Pacemaker or Ablation

[SirBeatalot]

Hi Folks.

I am currently on the waiting list for an Ablation but wondered if a Pacemaker might be an alternative.

I had a bypass nearly 4 years ago and have a slow heartbeat (40 to 45 resting) so i am unable to increase my Bisoporol 1.25mg any further to treat my PAF.

My father who is now 92 also had a bypass in his early sixties and also developed AF, however he went straight to having a Pacemaker fitted rather than an ablation.This may have been due to his age as I think he was around 80 when he had it fitted.

A Pacemaker does seem more straightforward to me but then perhaps there are implications I am unaware of.

[BobD Volunteer]

A pacemaker will not stop AF but it may enable more powerfull drugs without slowing your heart too much.

[SirBeatalot in reply to BobD]

Okay thanks.

[bantam12]

I chose pacemaker rather than ablation and it enables me to take meds without my heartrate dropping to low.

[SirBeatalot in reply to bantam12]

Thank you.

[Buffafly]

You can have both! My plan is pacemaker (already had one ablation supposedly to avoid the pacemaker), like you be able to take better meds, then can still have ablation again if I want. My cardiologist said that’s possible.

[SirBeatalot in reply to Buffafly]

Thanks for the reply.I thought a Pacemaker would solve my AF but it would seem from your reply and others that it only enables stronger medicine to be taken to actually solve the AF .

I would rather not take any more tablets and so might opt for the Ablation to try and cure my AF once and for all and come off the meds.

[Buffafly]

A Pace and Ablate procedure would ‘cure’ your AF in the sense that the atria would not be able to affect your ventricles which would be paced by the pacemaker but that is generally considered a last resort. For people with slow heart rates having a pacemaker keeping the rate up sometimes does reduce AF.

[SirBeatalot in reply to Buffafly]

Thank you.

[CDreamer]

I had pacemaker after 2 ablations - big improvement! I dodged the AV node ablation because the PM worked well.

I think a consideration is age - too young & you will need several revisions to replace battery which requires removing the device. Battery life is currently 7-10 years so for something like AF, they will consider how many times they may need to do that so unless it’s really essential, it may not offered.

I was 67 when PM fitted but certainly biggest improvement in QOL for me than either ablations as I had complications after both ablations.

[SirBeatalot in reply to CDreamer]

I am 65 soon to be 66 so not too young but not old either.Funnily enough my Dad who is 92, and like me had a bypass in his early 60's, is just about to have his Pacemaker battery replaced after 10 years.(My Dad has never been offered an ablation as far as I know)

I do tend to look at my Dad's experience as a guide but then we are all different.

[Alphakiwi in reply to CDreamer]

Do you still need to take drugs CD.. I've got the dual lead pacemaker but i think you know I never got the ablation. I consider i need it because after 4 years on a lot of different drugs tried im still putting up with misery. 1 drug even landed me in ambulance flat lined for maybe 2 minutes. I ended up with a very sore chest after much thumping. It's Amioderone. Not allowed again. Took 11 days. At 82 I'm quite happy to ditch such things. What do you think. I know it's everyone's choice eventually but to us here in nz it looks for me I just got to fight. After having been tested a week ago on the excersise treadmill I've been told that I can only have an AV nodal ablation due to left atrial dilatation which by the way was the reason given me 3 years ago !!!Colin.

[Clarrie]

I have a pacemaker and although I still get AF I am now able to carry on as normal. Pacemaker set so my heart rate does not fall below 60.

[Barb1]

My EP says a pacemaker is the last resort. I am waiting for my 5th ablation!

[Buffafly in reply to Barb1]

Does he mean Pace and Ablate? Because that is usually considered a last resort but a pacemaker is often used because of bradycardia - heart rate tends to drop too low. If I have an episode of AF I cannot take any extra meds at home or in hospital to reduce the rate so the only ‘treatment’ is a DCCV if the symptoms are too bad.

[Barb1 in reply to Buffafly]

Ihave tachycardia

[Buffafly in reply to Barb1]

So a pacemaker would only be helpful if you had AV node ablation as well.

[Barb1 in reply to Buffafly]

I think so.

[S11m]

I have had three cardioversions, two catheter ablations and two dual-lead pacemakers. My pulse rate was getting down to 75 at night - and I was waking up paralysed from my eyes down.

Do you wake up feeling rough?

Do you know what your pulse rate gets down to at night?

If ablations "kill all the nerves" in the atria, the atria will not beat without a dual (or atrial) lead pacemaker.

[SirBeatalot in reply to S11m]

Sorry for the delay.

(In general I think I need to learn more about my condition as everyone on here appears so knowledgeable about the heart and able to use abbreviations some of which I don’t yet understand.)

Unable to sleep for hours on end i often feel shattered in the morning.

During the night my pulse rate goes down to the low forties and occasionally below that to the late thirties.

My low heart rate is one the reasons why my Cardiologist is advocating an ablation as I am unable to take a higher dose of Bisoporol than 1.25mg to control my heart rhythm.

[S11m in reply to SirBeatalot]

It seems to me that a pacemaker might help - in addition to a Catheter Ablation.

[Jennywren2953]

I have had Pace and ablate for my chronic AF. I also had a leaking tricuspid valve at the time , 5 years ago. I wasn’t aware that the leads of the pacemaker go through the tricudpid valve which has now led to severe regurgitation and I am waiting to find out how I might have that repaired, I was told by a cardiologist that this can be an issue when people have pacemakers, just thought I would pass it on.