Pacemaker Rate Reduction and Afib

[BG2017]

Hello,

Today was my annual pacemaker check. Since implant (in May 2017) the rates have been set to 50 day and 40 at night. I was happy to learn today (from the pacemaker download)that since my ablation in December the only afib was the 3 days I knew about.

The technician also informed me that I use the pacemaker 18% of the time. He then told me he was going to reduce the day rate down to 40 and therefore my heart should be doing most of the work.At the moment my heartrate is potentially a bit higher due to the after effects of the ablation but that’s fine and I am not concerned with a resting heart rate in the 40’s for approximately 20% of the time.

I don’t have a good understanding of the aetiology of Afib and was wondering if the rate reduction has the potential to initiate Afib again? Will the slower rate lead to the formation of the rogue signals/pathways again?

I do have an appointment with my EP at the end of the month so I will ask the question to him; but was just wondering if anyone else had turned their pacemaker down and what was their experience? Or does anyone with a better understanding of Afib have any thoughts or opinions?

Many thanks,

Becky

[BobD Volunteer]

What is your actual heart rate? PM rate may not be heart rate unless you have had an AV node ablation.

[BG2017 in reply to BobD]

Resting heart rate (via Kardia) is usually around 53. It fluctuates a bit higher since the ablation and I get readings in the 60’s sometimes now. Previous to the pacemaker it dropped to high thirties but was also influenced by the Af /Sick Sinus Node causing pauses.

[37Polly in reply to BobD]

Bob can you tell me more? My pacemaker was set at 60 since I normally ran 40s to low 50s, and now my HR run around 60 unless I am exercising. I have not had an ablation.

[BobD Volunteer in reply to 37Polly]

HR would always be at least PM level. If it is higher for other reasons then the PM will not operate as it is designed to click in when HR too low. Thus if you PM is set at 60 and that is what your HR is then the PM is working 100%

[37Polly in reply to BobD]

Thank you. Very clear. I will have a wound check and staple removed this week. Is it unusual to have pacemaker function 100% ?

[BobD Volunteer in reply to 37Polly]

I can't say since I don't have one bit if your normal rate is very low then yes and of course after AV node ablation one becomes PM dependent.

[BG2017]

It is just a single lead pacemaker

[Hidden]

If the technician did not explain what the reason for this perhaps surprising decision was, maybe consider asking the arrhythmia nurse to check with the EP. There is most likely a very good reason I suppose, it may even be standard protocol for ablation in pacemaker patients.

[BG2017 in reply to Hidden]

Thanks Oyster, as is often the case we think of the questions we should have posed at the appointment when we get home! I think he reduced the setting to decrease the use and get my heart to do more - which seems like a really good plan. But I will check with the EP because I don’t want anything to compromise what looks to have been a successful ablation.

[Dickydon]

Before my pacemaker fit, if I got a heart rate below 60bpm I would be feeling lighteaded and dizzy but 40bpm I’d be rendered completely useless and would need to lay down.