Pacemaker question

[Profound15]

Met with my cardiologist last night. I had a very good day heart wise yesterday with no ectopics at all. That is very unusual for me. I had a severe afib event on Monday and had taken the maximum 300mg dosage. My cardio advised that the flec would probably been out of my system by yesterday.

I was fitted with a 24 hour holter monitor to check what’s going on in the ticker and whilst feeling good about the ectopic free day went home thinking nothings going to happen. How wrong could I be because as soon as I had a small bite to eat the heart went in to sustained and regular ectopics. I bought a kardiamobile and it recorded afib a couple of times and unclassified regularly. I spent the whole night going through this and I must admit to being shattered this morning. I’ve taken a flecainide and I’m now in normal sinus rhythm. Certainly the holter will have recorded significant information about my problem

The cardio discussed possible causes and he mentioned that the pacemaker could be an issue in the future. Has anyone had experience of this at all please. My blood pressure is generally 115/75 with a resting pulse rate in the 60’s

I think it’s probably going to be me going on a maintenance dose of flec and bisoprolol which is fine. The beta blocker might be an issue for me if previous experience is anything to go by but it is what it is. Perhaps a calcium channel blocker might be better but who knows

[CDreamer]

Yes, I have ended with a Pacemaker in 2018 after 13 years of doing the gamut of drugs and ablation x2. Best thing I ever did as now no AF, had 2 very minor episodes (to my knowledge because I felt them) one 6 weeks after implant, lasted 30 mins and one when I had a bad chest infection which lasted about the same.

Even in AF I didn’t have the horrendous symptoms I used to have as my rhythm remained stable, HR did rise to 135 ish but that’s way down on what it used to go to.

My PM is now set to kick only if my HR drops below 60 and that is where the most benefit seems to be gained - if your HR drops - which mine was doing and triggering AF so I was going from low to high and not much in between and it made feel lousy.

PM seems to being suggested these days more often - my guess is because the technology has improved so much. My PM data is monitored by an app on my phone which then gets transmitted every so often and goes to my PM clinic.

[Profound15 in reply to CDreamer]

Thanks CD. Do you feel anything at all when it’s in operation please. How do you find travelling abroad with security etc. I know daft questions but it’s the way I tend to think of things being a retired engineer

[CDreamer in reply to Profound15]

I feel it very occasionally if I am in a certain position, propped up on my left side & that’s the LV lead which is very difficult to place. Most PM’s wouldn’t have that. You would only feel it if a lead were out of position, which did happen to me and it struck my diaphragm which was most uncomfortable. I got an appointment within 48 hours and the technicians disconnected it electronically, I had a revision and it was properly placed and no further issues. I Don’t feel it kicking in but then it’s mostly when I’m asleep that HR dropped below 50 so the only way I know is by looking at my iWatch HR monitoring graph the next morning.

It seems to be that the more regular rhythm and rate is maintained, the better everything gets so I have seen a gradual general improvement over the 2 years.

Travelling is no problem - you just say you have a PM, occasionally they ask for proof and then wave you through and put a wand over you. The very modern scanners and PMs don’t pose a problem, it’s the smaller airports. In some ways it can be an advantage. The only things I was told to avoid was standing over induction hob - within 2 feet and mind I didn’t carry a mobile phone in left breast pocket.

Some older PMs have a problem with MRI scanners but they can deal with that now but need notice, mine is OK.

The only other thing I heard of is that Automatic Locking cars can interfere with PM’s but both my husband and I have both PMs and Central Locking and we checked the tech stuff and all OK.

[Profound15 in reply to CDreamer]

Thanks CD that’s really helpful. Sorry another question I’ve just thought about which I guess is daft. I’ve given up alcohol for the last 2 1/2 years due to afib. Are you able to drink a small amount with the PM please

[CDreamer in reply to Profound15]

Yes I have th odd glass of wine maybe once a week, can raise my HR a little, that’s all.

[Profound15 in reply to CDreamer]

Thanks CD

[IanMK]

I’m a recently retired electronics engineer and can confirm what CD says. I didn’t have AF but Heart Failure and dilated cardiomyopathy caused by an arrhythmia. After 2 ablations and impairment of my AV node and fitting of a PM I feel back to normal and enjoyed getting out and about on my bike again this summer. Perhaps it was my being an electronics engineer that allowed me to easily accept the idea of having a pacemaker when the risk of the second ablation and damage to my AV node was put to me.

I never feel it in operation. The only issue I have with it is that it is quite prominent and it can be a little uncomfortable if I lie on my left side.

I was told off once at an airport for going through the scanner. No noticeable effects, though 😊.

[secondtry]

Sounds like you may have vagally mediated AF, as no issues prior to appointment and relaxing with food afterwards kicked it off. I deal with this by slowly relaxing after a busy stressful time e.g. in your case getting home and doing something quite important first for an hour before having refreshments. I learnt this from the early days when I had a stressful job/personal life and come evening I couldn't have a TV dinner, had to do some light homework first otherwise AF would start. After 7 yrs, I think with many Lifestyle changes I have got my Vagus Nerve back to near normal so this is no longer an issue. Your proposed move to Flec/Biso sounds like a good move, so it is just how much of each?

[Profound15 in reply to secondtry]

Sorry for the delay in replying. See my cardio to get the results of the 24hour holter on Tuesday. Certainly I did have the whole gambit of issues that the holter will have recorded. Be interesting to find out what kind of palpitations etc I’m suffering from. Last couple of days I feel fine. I’ve totally stopped my magnesium supplements and have only had a couple of very minor ectopics. I’m making sure I take the daily recommended amount of magnesium and potassium through food using the Cronometer app which hopefully will be better for me.

[secondtry in reply to Profound15]

Hope it works out OK. Incidentally, my Naturopath treats his AF patients with a combination of Nutri Megamuscleze (principally Mg but lots more) and CoQ10; the former relaxes the heart and latter strengthens it.

[Profound15 in reply to secondtry]

Thanks secondtry