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Pace & Ablate Question

Afibflipper profile image
67 Replies

This just occurred to me - does anyone know the answer?

I’m not having one but it would be the next step if the recent ablation were to fail (PMA says it won’t though)

If however I’d need it - what happens if the PM fails? My thought is that I’d no longer be here because my own natural PM has now gone.

Also, if the PM hasn’t failed at all and I were ever to have a heart attack should people not do compressions and just breaths as the PM will keep the heart pumping

If it sounds absolutely ridiculous it’s the brain fog. Thank you 😊

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Afibflipper profile image
Afibflipper
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67 Replies
Gumbie_Cat profile image
Gumbie_Cat

My understanding is that your heart has an ‘escape rhythm’. Very low, but enough to keep you alive, until you can get help. I might have seen that on York Cardiology?

I think there a an answer to the second one too, just can’t remember that!

I am just the same - looking at pacemaker info, even though I’ve just had my first ablation, I guess I am being realistic, don’t know!

Afibflipper profile image
Afibflipper in reply to Gumbie_Cat

Yes very true, I’m trying to remain absolutely well and truly positive telling myself my 3rd ablation will be me set for life - as I know the EP doubts they’d do any more ablations and the P&A is then what will stop all arrhythmias. I’ll take a look at York Cardiology then. Hope your ablation is successful and enjoy the festivities. Thanks for the info x

Gumbie_Cat profile image
Gumbie_Cat in reply to Afibflipper

Feeling a bit gloomy - had it on Thursday, and have been in A Fib since Saturday morning. I know it’s the blanking period, but it does seem settled in again. Been to GP, as I’m also retaining fluid. Oh, the joys!

I know it’s just the first, but sometimes I wonder how it will go. I have a low resting heart rate, which just seems to make A Fib that bit more awkward.

Barb1 profile image
Barb1 in reply to Afibflipper

Just to point out that a P and A does not stop AF. It goes on in the background.

Afibflipper profile image
Afibflipper in reply to Barb1

I said before I’d never heard this - but you say you don’t feel it! X

Barb1 profile image
Barb1 in reply to Afibflipper

No, not at all.

Ducky2003 profile image
Ducky2003 in reply to Afibflipper

Pace and ablate does not get rid of arrhythmia, I'm afraid. Just prevents the high heart rate which can go with them.

Palpman profile image
Palpman in reply to Ducky2003

It stops the naughty ventricular response to the Afib.

Afibflipper profile image
Afibflipper in reply to Ducky2003

I thought it did stop the arrhythmias all together! Hence everyone seems to Coe off meds! Glad you brought that up x

Gumbie_Cat profile image
Gumbie_Cat in reply to Afibflipper

The ablation of the AV node removes the connection from atria to ventricles. So the pacemaker keeps those ventricles going at a nice steady rate, while the atria continue to party. Thing is, they won’t be affecting your main heart beat any more, and their wee party wont be as noticeable.

You can stop meds, apart from anticoagulants.

Ducky2003 profile image
Ducky2003 in reply to Afibflipper

You can come off meds as the ventricles will be managed. The AF still lurks in the background in the atria.

Barb1 profile image
Barb1 in reply to Afibflipper

I am still on diuretic and of course anti coagulant. It took me over a year to wean off the BBs

I’m not in the pace and ablate scenario but I’ve had a PM for 14 years and it’s never given me any serious problems and I’ve never given it a thought apart from “ I love you pacemaker “😁.

I’m on my third after the second tried to come out through my skin after a few yoga sessions. The new one is buried so deep it and unlike the last one doesn’t spoil the line of a nice shirt.

I’ve had a technical tweak to allow a lower heart rate at night (40bpm). That saves on the battery so delay another refit.

There’s a bedside monitor so any issues can be picked up … it also can tell about episodes of AF I have that I’m not aware of …

It’s a such a lovely little device I think I’ll send it a Christmas card too ….

If you had to have one and it improved your quality of life then you might just love it too and put the others fears at the back of your mind.

Whatever your next step I wish you well

Afibflipper profile image
Afibflipper in reply to

Very handy information thank you. If the need arises I’ll remember the bit about lowering the night HR as the reason they don’t want to do it now is the number of changes I’d probably need so opens up heart to infection at each change so as I’m only 58 he feels relatively young to be dependant on one but if have to he will. Also the fact of them migrating out of the skin - I know that pierced jewellery is not comparable to PM but have had that happen with a few.

Thanks again and all the best for good health and festivity’s x

Fullofheart profile image
Fullofheart in reply to Afibflipper

HiI'm in the same boat. 3rd ablation in 2 days but surgeon, cardiologist and myself all have lowish expectations.

Options are limited though.

Cardiologist does not want to do pace and ablate at age 48, for same reasons you mention. And I also have concerns re taking out the hearts natural rhythm control.

But my concern is that doing nothing (meds route hasn't gone well so far) is just continuing to put pressure on a stretched heart that is not performing well overall.

Let's see how it goes!

Wishing you all the best! 🌸

Afibflipper profile image
Afibflipper in reply to Fullofheart

and of course to you too x

MummyLuv profile image
MummyLuv in reply to Fullofheart

hi full of heart, I am sure we have spoken before, good luck with the ablation and I hope it does work!

If for some reason it does not, at 48 and your EP not wanting to do a pace and ablate perhaps you could ask him/her to refer you to Mr Hunter at Northern General to see if he can help with surgery. X

Fullofheart profile image
Fullofheart in reply to MummyLuv

Hi, yes we've been in contact a few times. I'm actually 47, I aged myself for some reason in that post! 😆I've just had 3rd ablation last week which was not successful. I went back into persistent AF within 48 hours, same as last time.

I've had AF for 18 years.

Im in Wales and there is no clear route to refer for the mini maze. I've looked into it. Cardiologist and surgeon don't believe it will work in my case so won't back it anyway. I can't afford to go the private route.

Maybe the pathways to this procedure will change over time. For now, access is not equitable and not possible for many.

The plan now, for me, is for rate control drugs and hope that helps a little. Pace and ablate at a later stage.

MummyLuv profile image
MummyLuv in reply to Fullofheart

Aging yourself 😂😂 life seems to do that fast enough!

oh sorry, I thought you were England. Just seems so wrong that you can’t access in Wales just like us in Scotland. My local EP from being sceptical is now wishing he could offer to persistent afibbers here.

What is comforting is the positive experiences of lace and ablate being shared 😍

dmjtanner profile image
dmjtanner in reply to

Were you able to get back into yoga after the deeper implantation?

in reply to dmjtanner

oh yes … but a little less ambitious when stretching my right arm when I first started back…. and down at the gym I use weight machines. Again my ambition is tailored to my age so I aim for muscle maintenance/retention and don’t dream on being a geriatric Schwarzenegger ! Yoga is the most important exercise to me …

Hylda2 profile image
Hylda2

you are left with an escape rhythm. Enough to get you to a hospital. Just had pace and Ablate, mines 35bpm

Afibflipper profile image
Afibflipper in reply to Hylda2

that’s good to know I thought it literally packed up

I like your ‘Clubcard’ description 😆 does you get points 😂

Hylda2 profile image
Hylda2 in reply to Afibflipper

hubby has pm too so it’s double points

Afibflipper profile image
Afibflipper in reply to Hylda2

😂

stargazer52 profile image
stargazer52 in reply to Hylda2

hi Hylda2, how are you doing? I've just recently had a pacemaker fitted and am now waiting for a date for sn ablation. To be honest Im quite scared about what will happen, I didn't feel too good when Id had the pacemaker, my heart felt as though it was fighting itself and jumping in jelly. Had pm checked and it was working ok but still felt strange to me. meds didn't work for me and I have mild atrial and mitral stenosis due to covid. Did you have any underlying condtions?

sorry to be asking so many questions.

thanks

stargazer52 profile image
stargazer52 in reply to stargazer52

also my ep said that the heart has a natural slow rate if pacemaker fails, enough to get you to hospital

Hylda2 profile image
Hylda2 in reply to stargazer52

After they have done the ablation they will tell you what your escape rhythm is. Mine is 35 bpm enough to get to a hospital. Had my pacemaker checked Thursday and was surprised to be told I’m in AF 60% of the time. Don’t feel a thing.

D

stargazer52 profile image
stargazer52 in reply to Hylda2

One more bit of information, thanks

Hylda2 profile image
Hylda2

paddles have to go in

A special place. We have a club card to carry. 🤣

Jennywren2953 profile image
Jennywren2953

I have had Pace and ablate after unsuccessful primary vein ablation. I was also told there was an escape rhythm as Gumbi_Cat said, I hope that’s true🙄. A question I have is, now that defibrillators are in shopping centres her in Australia, I wonder if I were to pass out it the shop and someone used one on me, how would the pacemaker cope with that?

Gumbie_Cat profile image
Gumbie_Cat in reply to Jennywren2953

I would be fascinated to know if it’s in the instructions that the machines give. Would have thought it should be, I think they take the user through it step by step?

IanMK profile image
IanMK

I’ve undergone a pace & ablate procedure and had the same concern, not surprisingly 😉. As I understand it, there are several potential sources of ‘escape rhythm’. Mine beats somewhere in the 40’s. I believe it’s one of the things they check at the 6-monthly pacemaker clinic.

Nannysue1 profile image
Nannysue1

I've had the pace and ablate procedure too. It's a big decision but for me it's the best thing I could have done. I feel like I have my life back again for the first time in many years. I have my energy back and although I know that I'm still in fibrillation , I cant feel it and my heart rate is calm and steady. I only take apixaban now, no other medication, which has had a positive effect on my digestive system and I'm relieved after so many years of popping pills that I no longer have to take them.

After the original setting of 80bpm which my EP sets everyone on to enable the heart to settle, after 6 weeks,they lowered it to 60bpm ,which before the dreaded AF ,was my natural bpm but very quickly I felt like I'd lost the energy again ,so they put it up to 70bpm and it's just great.

All very clever stuff,they can tell how long the battery life has and at 60bpm, it had 14yrs 2 mths and putting it up to 70bpm lowered the "shelf life" to 13yrs 3mths.

I'm 68yrs, so realistically, will only need one pm change ( hopefully!).🤪 however, I've come across quite a few people who have had pm's from a very young age and have had several changes.

I dont have a monitor at home, instead, I have the app on my phone, so all of the time that I have the phone with me and have wifi, its transmitting. I've sent a test transmission to the hospital and it's all working well.

It is a big decision and this is only my experience but personally I am so happy with it.

I asked the same question to quite a few cardiologists "what if the PM fails" and each time the answer is "they dont". It is true however that they try to leave you with an "escape" rhythm, should you ever need it.

Hope that helps to settle your mind a little, should you ever get to this stage.

Merry Christmas

Afibflipper profile image
Afibflipper in reply to Nannysue1

thankyou that’s great information - this is the first time I’ve heard of this about still being in AF - I really thought it got rid of it because the HR is kept normal - learn something new all the time on here so very grateful xx

Pacer22 profile image
Pacer22 in reply to Nannysue1

Same here, I had pace and ablate 7 months ago.

I have an occasional episode, but by the time I notice it, it is gone, nothing compared to the hours I spent with my heart rate edging close to 200, it had controlled my life.

I suppose this is quality over quantity. It was worth it for me,

Merry Christmas and Happy Pacing

Nannysue1 profile image
Nannysue1 in reply to Pacer22

Not sure about the quantity bit! All of the professionals that ive spoken to about it, say that it neither shortens your life or extends it. If you use Dr.Google the figures they give out have to take into account ages and other underlying conditions. They can be scary but I have been assured that it will not shorten my life. ,🙏🤞

MummyLuv profile image
MummyLuv in reply to Nannysue1

so delighted to read this outcome Nannysue! I know how much agonising there was in that decision.

Nannysue1 profile image
Nannysue1 in reply to MummyLuv

Thankyou, yes there really was but I had really forgot what it felt like to have a steady heart, not to have to take medication and feel tired for much of the time. Hope that you had a lovely Christmas and wishing you and yours a very happy new year.

localad profile image
localad

unlikely a PM could keep the heart beating after a 'heart attack' caused by lack of blood flow to the heart muscle

dedeottie profile image
dedeottie

By the way, it doesn’t sound ridiculous at all. The only way I could get through the blanking period knowing that I couldn’t have another ablation, was to research and make peace with the idea of pace and ablate. In a way I am happier knowing that my decision making days are over. My ablation seems to have been a success four months down the line but if AF comes back I now know that I will have pace and ablate and then get on with the business of enjoying life. X

Afibflipper profile image
Afibflipper in reply to dedeottie

wry true xx

Singwell profile image
Singwell in reply to dedeottie

Sensible and pragmatic attitude! I'm 66 and have had ablation #2. All going well at present but if things go belly up I'm likely to ask for pace and ablate and have done with it!

Afibflipper profile image
Afibflipper in reply to Singwell

At 58 I’ve had 3 ablations and 2 cardioversions. Touch wood my HR is NSR, bit fast for my liking at 85-90. Still not back on my feet and have come down with a cough & cold so having to be careful the asthma doesn’t start as I’m 4 weeks post ablation and already had a big one straight after it. I’m just looking forward to next year and hope the slate is clean at the start. Long may you remain OK x

Golfer60UK profile image
Golfer60UK

Hi Afibflipper, had pace and ablate 18 months ago and have never regretted taking the decision. My energy levels are back to pre AF levels and only take a blood thinner.

I also asked my cardiologist what happens if they stop working, they don't she said with a slight smile, I said my background suggests it may stop. At this point she explained the heart has a natural reduced rate enough to get help.

Merry Christmas

Dave

Afibflipper profile image
Afibflipper in reply to Golfer60UK

thank you - good to hear you feel good after it x

Nannysue1 profile image
Nannysue1 in reply to Golfer60UK

Ditto to all of that

Afibflipper profile image
Afibflipper in reply to Golfer60UK

Ducky2003 answered below that pace and ablate doesn’t stop the arrhythmias it just stops the HR speeding -do you know if this correct as I thought it did stop them x

Golfer60UK profile image
Golfer60UK in reply to Afibflipper

Hi Afibflipper, correct it does not stop the AF but you don't feel any symptoms. I check my pulse regularly and occasionally AF shows, but I feel so much better, back to golf three times per week 😁😁😁

Dave

Slidingdoors99 profile image
Slidingdoors99

Thank you so much for asking this. I don’t know the answer, but it’s been recommended as my possible next step, so I will read with interest re what people say…

I hope you won’t have to go down that route (because, like you, it sounds really frightening to me!)

🤔🙏

Afibflipper profile image
Afibflipper in reply to Slidingdoors99

I found it a bit scary when I thought of that question. I’ve had a loop recorder implanted before (now removed) - thing I hated about it was when someone gave me a hug it felt painful as if pressing against rib or something but if I ever needed it it better to get your life back.

Good luck if you have to proceed with it - I have one of the Apple Watches which recognises if I were to fall but also you can dial SOS at the push of a button and it’s handy if my phone is out of reach xx

Slidingdoors99 profile image
Slidingdoors99 in reply to Afibflipper

Thank you for that and all the best in the future for you too Afibflipper.

Snowyowl01 profile image
Snowyowl01

I had a pm last June and AV Node ablation in April after failed ablations, complications and numerous meds changes that did not helped my very fast AF frequent episodes and trips to resus. I am glad i had it done and have regained control of my life etc. I will still have a natural HR of around 38 bpm if the pm should very unlikely fail giving me enough time to get medicsl help. x

Afibflipper profile image
Afibflipper in reply to Snowyowl01

That’s reassuring and glad it’s worked for you x

Adalaide2020 profile image
Adalaide2020

Thank you for asking the question. I'm 67 and just had ablation #4 I'm still in af and more often than before the ablation but it doesn't last as long. I have mulled over the P&A question for some time thinking I was too young to go this route, but I see there are a few folk in my age range who have gone that way.It is a scary decision to make, no going back, but I'm so tired of being tired and losing half my days to af. I have two more months to go in the blanking period and I am always positive so time will tell. It is reassuring to read how well folk have done once paced and ablate. Long may that continue. Merry Christmas everyone 🎄🎉🎅

Afibflipper profile image
Afibflipper in reply to Adalaide2020

So far my 3rd ablation has been continually in NSR - it’s taking me a while to get the tired no energy feeling gone but my pain has just about gone just need to get rid of this cold and hopefully 2023 will be brilliant. Good luck with your recovery xxx

Tut7iFru7i profile image
Tut7iFru7i

i have a pacemaker a year ago .i went to have an ablate 4 weeks after but luckily i didnt need it.i am on duretics and digoxin,bisoprolol, and rivaroxoban .i feel absolutley wonderful.as before i was so out of breath after 25ydsthrough heart failure.it took quite a while to mentally come to terms with all of this .but what we must remember in the not to distant future there will be break-throughs to repair all heart problems.look at the little boy who would probably died .he was injected with stem cells into his heart .he was on the news i hope you veiwed him -AMAZING xxxxxx

Afibflipper profile image
Afibflipper in reply to Tut7iFru7i

I didn’t see the article or programme about the stem cell boy

I’m so glad to from everyone and it’s so reassuring that everyone says how wonderful they feel - it does take a while to sink in doesn’t it - I had 3rd ablation 4 weeks ago, got asthma following the GA, now I’ve picked up yet another cough and cold. Thank you for sharing your case x

reinaway profile image
reinaway

I've just gone through the P & A procedure starting in August this year and can understand your reluctance to try it as it took me 10 years of misery to finally decide to do it. I spent endless days reading about the whys and wherefores and the fact that I will still have AF but not feel it. I suffered terrible mid chest pain and although I know when my atria decide to do a dance there is no pain and the odd feelings are momentary my pacemaker soon stops all that. I'm off all drug's except Apixaban and Ramipril and feel a new life is before me at last! Oh and one important thing is that I can Sleep at last😉 Have a fun Christmas 🎅

Afibflipper profile image
Afibflipper in reply to reinaway

so do you physically feel anything when the PM takes over? I have ad all this about 18 years but this year is the first I heard of P&A. I’ve had insomnia for years too, but it was only about 18months ago that I realised the the arrhythmias were what woke me. So glad yours doing well - have an arrhythmia free Christmas and and a dream new year xx

reinaway profile image
reinaway in reply to Afibflipper

No I don't actually feel anything except that my breathing calms and my diaphram relaxs.

in reply to reinaway

good morning, I’m looking at getting pace and ablation. If you still get afib, Did the doctors say that it still damages your heart? Or with the pacemaker settling things down, no damage is done by the afib? Thx for your time.

reinaway profile image
reinaway in reply to

My GP and Consultants have always gone at great lengths to explain to me that AF will not damage my heart but could cause it not to work so efficiently. I do have a slightly enlarged left atrium so I am supposing that's what they mean. I used to have episodes that could last anything from 6 to 24 hours or so with unbearable chest pain and abdomen discomfort and over the years tried every known BB which usually worked for a while and then failed. I can't take rhythm drugs because of CAD so that's why I decided on P&A. It is wonderful to be able to be AF sympton free and look forward to seeing my family again without worrying about having a debilitating attack because of enjoying myself. 😊

in reply to reinaway

thank you. I’m glad you are feeling better.

DawnTX profile image
DawnTX

I don’t know all the answers but here in the states CPR is just compressions now they no longer do breaths

Afibflipper profile image
Afibflipper in reply to DawnTX

Anyone fully trained and competent at CPR will use breaths and chest compressions. If someone who is not competent in CPR the hope is the compressions alone will pump the already oxygen rich blood around to vital organs while waiting for help to take over

Always call for help First whether competent or not at CPR so they are on the way

DawnTX profile image
DawnTX

Chest compressions only is the latest training. I was a medic and we were taught with both however I also watched things change off and on over the years since for us going into law enforcement. At one point the Heimlich maneuver was not considered acceptable. I say whatever it takes to save a life but you may be aware many people would not do mouth-to-mouth. I was part of the first group being trained as medics when aids first became a health concern in the states. There was a lot of paranoia which severely impacted people stepping up assisting the injured. They did develop mouth shields later on.

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