Pace Maker for Bradycardia with AF - AF Association

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Pace Maker for Bradycardia with AF

Hello everyone. I read your posts every day with interest and have learned so much from you all, thank you. I haven't posted for ages so to recap, I am a 72 yr old woman, not overweight and before diagnosis was doing pilates twice each week and walking 5 miles and more regularly and easily. I was diagnosed with paroxysmal AF a year ago. I feel every bump and know precisely when I have gone into AF and when I go back into sinus rhythm, which takes anything from 10 minutes to 8 hours. I have tried many drugs but I seem to be sensitive to them and feel awful. Since January I have been on Flecainide 50mg, Bisoprolol 2.5mg daily and Apixaban 5mg bd. I still feel tired, breathless etc but have to stick with it. My dilemma is that I feel very faint at times when I go into AF and it is only since I bought a Kardia and am able to show the pauses in my ECG, that I have been taken seriously. I am told the pauses are Bradycardia, lasting up to 4 seconds and causing the faintness. My cardiologist has suggested putting in permanent pacing to overcome the Bradycardia. I will still have AF which I have reduced to two episodes in 30 days from 18 episodes in 30 days. I have done this by adopting a plant based diet, giving up my evening glass of red and eliminating caffein and processed foods from my diet and many of the other tricks suggested by you all. Finally, has anyone else been in this situation and how did you get on? There is more to tell but I won't burden you with it all now.

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I have similar symptoms although I'm not always sure when AFib is happening, my choice is ablation or pacemaker but waiting to see the EP at a different hospital. I can't take meds as I have other issues and Bisoprolol made me more tired than I already am ! Just been prescribed Verapamil to use as and when I need it but not sure about it. Plant based diet is not an option for me but it sounds like it's working well for you.

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Thanks for replying. I guess that makes sense.....if you stop the AF with ablation then the Bradycardia shouldn’t be an issue. My cardiologist isn’t recommending ablation for me. He thinks my heart “has had enough to put up with” his words. I was born with a ventricular septum defect and was unlucky to have bacterial endocarditis when I was 19. Even so I have lead an active life and completed many long distance walks. The EP, at another hospital, was happy to do an ablation and said I had a 70% chance of “ success”. Like you I don’t know which way to jump. I wouldn’t wish AF on anyone but it does help to know there are others facing the same issues. All the best for your appt with the EP.

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It's the uncertain outcome of ablation that puts me off, I don't want to end up worse and needing it done again and again, difficult decisions although the E P might not give me a choice.

Good luck to you to x

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"if you stop the AF with ablation then the Bradycardia shouldn’t be an issue."

Sorry, I didn't understand this part. How does stopping the AF make the bradycardia a non issue?

I am under the impression they are "separate" conditions, with different treatments. The bradycardia with a pacemaker, and the AF possibly with medication.

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Bradycardia and afib are like being in a rock and a hard place SingingT. For me it was either to fast (99.999% of the time) or those missed beats. I picked those up a couple of times a month but they were there for sure. That`s when I was monitoring myself (home monitor 1or 2 minutes a day) so I`m sure it happened more often.

I`m unable to answer your questions Sing because I don`t know. However I wanted to post because you wrote

....I will still have AF which I have reduced to two episodes in 30 days from 18 episodes in 30 days. I have done this by adopting a plant based diet....

Well done you ;-)

Diet seems to be all important with afib. I`ve started on my exercise target and am doing pretty well TBH. However I`ve not really changed my diet yet - not to any great extent anyway. I have a bit for sure - but not enough.

I think a combo of good diet / exercise will be really beneficial. Please (when you have a minute) can share your plant based diet. I`m really interested to learn more ty.

Sorry to go off topic.

Best,

Paul

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Thanks for your reply Paul. I went to see a nutritional therapist and she advised me how to change my diet. I use a book called “Eating Without” and other books and then choose the meat free recipes. If you decide to see a nutritional therapist then make sure they are on an accredited register. It’s not easy to make big changes in lifestyle. It wasn’t too difficult for me because I have been interested in wholefood cooking since the 70s and my husband is happy to eat anything. If nothing else eating a vegetarian/vegan diet should help to keep us generally healthy.

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Thanks ST.

I`ll look up that book for sure. I`ve just Googled it and it seems to show some interesting sites. I also Googled 'Eating without afib' and the search engine chucked out a few good sites. Worth a look.

I don`t have the time to have a good gander just now - will do so for sure tomorrow.

Have a great evening.

Best,

Paul

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They told me that my bradycardia was more cause for concern than my AF, and they inserted my (first) pacemaker before the three cardioversions and two catheter ablations.

I had AF the other day... and worked out that it was caused by gluten - which I now know is a known cause of AF.

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Thanks S11m. I’m not strict about gluten but will bear it in mind now I know of your experience. I learn something new about AF every day.

Yes, I think the Bradycardia is more concerning. I haven’t passed out yet but I’m not far off. My AF is still paroxysmal. Cardiologist is “watching and waiting” presumably for me to go into permanent AF.

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Before I had a pacemaker my SPO2 (blood oxygen) was getting down to 75 at night - and I was waking up paralysed... so that I could only move my eyelids.

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OMG that must have been terrifying. Think I’ll push for the pacemaker ASAP.

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Bradycardia affects different people differently. But if your pauses are 4secs and you are feeling faint, perhaps it's time to get that pacemaker before you really faint, fall and hurt yourself?

My mom's 84 and just had her pacemaker implanted. Her pauses were 3+secs and had started happening in the day time as well. She didn't have dizziness, but her BP was all messed up amongst other atypical symptoms. Her cardio said given her age, he would prefer to get her on the pacemaker before dizziness and fainting developed as it would be very dangerous for such an old person to fall down and break something.

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Man, that's serious!

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I may be facing the same decision one day Ive been warned. I wouldnt hesitate to get a pacemaker if the bradycardia is causing you to be faint. The risk of you falling or being in a car wreck are too great. You may find you feel alot better with the pacemaker

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Yes you are right. I haven’t noticed this discussed before but it seems it’s not unusual.

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My bradycardia is unrelated to the a fib. It is caused by “

Sick sinus syndrome” which my mother also had and she ended up with a pacemaker. The heart meds also slow the heart down so it is a double whammy. Right now Im lucky to not have to take any heart rhythm meds as my a fib hasnt hit for over a year. But cardiologist has warned me a pacemaker will b on my “ to do” list for the future. I am not afraid of it .

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Im not at all phased by the prospect of a pacemaker either. Both my older sisters have one. One of my sisters fainted and cut her head open so I know the dangers. I think they have AF too but didn’t know it. Not sure why I get bradycardia in the middle of a session of AF. I need to research it.......I did wonder if I might have sick sinus syndrome. Think that requires pace and ablate. Listen to me! I know nothing.

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I've got sinus node dysfunction so get brady pauses amongst the AFib although I wasn't aware until I saw the print outs from tests.

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If I hadn’t invested in a Kardia I wouldn’t have known why I was faint. Haven’t yet been told it is related to the sinus node. Very interested to hear about the experience of others. Thank you.

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Ha, you go girl👍🏻🌟

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"Not sure why I get bradycardia in the middle of a session of AF. I need to research it....."

Yes, that's a really good question. Please do post and let us know if you discover anything!

I imagine it must be pretty jarring and awful to be having both bradycardia and AF all at the same time.

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Hoski, I have sick sinus syndrome too, also known as tachy-brady syndrome. Sometimes the SA node oversignals and sometimes undersignals. Quite a predicament, limits my Sotalol to a small dose, but so far so good.

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Yes, Im really thankful I dont have to take daily meds except blood thinner and a very low dose betablocker. ( so far)

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Yes, PM implanted Sept 2018 - just had a lead revision. The best decision ever after 14 years of AF, drugs, 2 ablations. My QOL has been improved beyond expectations.

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Wow thats amazing!

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Did implanting the pacemaker stop the AF?

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Not completely but only 2 recorded episodes since implant & then because my pulse remained regular- none of the major symptoms like breathlessness, drop in BP etc.

The aim was never to stop the AF but to regulate the pulse and so reduce the symptoms. I can’t take any drugs, had 2 ablations, sedation & GA are very risky for me so PM with AV node ablation was the last available option. Life had become very miserable as I was having episodes every other day lasting 10-12 hours which then exacerbated Myasthenia so I was on a downward spiral.

I am still holding off on the AV node ablation because the PM has proved to be so useful for me but it’s not a recommended treatment for AF & will not stop AF although if like me, your AF was triggered by bradycardia- it may very well. Hope that helps.

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Yes! Yes! Can certainly identify with that : ) keeping the pulse regular! Feel completely validated reading your words. Thank you very much!

When my mother's bradycardia started deteriorating to the 30s and 20s, with increased sinus pauses and arrests, her BP started to fluctuate off her baseline and could get freakingly low! When we tried checking this with her then cardio, we received no answers and were made to think we were asking silly questions?!

I am glad to hear you are doing so much better. And thank you also for clarifying the pacemaker AF connection. Really appreciate it : )

God bless you CDreamer, and keep you well : )

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I have paroxysmal atrial fibrillation too and can always feel when it starts and stops. When in bradycardia I felt faint , I had a pacemaker fitted over a year ago and this no longer happens. I still get PA F, but the number of times I get it has been reduced by taking Magnesium Taurate. Neither alcohol or coffee causes me to fibrillate so I am lucky in that.

Hope you resolve your problems soon,

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Thanks for taking the time to reply. I am heartened (no pun intended🥴) to hear your story. Does your pacemaker only kick in when needed or does it govern your pulse all the time to one speed? I haven’t looked into this with the cardiologist yet.

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My pacemaker only kicks in when my heart rate drops below the selected rate below 60 in my case. I do not feel it working, but I am assured that it is working ok. Never had any further episodes of feeling faint. Bonus I am allowed to drive. Dvla has to be informed.

All best wishes

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👍

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When I first started Afib I was getting short periods of syncope during each episode. I had a pacemaker fitted as I wanted to keep my drivers license. This has sorted the syncope completely and then I was put on the list for an ablation. 5 years later and 2 ablations later things are much improved but the biggest change was moving from bisop 7.5 to verapamil. No more tiredness or breathlessness at all. An unexpected bonus of having a pacemaker is that when I occasionally have an episode of Aflutter they can stop it by using "overdrive" on my pacemaker! Hope you get some success soon.

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Thanks for your reply. I tried Verapamil but didn’t like it. This was nearly a year ago and I didn’t have as much info. as I do now. Wondering if I should try it again. There are so many ifs what’s and maybes with this condition. Thanks again for sharing your experience. Very helpful.

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Did you take Verapamil all the time or just when you needed it ? I've been given it to use only when the AFib kicks in but I don't normally tolerate meds well so I'm not hopeful.

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You are not alone!!😘.

As you will have gathered, most subscribers here seem to have high HR problems, and cardioversions and ablations as well as medications feature prominently. It would seem that those of us with low HR (resting 60bpm) and syncope are in a minority. I had AF for years helped by Sotalol, but following syncope faints was switched to Metropolol and Flecainide and promptly had three bad syncope faints in 5 days so was switched to Bisoprolol and given a loop recorder. With syncope episodes of up to 14 seconds showing up I was rapidly given a PM and life goes on....

A TIA prompted a switch from aspirin to Edoxaban and Omeprazole and at my latest PM check up my AF load had dropped from 74% to 55% and as people had asked me if I was aware of the PM cutting in (I am not) I asked, and was told 'Yes - 25% of the time !!!

So life goes on - 3+ mile walks every day ( admittedly a bit slower than I used to go), decaff, Gluten-free (Coeliac) and other dietary restrictions and keep taking the tablets. No probs....

P S - Ablations and Cardioversions have never been mentioned throughout my journey.

PPS - until PM sorted avoid driving and take extra care crossing the road!!

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Thanks for that. Made me smile as well as being informative. Great.

I don’t drive far on my own these days just in case I go into AF. Husband comes with me. I don’t get syncope other than when I am in AF. I love driving and would normally drive anywhere and everywhere on my own. It would be good to have the confidence that a PM should give me.

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Flecainide is supposed to just correct rhythm but I found it reduced my HR by 5+ points. I may also be heading for a PM and glanced at something the other day, amazed how advanced they have become, I think it said they now have units they can just insert in your leg?!

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You are probably thinking of the leadless ones that can be inserted via catheter. I think they are still only single chamber at the moment. But yes technology is moving apace (geddit) so there’s a fine line between jumping at a PM now or waiting - as most common pacemaker complications are lead infections and at battery changes. Most medics will wait as long as possible (as obviously you need less of these the older you get) but if you need one you get one at any age. I was hoping to hold out for a leadless one as they were being trialed 5 years ago, I had to give in last year.

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Thanks for the info. folks. I am normally a practical, decisive, problem solver but this disorder has me stumped. There are so many variables! I am having to relax and trust that my cardiologist has the knowledge and experience to do what is in my best interest.

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"Most medics will wait as long as possible (as obviously you need less of these the older you get)"

Sorry, how did you mean by this sentence?

Thank you

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I mean that they won’t rush to put a pacemaker in a younger person unless absolutely necessary, the balance of risks changes as you age. If younger you will likely need many more battery changes which increases risks whereas it might be thought worth putting a pacemaker in an older person before they are overly symptomatic because it would be worse waiting until they’d had a fall. For instance I and mother both have pacemakers as of this week, if I live to my mothers age I’ll have the risks associated with battery change 3 times and might even need my leads changing (a big undertaking). Given my condition I suppose it’s unlikely I’ll reach my mothers age though!

A common misapprehension I find even on my pacemaker group is that all pacemakers are ‘life saving’ and the decision and timing is often more nuanced than that. If you are talking ‘life saving’ any risks just have to be accepted. Equally many don’t acknowledge the risks from having a pacemaker. Infections and lead replacements being biggies. It is a big decision best taken with a medic prepared to consider all your history and risks and age is one. I doubt I would have one with my mothers symptoms but I don’t have an age related falls risk and would likely recover better if I did.

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Thank you for writing in detail.

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I have sent you a private message as well.

Jo

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I can relate to your situation. I began to have AF last year. I ended up in hospital due to AF. After a few hours or days I would convert to normal rhythm. Doctor put me in 30 day heart monitor on February 4. No AF until Feb 27 I was standing at my sink when I began to convert. I passed out, fell and fractured 2 bones in my right ankle and sustaining a large knot on my head. My heart stopped for 8.6 seconds. Admitted to hospital where I had a pacemaker installed on March 4. Put on flecainide and metoprolol twice a day. So far so good. I am healing and getting better.

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So pleased you are recovering. My heart only pauses for 4 seconds currently and I don’t pass out completely. I do often find I get ectopics while standing preparing food. I might be holding my breath so make sure I don’t.

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Your story could be my story. I'm also 72 and on very similar meds which I am sensitive to. I was having afib episodes about once a month for the past 2-1/2 years lasting anywhere from 2 hours to 2 weeks. Last March, my heart rate, which had been steadily decreasing since my ablation in July, 2017, dipped into the 30s one evening. I had a pacemaker inserted the following day. I can honestly say I wish I had had it sooner - I was always out of breath, lacked energy, felt faint and felt awful in general. I have only had 2 afib episodes since March which is a huge improvement for me. One lasted 3 hours and the most recent time it was only 1/2 hour. My pacemaker is programmed to attempt to override the irregular beats as well as not letting my heart rate go below 60. Please keep us posted and let us know what you decide to do. Judy

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Thank you Judy. Good to hear of improvement coming from adversity. Sounds as if it’s probably a combination of ablation and pacing that has improved your situation. Are you off medication now? If only I could do that!!

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I'm on Pradaxa and will be for life but I'm OK with that. I'm also on a very small dose of metoprolol - 12.5 mg. 2X day and 50 mg. of flecainide 2X/day. When I see my EP in November, I'm going to ask if I can try to discontinue the flecainide since, prior to the pacemaker, it didn't seem to be helping that much in preventing afib episodes.

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I don't know why some of you seem hesitant to get a pacemaker. I am 71. Last summer had 4 cardiac arrests where my heart stopped beating suddenly. Fortunately I was in the ER at the time. They put in a temp pacemaker to stop these from happening (I was totally out of it). Then in a couple days we discussed putting in a permanent one. I agreed, and got a shiny new pacemaker and ICD defibrillator. I was dx with AFib and mild heart failure. I'm on meds, and it was a slow recovery, I was very weak for a long time. I am still not back to normal. but I am doing fine. At last check up, the pacemaker was working 32% of the time! That means that 32% of the time, my poor heart needed some help to keep beating. That is so scary!! I love that the pacemaker is on the job keeping my heart humming along. I never feel when I have an AFib episode, I never feel faint or dizzy. If you feel faint, that means your heart needs help!! Please don't be afraid to get a pacemaker, it's VERY COMFORTING to know it's therel!!!

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I totally agree with you. A pacemaker has helped me feel so much better and puts my mind at ease.

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In your situation you presumably had no choice but for those of us who are given the choices of meds, ablation or pacemaker it's not so easy to decide which road to go down, I'm hoping my EP will make the decision for me !

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Couldn’t agree more. I’m not at all worried about a pacemaker just curious to know if other people have bradycardia whilst in the throes of AF.

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I have bradycardia constantly, dip into low 40s at night, and resting hr is in the 50s. When I go into aflutter or afib ( I do both) I know immediately as I am tachy-brady they tell me. Can go to 140, 150 or 170+. Not fun. Thankfully Tikosyn has me now in pretty good shape with very rare, brief episodes, unlike the past. No one seems particularly concerned by the bradycardia as I have had it for many years, and I no longer take and rate medication.

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What symptoms do you experience?

Thank you

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Rapid heart rate, severe tremor and weakness, cannot function must lie down. Can’t walk. This can last a hour or days. Thankfully since I began Tikosyn 16 mo ago have only had a few brief episodes. Major change.

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Very happy to hear there was recourse for your terrible situation.

Thank you for sharing.

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I have been battling with AFib for 20 years, I’m 70 now.

I’m always very symptomatic. Also felt everytime I started AF and when it ended. Was treated with betablockers and anti rhythmic drugs. Episodes frequently, and sometimes long 24-72 hrs. Had two ablations within the last six years. Unfortunately no help. After the last one still had to stay on meds, bisoprolol and propafenone. Started having long pauses when in AFib. Had a pacemaker put in, which has made a good difference. No more too long pauses, which were the unpleasant ones. Still get episodes, but not always as symptomatic. So, have decided to live with this. Good luck to you! I’d just like to remind afibbers that ablations are not a cure, but in many cases they do help and sometimes for a few years. Heard also that for some reason they work better with men.

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Thank you Flimmeri. As Bob often reminds us it’s only we “difficult” patients that tend to use this site for reassurance from others. Those that tolerate and respond to medication and ablation just get on with life. I have learned to be positive and to ride the AF when it comes but would like to reduce the frequency of attacks and my cardiologist (and I) would like to stop the pauses that come with them. Lovely day here in Scotland, I am planning on cleaning the windows!

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I think the pacemaker would stop your pauses.

Beautiful here in Canada also. Getting redy to celebrate Canada 151years Day tomorrow.

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