken about much to me by the cardiologist he was leaning toward the pacemaker without the ablate he felt that I was too young (58) to have this.

I wish you well for the future let’s know how you get on, you never know he may change his mind lol.

[IanMK in reply to Johnno333]

Amiodarone is one that I particularly want to stop as many people consider it to have too many serious contraindications. Has your cardiologist explained why a pacemaker is an option when an ablation is not? I would imagine that fitting the pacing wires is not too different to positioning a catheter for ablation. Perhaps his suggestion was to implant an ICD to shock your heart to NSR rather than to pace it?

[Johnno333 in reply to IanMK]

I agree Amioderone has so many sideffects I would stop taking it now if I could.

My heart is unfortunately on its side and getting the wire to where it is needed would be too risky so hence the PM. I think a PM would work better so that drugs could be increased (bisop for instance) without it slowing the HR down is the impression I am getting from cardiologist. I don’t want the ICD if I can get away with it

[beardy_chris]

Apart from Pace & Ablate, a pacemaker can be used to prevent syncope (fainting) resulting from Bradycardia. When your heart runs fast in AF, you are often given drugs to slow it down (Beta Blockers like Bisoprolol or Calcium Channel Blockers like Diltiazem) - these often work very well but can result in the heart slowing too much (in or out of AF) which, in turn, can lead to fainting. A pacemaker may be used to give you a 'base rate' below which the heartbeat cannot drop - say 60 bpm. It won't control AF, it just mitigates one of the more serious symptoms or, arguably, side effects of the drugs.

[opal11uk]

No but it certainly improved my quality of life, 3 years on with 2.5 mg of Bisoporal and Disopyramide to deal with the A/F I can more or less say 'what A/F' so I'm doing ok, pacemaker is checked now just once a year and I can get on with my life.

[Johnno333 in reply to opal11uk]

Oh man I so want that to be ME!

This is actually what I am hoping for when I see the cardiologist in November.

That is fantastic news and I feel very encouraged that I could find myself in that position in the not too distant future. Long may you stay in rhythm.

[opal11uk in reply to Johnno333]

Thank you John lol, the new pacemakers are even smaller now and the procedure to insert them is straightforward and under a local anaesthetic, to be honest I wish I had this years ago having suffered for 20 years, I resisted ablation for the longest time and then my cardio more or said that the ablation was really the last resort as I had tried all the medication, non of which kept it at bay for very long, the condition just over rides the drug, so I went for it and for me it was the worst thing I have ever done, mind you I was feeling pretty grotty beforehand but, for me, the ablation did not work and I refused more on a trial and error basis so was then put on a monitor where it was detected that my hb was stopping for so many seconds and obviously not desirable so had my trusty pacemaker and life is good at long last lol. I would suggest you do discuss this option with your specialist and wish you good luck x

[Johnno333 in reply to opal11uk]

👍

[beardy_chris]

I stand corrected - though I was careful in my mail not to make 'strong assertions'. If you re-read it you will see it is peppered with 'can', 'may and 'often'. Perhaps I should have made it clearer that it is based solely on my own experience.

Yes, I would always defer to the medical experts. I'm sorry you take exception to my reply which was intended to help and not to do anything else.

[beardy_chris]

In the context of the discussion of the aim of the pacemaker, I think it is argumentative to pick one sentence out of my post and object to it. I could have said "in my case, it won't control AF". I apologise for not doing so - happy now?

[seasider18]

There are newer types of capsule sized pacemakers that are implanted directly into your heart and easily replaced. There have been extensive trials on them at some UK hospitals. Ask your cardiologist if they are available in your area. They replace single chamber two wire models. Medtronic are the main maker of them.

nice.org.uk/guidance/ipg626...

[Hidden in reply to seasider18]

Thanks for that. They sound a bit risky at first glance. I wonder what the advantage is over conventional pacemakers. I think enthusiastic EPs looking to recruit patients for studies of a new technique might be difficult to resist, and we should do our research carefully. Reminds me of the early days of ablation for AF, when there was a rapd increase in the number of EPs who had to learn their trade.

[seasider18 in reply to Hidden]

Probably less risky than my conventional one !! It was supposed to be dual chamber but a single chamber one was fitted and my lung was also punctured and of course even although my one is MRI compatible very few hospitals will scan them.

[Hidden]

Thank you. I found this very interesting for personal reasons. In 2010 I was referred to Papworth for an ablation for paroxysmal AF. In the event , I had a dual chamber pacemaker with a view to overdrive atrial pacing This was removed soon after because of sepsis.

I had an ablation in 2013 which kept my AF paroxysmal, and another this year for persistent atrial flutter which didn’t work.

I had accepted this would be permanent, but with minor dizziness due to bradycardia, I can see another PM looming (that would be pacemaker rather than post-mortem 🙂).

I would be grateful for any information about an EP in Yorkshire with a particular interest in atrial overdrive pacing though I suppose it probably wouldn’t work after 6 months of persistent AF/AFL.

[Johnno333]

Thanks for your reply.

The cardiologist that I have now has given me options which the others I have had tended to lean towards taking tablets and see how you go.

I have tried one of his options so far which is 1.25 bisop daytime and 2.5 bisop at night along with my Amioderone in the morning. My last episode last week was only three weeks apart but wasn’t as fast and cleared with increased bisop for two days. So perhaps with a pacemaker on board it may have controlled it?

I will know more in November when I see him again.