AF with pacemaker

[barbharris1937]

9 weeks post ablation and pacemaker set at 60bpm at rest i still get AF at times. Heart rate only 90bpm now but i dont understand how the pacemaker allows this to happen. can anyone explain how it happens? Thanks for any replies.

[BobD Volunteer]

The pacemaker can only assist the ventricle if it goes too slowly.

Unless you have an AV node ablation then there are still pathways opeen between the chambers to allow fibrillation to affect the left ventricle and hence your heart rate. A PM alone will never stop AF and even after AV node ablation the left atrium can still fibrillate but would not affect the ventricle.

The main reason for fitting a PM in AF is to allow stronger medication to control heart rate without the risk of stopping it or making it too slow.

[barbharris1937 in reply to BobD]

I had an av node ablation which i think left a natural 30bpm. Thanks for your reply.

[CDreamer in reply to BobD]

Never say never Bob. PM alone worked for me and I know I’m not the only one.

[ken280 in reply to BobD]

The Doctor who did the ablation that he did lots of burns small circles not and X this was my second and had to got for check ups after ablation for about three month for 1 year I never got to see my Doctor as we have a Afib team and when my doctor was going across the country they were in charge. when I ask my MP when can I stop taking my meds Diltiazem they told me that I needed take these for the rest of my life after the 2yr mark the pausing came every 3min heart rate at 30 then a long pause of 6 seconds every med I took eventually I got the pauses. My Doctor was furious and asked me who told you to stay on these medications, I told him the MP and other Doctor he told me he wanted me off meds because they don't work for me! Now when my heart was slowing down and then stops I was talking to Jesus some other staints but the Er doctor on call just looked at me and did nothing but I was in for an emergency pace maker done by my doctor now that was in 2016 sometime I have bumps and jumping,maybe a racing heart at night but never in the day! Life is good, anyway we have it,They did say it will come back so I'm enjoying the space inbetween. At 72 with a wife of 38 two dogs, how can I not be happy. I pray to those people who came to talk with me in that dark hour but it gave me hope and I stopped all my meds diabetic,like warfrin,metformin,lipitor the side effects are terrible! Do what you feel best but not just because!

[barbharris1937 in reply to ken280]

thank you for your reply.

[CDreamer]

Very simply the pacemaker will not allow the HR to dip below 60 but will allow it to go higher, as it would need to do on exertion. When in AF some signals will get through hence your HR will rise.

Because I didn’t have the AV node ablation as the pacemaker worked really well on it’s own, my HR will only go to 120 on exertion but on the few occasions I have had AF I’ve had reading up to 160.

My understanding is that the lower limit is set so heart cannot dip below 60 and an upper limit programmed in but pacemaker can’t stop the heart beating faster if it wants to but it will limit the natural increase on exertion that would normally happen ie; for me if I walk too fast up a hill, my HR sticks at 120. Hope that makes sense.

Most importantly - is it improving your quality of life generally?

[barbharris1937 in reply to CDreamer]

yes I must say it is but not the miracle I hoped for. Thanks for your reply.

[Barb1]

To piggyback on this thread. I am having my pm reset at 60 in 2 weeks. Then seeing EP. I'd like to come off beta blockers. My av node is ablated. Is it a reasonable request?

[barbharris1937 in reply to Barb1]

good luck. I am supposed to be off bisoprolol but still clinging to 1.25mg as i feel jittery without it. must make the plunge!

[Jimmy37]

Talk to your cardiologist re medication.