I’m 80 and been in persistent AF for one month now struggling with the symptoms because any exercise makes me very tired and breathless with tight chest. I’m on 5 mg bisoprolol and heart rate does not go above 100 when resting and in exercise rises to about 130. Previously have a resting heart rate of about 55 when in NSR.
NHS cardiologist recommends ablation. Long waiting list so I went to see Private cardiologist who has recommended pacemaker followed by node ablation. I’ve been doing a lot of reading and cannot quite understand why a pacemaker is going to help my AF. far as I can understand my heart will still be in AF.? And how determine what rate to set the pacemaker? Will the pacemaker put extra strain on my heart muscles? Will I be aware of it beating? How will it affect me in long term and when I’m dying? I’m feeling really scared have any of you been prescribed pace and ablate to cure PAF? How do you feel?
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Midnight2022
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I am 80 and if offered P&A would jump at it because I have read lots of reports from others who had it and because I’ve already had an ablation which failed after two years and if I had another procedure I’d want it ‘one and done’ so I could get on with my life in peace! I can’t go through all your queries but I believe the AFA has a good leaflet on the subject and I hope one of the Admins will point you to the right one.
Hi I totally understand your confusion and I can only share with you my experience. Firstly, an ablation might cure your AF but it's not unusual for AF to come back. Secondly a pacemaker won't cure your AF, nor will an AV node ablation but it will control your heart rate whilst at rest and when you move around/exercise so you won't get the irregular or overly rapid HR that you get with AF.
I have atypical atrial flutter, my resting HR was a bit lower than yours because I have a grade 1 heart block, this meant I couldn't take enough beta blocker to control the AFl without my HR becoming too low. Currently I take 5mg twice a day + digoxin, this generally keeps me out of flutter or at least stops my HR being affected but I need a pacemaker (set currently at 60bpm) to keep my heart rate up (previously I could only tolerate 1.25mg bisoprolol daily). Although I generally feel pretty OK I am somewhat slowed down by the drugs and at 76 it does affect my QOL. I've been offered an AV node ablation because it means I'll be able to either drop the bisoprolol completely or at least reduce it substantially.
I haven't been offered an ablation for the AFl because my EP doesn't think I'm a good candidate and it's unlikely to be successful in the long term. Also an AV Node ablation is much more straightforward procedure. My pacemaker responds to exercise as well as keeping my HR dropping too low, I can walk the dog at a brisk pace
whoops sent too soon! I also do reformer pilates but I do get very tired with the drugs and will be very pleased to reduce or get rid of some of them. I hope this helps.
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Hi, I'm also 80 and had the pacemaker implant part of Pace/Ablate just 9 days ago. It was the Medtronic Solara CRT-P (3 lead) which has anti- AF algorithms. I haven't noticed any difference in my symptoms yet so unless I do, the ablation part will be in about 8 weeks or so.
I was very reluctant to go for this as it is so final but so many people have said what a difference it has made to their lives. Plus the fact that I have already had 5 ablations, the last one 8 months ago, also LAAO & numerous DCCVs ( 28) this was the only choice left to me other than stay as I was.
This would hsve been a poor QOL.
At the moment , apart from some soreness, I'm not aware of the PM although I can feel it. I know I shall feel apprehensive about the ablation part but also at the same time looking forward to feeling some normality after 32 years since diagnosis.
Hope that helps. You can always pm me if you want further info.
For me the argument that node ablation at our age is not realistic. Ive just had the ablation part just 5 weeks ago and my argument against finality is that so far i had been on the finality of terrible drug side effects and so are millions world wide who are lousy side effect drugs for all sorts of things. So far im much better off. Apparently my pacer has 6 and a half years left at the rate its being used which is full time of course. At the time of its replacement i presume i will het the very latest edition of 2031. COLIN
I had CRT pacemaker - similar to Jalia but in 2018 so earlier model. From the moment implanted my AF improved. Worked so well for me that I didn’t go for the AV node ablation, best thing I ever did!
I’d had 2 ablations in 2013 & 2014 - first made things worse & second gave me 3 years AF free.
If you are young and fit then ablation but as we age the chance of good outcome diminishes. Took me 9 months to recover from ablation, pacemaker a few weeks.
I wouldn’t hesitate in going for pacemaker considering your age but explore your options and research the detail - what sort of pacemaker etc etc.
Also 80 and now in perm.A/F. I had an ablation in 2015, told it was successful but very shortly afterwards I had a Pacemaker fitted, it is paced to suit age and condition, mine was set at 60 and if really was a life changer. A little uncomfortable after the implant, which was undertaken in a day clinic, but after a couple of weeks all was well and it has just had a battery change to keep me going another 10 years!!!!! When we die I believe it is the Funeral Director staff who remove it, I'm donating mine to dogs...... As for my condition, well I still had to take heart drugs after the ablation and with the Pacemaker together with anticoags due to having had a stroke in 2000 and up until breaking my hip two years ago was fully active, played competitive table tennis twice a week and did exercise to music classes so as near normal life style as possible. Originally diagnosed when I was 54, travelled the World and enjoyed my life to the full. Good luck x
I have afib and tachycardia. Consultant didn’t know whether ablation or pacemaker. He decided on pacemaker. It was so easy and absolutely painless
Of course my pacemaker is because my heart rate kept going below 30 snd I would faint or feel very weak and lightheaded
However with the tachycardia although thankfully it doesn’t raise to the enormous levels as before, some pacemakers also have the ability to be set where heart rate doesn’t go above a certain figure
I certainly most of the time feel so much better and was stopped on my flecainide, but given a higher 2.5 dose of bisoprolol, but BP dropped too low snd afib made itself felt again snd high heart rate. So went back on flecainide and dropped back to 1.25 bisoprolol
My husband also has a pacemaker and improved his life tremendously. He is 83 snd I am 81. It is such a simple and painless procedure, no you don’t know it’s there or hear it, and normally the rate is set to 60. Of course that depends on your EP or cardiologist. The scar is only about 1” long, but you do have about 6 weeks where advised not to stretch up high with your left arm until the leads are settled into your heart properly. Not a problem there. The good thing too is that you are given a monitor to go beside your bed (about as big as a small mobile phone) snd this gives readings to your hospital to see how you are which is quite comforting
I wish I could have had the pacemaker which also stopped the high heart rate like some people on here, but as that cut off is 130 since the pacemaker bisoprolol snd flecainide it doesn’t go that high any more (it used to go crazy sometimes to 169-240)
Hi Midnight2022. Im 82 and had a Pace and ablate completed 5 weeks ago. The Pace maker went in 3and a half years ago and the Node ablation was done 5 weeks ago so im all done now I can tell you from .y experiencr dont let any cardio deny you the ablation. I had to put up with a myriad of terrible drug trials all because i was handed over to a cardios care after the pacemaker inplant because that cardio didnt believe in node ablation. So a lousy 3 years more of suffering that i didnt need. The ablation is so simple as well. Its a bit late at night here in NZ so i will sign off for now but get back to me anytime for an upfate of my expetience. COLIN
If it were me, I would do the ablation asap! If there is ANY chance of nsr for you, I would do it right away, the sooner the better for a few reasons. A pacemaker is in the case that nsr is not possible… and it would keep your heart rate at no less than a certain rate, that they determine. My father was in the same situation as you, and the pacemaker has given him more energy because it assures a minimum rate. There may be other reasons, your doc can tell you that. Good luck!
Hi there. If you search "pace and ablate" or "ablate and pace" you will find my (and many other) postings. It's been pretty good for me, but they are still fiddling with the settings on my Medtronic Azure pacemaker. Apparently it's more of an art than a science as people vary so widely.
I had a pacemaker fitted last summer and I don't notice that I have it. Although I do feel much better as my pulse is now in the normal range - was in the low 40s before. I can now take the bisoprolol and flecanide and my AF seems a bit more under control. Like others have said a pacemaker will not cure the AF but will keep you heart rate at a reasonable level, although it won't stop it increasing from exercise or AF.
if I could’ve chosen from day one I would’ve gone for the pacemaker and the quality of life it has given if I could’ve seen ahead, unfortunately we cannot. your AV node is the natural pacemaker and it’s messed up by blocking that your pacemaker will be in charge and keep your heart beating right. You have nothing to do with the way it is set, etc.. All you have to do is relax. listen doctor allow yourself time to heal. It took me almost a but it’s not difficult no excruciating pain, etc. it just heal like any or trauma. It does not heart failure from 40s to 70s for ejection rate. most of the time all I feel is normal and I can do pretty much anything. That being said you are 80 I am 72. That’s gonna change what we can do but it has nothing to do with the pacemaker, etc. you might be exceptional and be able to swing from the moon I didn’t have any option, but I’m glad I never thought I could feel like this again. I was unable to walk for six months because of my circulation standing up to breathe made me cry. I didn’t know why I was still on earth and I wasn’t sure I be but then along came this incredible EP.
I think most of the people on here will tell you there’s nothing scary about the pacemaker people talk about being totally dependent on it, but you don’t have anything to count on right now because your heart is messed up anyway. A month is not a long time. I don’t know how bad your a fib is what it does to you.
need to sit down with again and get the full about quality of is no cure ablation is a Band-Aid that is going to fall off most likely not always. I was not impressed with them although I appreciated the gave me from a fib and flutter. It depends. Do you want to let a your life? I don’t know anything about you how bad it is everyone’s different you and I could have exactly the same and I might feel it differently than you do. Talk to the doctor mention your age and how you would like your life to be what things you do right now because of a fib? For me, I couldn’t stand up and get to the bathroom without almost blacking over and by scuffling in pain. be honest with yourself how bad is it if you’re bumps and palpitations I find them annoying not painful unless they interrupt my breathing. Best of luck whatever you do don’t keep yourself from getting the pacemaker if it really points that you could use it. if you go for the ablation, it’s going to take a year just to get it then add the time to heal I would consider it a waste of time, but I would never tell anyone to get a procedure. It’s your choice. I just saw a little bit of butterfly below. I can see she pretty much agrees with me. I have no regrets about my pacemaker. when I say a lot of things like fatigue not pain with a fib and always have learning curves. Be aware if you get a pacemaker, you are still going to feel a fib and flutter from time to time it just no longer damages the that’s why they do the AV node.
I can't remember all the details (over 5 years ago now. I also had persistent AF but didn't have the debilitating symptoms some have described however, for no apparent reason I collapsed at home unconscious for a few minutes. Consultant Cardio was concerned that I had experienced a "ventricular" event and to protect in future he suggested I should be fitted with a defibrillator(which also has a pacemaker function). This done I was more symptomatic than previously but in the event of a further collapse the defibrillator should kick in. It took a while and several visits to Cardiology to try and sort out the pacemaker side of things, basically my natural pacemaker was often at odds with my fitted one. At that point the med opinion was that I should have a node ablation. All I can say now after 5 or 6 years apart from a lump in my upper left breast area I have no symptoms at all. Pacemaker is set to 65bpm unless there is extra demand (exercise etc.) when it might go up to say 130bpm. Everything seems to be functioning normally and I'm oblivious to any side effects at all. BTW I will be 83 at my next birthday. For me it seems to have been (and still is) the perfect solution. Hope this helps.
if you have a pacemaker fitted the AV node ablation. The pacemaker then controls your heart rate & rhythm. My heart rate has reduced from 140Bpm to a very stable 70bpm so the pacemaker has been a big improvement for me.
I’m very similar to you. Only difference was that I had an ablation but unfortunately I had a TIA during op.
I’ve since had a pacemaker and have never looked back. I’ve had a couple of episodes of Afib and like you I’m a permanent afibber. I have a cardioversion each time and it does the trick. Pacemaker won’t stop you having AF. I would ask for a cardioversion to get you back into sync. You will feel better immediately. Be firm with them.
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Ablation v Pacemaker 
Post pacemaker implant and AV node ablation 
AV NODE ABLATION
