I'm 76, relatively active and still working in my health & fitness business. AFib first diagnosed at 50 (my bio has details) I have been on flecainide (Tambocor CR 200) single morning dose for the past 7 years together with bisoprolol 2.5 taken at night, apixaban 2 x daily and daily telmisartan plus 40/12.5 and diuretic. I had a reaction to Amiodarone. I had cardioversion 2 years ago then no AF until a long bout from mid December to mid Jan this year (the whole of the medical profession in SA goes on holiday!). Reverted to NSR without change to meds. Started AF 2 weeks ago and after a week my cardiologist told me to up flecainide, one dose am and pm but had unpleasant visual disturbance and no change to high HR and AF. Had successful cardioversion yesterday but woke up this morning back in AF. Apart from some breathlessness walking uphill I always feel fine during AF episodes. My options now are ablation and pace maker. I'm leaning towards pace maker. I find the replies to various questions on this website so interesting - I'm not sure what to expect but looking forward to hearing from you!
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It sounds like you may need a second medical opinion on this. In your shoes I’d probably be paying for a private consultation with an EP so I could have all my questions answered and weigh up the options. If your heart is structurally sound I’m not sure why you’d be offered a pacemaker?
Thanks for quick response Rainfern. I am with a private cardiologist physician, but I had not heard the term EP until this site and your post has prompted me to check where I can find one in Johannesburg. I have a microscopic leak from my repaired mitral valve, my tricuspid repair is still going strong after 15 years. I will take your advice and get a 2nd opinion, thank you
Thank you - I have heard on this forum that pacemakers don’t actually stop the AF so it’s good to learn that’s a possibility for some people. I never know if my persistent AF will return and I can now include pacemaker as a potential treatment for if it does!
I had a two lead pacemaker installed five years ago solely to allow enough beta blocker to deal with my bradycardia while in high tachycardia. It never stopped afib nor was it expected to, though I believe it helped. The pacemaker was to keep my heart rate from dropping too low. More recently ( last August ) I had an ablation which seems to have been successful. But no it wasn’t an either or. Eventually it was both.
There is a theory that AF is induced in some people by the HR temporarily dropping too low which allows rogue signals to jump in, in which case a simple pacemaker would be helpful.
That is what happened to me. The EP realised this when he was doing the second ablation and said no more ablations you need a pacemaker. I've now been able to take the medication Bisoprolol and Flecanide and so far keep well.
I am due a pacemaker soon. I have PAF which is becoming much more frequent - now around 50% of the time. I also have CAD and have a stent in right coronary artery so cannot use flecainide.
I have sinus node disease with Holter showing sinus bradycardia when not in AF. I am to have a "left bundle branch" pacemaker which means one of the leads is placed in a slightly different position from usual. I think the idea is to stop the bradycardia which is though to be triggering the AF, although I have been warned that I am likely to need medication as well or even proceed to ablation at a later date.
Pacemaker or ablation? Two of the consultants I have seen have disagreed on what is needed and this does not instil confidence. But the decision seems to be pacemaker for now and, since I am no expert, I have no choice but to go with the flow.
Good luck with this. I have heard very few complaints about pacemakers on this forum of wise people. In fact should I ever need one I would find all the confidence I need to go ahead right here!
Hi - sounds as though you are heading toward persistent AF, are not self converting to NSR but do convert on cardioversion so crucial point in your AF journey.
First question to ask - what type of pacemaker?
Second - how symptomatic are you? You say you can walk uphill with just a little breathlessness whereas I could not walk across a room in fast AF as my BP would hit the floor, just before I did! Many people can live in persistent or permanent AF as long as rate is controlled and find they can be active so a third option could be do nothing and accept that the Flecainide is not holding the AF so stop it. I felt SO much better after stopping the meds.
I had a CRT pacemaker fitted whilst in my 60’s after I was obviously heading toward persistent/permanent AF in 2018 with more and more frequent bouts. I could not take any meds by then and had two ablations in 2013/2014. I took a very long time to recover from the second ablation, as many people do, but it gave me 3 years AF free so not always a forever solution.
The pacemaker reduced my AF burden from day 1 from AF burden of 70% plus to 2% today. I have to say I have always self converted to NSR - eventually - longest bout was about 4 days. Pacemaker wasn’t without problems initially but has been of more lasting help to me than anything. I take anticoagulant only. I seem to be unusual but my EP does know of at least 12 of their patients with similar experiences who have benefitted from CRT alone. Mine was implanted in preparation for the ablation of the AV node making me pacemaker dependent but as it worked so well within the first 6 weeks I postponed and then cancelled the procedure. 8 years on I feel unbelievably better so it was the right solution for me.
Do you mean of pulmonary veins in the hope of stopping AF? Ask a LOT of questions as outcomes vary so much depending upon your age, health and fitness; the competency of the EP and their equipment; how you recover; the vagaries of this condition as the source of the irregular pulses may be ablated but a new source may then pop up.
Pace & Ablation of the AV node is a last resort treatment option, alongside Amiodarone but both can improve QOL hugely but is not worth considering unless you are very symptomatic.
Only you can decide, you say you are fit and active so in your position, knowing what I know now, I would research the pacemaker option but ensure that the pacemaker was 3 lead and had an AF algorithm.
Suggest you look at the Medtronic website to view the different types and ask searching questions.
Unless I'm missing something, a pace maker in cases like yours is a last resort after medications and multiple ablations have failed. I would opt for ablation if in your shoes and I pretty much was and did. Only regret was I didn't have the ablation earlier in life.
Just to be clear, is that ablation or pacemaker or is it pacemaker plus AV node ablation. The second would make sense, the pacemaker alone not so much unless you need it to allow more aggressive treatment to bring the rate down. Ablation is less likely to work if you have persistent AF.
Ablation is less likely to work if you have persistent AF.
Odds should be similar unless you have long-term persistent, meaning continuously out of rhythm for at least a year.
Pace and ablate is permanent dependency on a mechanical device. Unclear if even medically indicated. Given what we know/don't know, I think the best advice is a second or third opinion from a good ep. And I would also get one from a cardiothoracic surgeon who performs mini-maze or similar.
I have not read through all the replies, but I am sure someone has said this already: an implantable cardioverter defibrillator can stop/prevent a-fib, but a pacemaker won't do that. A pacemaker also can't control a high heart rate. They are very similar things (pacemakers and ICDs), but different.
Ablations are not major procedures, so if its recommended then go for it - only the Lord knows if it will be successful (I have had 2). If a pacemaker is going to help you, then I wouldn't hesitate getting one and they are usually a longer lasting solution than an ablation - but I can't see how its going to help you.
Prof Chin at UCT Private Academic is a genius rockstar EP - if you can't find one in the City of Gold, I recommend contacting them to point you to one.
FWIW I am in constant a-fib and have a pacemaker to prevent pauses in my heart.
I had both, the Ablation although deemed a success was not and my HR started to dip too low and I had 'white outs' same as black outs although I didnt pass out as such so they fitted my trusty pacemaker which has been a God send, in fact just had the battery changed and they said they would see me in 10 years (they'll be lucky lol). Good luck x
hi. Just to say I have both a pace maker and AF. My last ablation was June last year. I’ve had a pace maker about 8 ish years. My pace maker doesn’t protect me from AF . My pacemaker is for sick sinus. I’m not sure this helps your decision making but thoughts just share that my pace maker doesn’t actually prevent thevAF.
omg Stormy, we may well have been in old Papworth at same time, same Francis ( lives near me ) and Len Shapiro. We are same age too and possible rheumatic fever as child. I knew nothing of that though!
AF kicked in after bad flu 12 years ago. At first no one believed me bla bla, then horrible medication now it is persistent/ permanent AF . Mainly controlled by apixaban, digoxin and losartan. 2 failed ablations . Now rheumatoid arthritis in various forms has kicked in . Deal with both usually , our wonderful nhs has crumbled and one cannot expect the support from hospital or gp. ( in my case here in Cambridge, other aress msy be better).
Like you stress is abundant ( unfair at our age) and death of loved ones . These impact hugely on my health !!!!!!! And morale!
I hope you make the right decision and get the support you need! Let us know . Keep feisty!!! L
Hi Luludean! It's great to 'meet' you! Thank you for your thoughtful response. I always joked with Mr Wells that he was the only man who truly held my heart in his hands😍has he retired now? I'm sorry you're not in the pink but like me you love exclamation marks which I think shows an upbeat personality!
the best thing I ever had was the CRPT pacemaker , I have multiple atrial arrhythmias , initially my cardiologist put in a dual pacemaker with high doses of drug therapy to help with tachycardia’s, to say it wasn’t a happy marriage was an understatement. To within2 years I saw an electrophysiologist who suggested the 3 lead CRPT and hay presto I was a walking and talking new person. A year later an anode ablation as I was having 3% breakthrough . It’s made my life so much better . The pacing needs to be set up by a wise EP as those pacemakers need a specialist within the EP world . The recovery period for me was a little rocky but I think that unusual. Go for it if you can find a suitable genius to perform the magic . I am still on apixaban, and calcium channel blockers for another heart problem .
I am sure many of the members will be offer you advice based upon their own experiences. Everyone's journey and experiences of AF varies on an individual basis, including treatment options, and will obviously cause some anxiety. If you prefer to contact a member of the Patient Services Team for advice and support, then please feel free to contact us: heartrhythmalliance.org/afa...
I have also attached a link to our 'Treatment Options for AF' booklet for an overview of treatments to share with family: api.heartrhythmalliance.org...
a pacemaker only stops your heart from going too low. Both me and my husband kept fainting low heart rate. Pacemaker stopped that. I believe that there is a pacemaker (the rolls Royce of pacemakers we are told) that does stop a too high rate, but I can’t remember what it is called
Ablation many people get short term or long term relief and easy for you to look up on this site
I wonder whether the slight breathlessness on exertion is a result of both your heart rate going higher and the lack of atrial pulse from the AF pushing the body’s oxygen into mild deficit?
I get similar and cope well with my AF. I’m awaiting an ablation but a PM has been mentioned in passing. I have LBBB alongside which adds to fatigue and reduces my rate, too.
Hi Steve, thanks for sharing and yes you are correct in your wondering. Because I live at fairly high altitude it doesn't take much to push my oxygen levels down and my apple watch continually warns me that my HR is above my training zone when I'm in AF whereas in NSR it annoyingly tells me I'm always below! I had to Google LBBB (Left bundle branch block?) but no wiser as to what it is, it was like reading a strange language. Please explain- I'm learning so much from this forum!
I’ve got it and it means the ventricles aren’t beating quite in sync so on an ecg the R wave, instead of being a very narrow upside down v is more like a mountain with a bit of a bump halfway down, or, more extreme a w upside down at the top or else a little plateau! I posted a picture of my rhythm strip recently.
As Buffafly says - but I'd add that it's an odd thing to have since online suggests it's pretty much symptomless but many with it know it's not. My ectopic beats and AF are much less trouble to me than when the LBBB "switches" on when I can feel slightly breathless and tired.
Heart block sounds the same but is different. It is categorised from 1-3 degrees, if I recall and can be of no consequence or a serious complaint depending on the severity. It's when the electrical signals from the atria completely fail to reach and stimulate the ventricles to beat.
The "branch" blocks are very different. The branches refer to two (left- and right-) elongated bundles of cells that conduct the atrial signals from the atrium to the two ventricles. A block in one of these, which seems to me to switch on and off at will, is usually much less important because it is easily compensated by the one that remains working well; except that the compensated beat comes a touch late and creates two "R" waves on an ECG. These are so close, however that the appearance is a wide peak or one with a dip at the top. You'll see it below.
Aren't they - so complex. It seems to me that the closer the scientists and doctors look, the more they realise they don't know as much as they used to think they did! I read recently that it's not truly known how beta-blockers work, for example, despite the seemingly full explanations online. My son showed me an article last week that showed how serotonin, which is supposed to be the "good mood" chemical which a third of the nation is taking as SSRI tablets has nothing to do with moods after all...
had a pacemaker for two years. Best thing I’ve had done, but I didn’t really have options. Bottom line is do not last. You are still going to get the feelings of a fib or flutter, but they are not going to be doing damage I don’t know what you do in your business. You are going to. be somewhat limited while you heal. Those leads really need to anchor in if you are getting one with leads. You sound in great shape to be getting one. It took me almost a year to really feel 100% but when I say that it wasn’t anything so bad or painful. it just heal everything‘s been traumatized so you have to really take it easy especially moving that arm. I am aware when I have my I don’t really get a fib, but I do have a typical It’s just there I won’t say it really bothers me. I’m just aware of it. Only a few times have I had some really bad thumps. I had tachycardia and I had a it for six months after the last ablation that was a bad one everything about it was bad, including not being able to walk even standing up the pressure was a nightmare. I am so thankful I found the doctor that I did. They tried to cardioversion worked for a couple of weeks it was heaven, but the second one failed completely. Nothing was helping and I have heart failure because of the tachycardia. The day I was going home from the hospital after the AV node was done I couldn’t believe how normal and good I felt considering what had just been done. I was able to stand and get into the car I had arrived by wheelchair because I had no choice. sounds like a miracle it was for. I personally would get it while I’m in good shape like you sound that you are. You sound so smart about the whole thing. Everything is a Band-Aid. It’s about having quality of life you definitely have quality of life from the sounds of it right now. I would love to see you continue and not wait until you get as sick as I was to get a pacemaker. Every day they are improving on those my doctor unfortunately has gone to Florida, but for a good reason. He is director of the university of Florida We are in touch. I have seen some of the things he is teaching. It’s amazing the wireless pacemakers are so small not that mine is large, but it’s good about no leads. my doctor believes in quality of life for the two years since the pacemaker I have felt normal. When I have triggers, I’ve done it myself lol they aren’t that bad. I’m just aware of them. The hardest thing for me was keeping my left arm from waving around I’m Italian. I talk with my hands lol.
ablations are very hard to get the right spot. I have so much scar tissue from the last ablation that my doctor couldn’t consider doing if he wanted and he the odds of getting the spot are so just doesn’t like them. I had previous ablations one lasted six months the other a year, so it was pretty good as was my meds, but after that, it was all downhill my third was a total failure and a nightmare that’s was created along with everything else including tachycardia. I already had it but this time it was permanent around 200 and constant I had an implant of a loop recorder so they have records of everything. My P felt it was urgent for my heart and for me to have the pacemaker. I also have HIS pace bundling and three leads. The third lead is not attached right now. All four of my heart chambers have issues at least the other one is there and ready to use if necessary lol even my pacemaker is different. My doctor had to create it from a shortly after coming out of the I was called unique I’m thinking of legally changing my name to that lol even the tech that’s been with since the OR teases me about being unique. that’s me. I never want to be like everyone else. it is your body. I don’t see any downside to a pacemaker and AV node. Make sure you get that without it. It doesn’t make sense to me. Once you have it, the pacemaker is in charge. People worry because you’re dependent upon it, but it’s not working right anyway if things were working right, you wouldn’t have a fib. Sooner or later you may need one anyway I’m jealous you sound so healthy not really I am happy for you. It’s a good time to get things done. Within days of getting home I was able to take my big dog 69 pounds out and I was so happy I still get tired, but I can actually grocery shop I been able to do for over a year because I couldn’t walk or even push the cart because my arms were also affected.
good luck you decide there’s got to be a reason you are considering it. My doctor made it easy. I had so much faith in him. He always made me feel swaddled in safety. He’s been gone for six months. I will be meeting a new the middle of April and I think I have found another diamond. Their training and everything is almost identical if you changed names on resumes. It would be hard to I have spoken with a few of his staff. They seem to love him just like my other one was loved. They are both young and forward thinking outside of the box. My other one told me I wasn’t going anywhere. I don’t know what I said in the OR, but after that, whenever I woke up from a procedure, he would be standing beside me patting my hand. He would say I told you you’re not going anywhere. I was sure I was going to die or I wanted to just before this procedure. It was that bad and painful.
let us know how you are doing and what you are doing doctor looking for a candidate I would pick you you sound so positive
I just saw your bio. Caffeine doesn’t really bother me. Although I can feel a little bit. I have switched to mushroom coffee. It’s yummy. it’s half the caffeine and has other gave his blessings. Stress getting upset in anyway can shoot my heart rate up crazy.
Ciao DawnTX! Thank you for sharing your story, what a ride you have had! I didn't expect so many replies from such wonderful people. I love reading them all and the variations about treatments don't worry me, it's good to get such wide opinions and every heart is different so yes you are unique. I don't love the taste of coffee so going without is fine, I do love Red Bush (Rooibos) tea which is naturally caffeine free and locally grown - you may find it in your local supermarket - give it a try!
I am also a I have a black tea with spices chai that I like to sip on also Thai tea which is awesome when it is iced. I only have one cup in the morning although I’ve been sipping at night after going to bed, I don’t know why it’s just something I started doing. It’s very soothing. The mushroom coffee is almost like I add some cinnamon and ginger. The other one I drink is called lol it’s actually instant so you can pour in water. I like a little bit of French vanilla creamer with it. It has become my dessert. I’m not a big coffee lover. When I worked. It was just something you did. It seems to be the only routine I still have in the morning lol
as far as opinions I always say we are all different. You have to go with your feelings how much you want to deal with because I don’t know what you’re a fib is like. I don’t have a fib usually I have atypical annoying they say pain has no memory. I don’t know if why I don’t really remember the beginning. My first episode was me waking up on the floor. When I was on amiodarone, I was really sick. Evidently I didn’t tell my doctor how sick because when he saw me, he pulled me right off of it. I was trying to roll with it and give it a chance to work. This is all new to us. What do we know? I see people writing on here that sound like books I don’t bother getting into that because it doesn’t change a fib and are what they are. It doesn’t matter how often you get it unless you are getting physically ill and damaged. there was nothing more they could do for My heart failure was 40 ejection rate. There was nowhere to go, but down at that point we all have our reasons for our decisions. I didn’t really need to make one. There was only one decision to do my was my everything also, if you knew my background, you know I don’t get easily swayed. I was just came into my life when he did. He was the whole everything for could meet him and hate him. Who knows? I don’t try to talk anyone into anything. I just share my story. I will have to check out your tea. I be able to drink licorice fruit, but one thing about all of these things is it depends what you are taking for meds among other things. Because I am on an anticoagulant and high blood pressure med licorice is not a good thing. There are other spicy flavors you can use. It’s too bad because it has some great things it. My friend had sent me a big bag of organic when I was so sick and could not stop coughing my dry cough for over a month because it heal the lungs supposedly. I say supposedly to everything because it could work for you and not
you have a great attitude. I have seen a couple of you on here today and it is awesome sometimes not to be mean but some people are so dramatic. They talk about they took this pill or they had this done and now they just had a fib again people need to realize it doesn’t go away. It settles down it acts up when it wants to some people are much luckier than others. We have a lot of moving parts inside of us it’s not even always the and it depends on which part of it. The more I about mine I feel like somebody got a Lego set and didn’t know what they were doing playing with it lol wow my heart is all mixed up. I have a weird sense of humor. It comes with having been in law enforcement it’s a way of protecting your psyche. I always say I’m not allowed to play with real people lol.
best of luck with everything try to stay positive I think that’s one of the best medicines. I’ve been having trouble doing that lately and when I let that take over, I feel lousy. I’ve always been a person that believed that if you look around, you’re see people with so many kinds of problems much worse that you will feel lucky and blessed. Since my a fib journey, I know I had that six month bout with that bad doctor but overall, I think life has been pretty easy on me compared to others. my adopted little brother has he’s only 58 unfortunately it affected his attitude or whatever and he has turned against people because I was supposed to be with him through the end. He has decided to choose that. That to me is much worse than having my flutter. I’ve never been big on feeling sorry for myself. I have had serious depression and anxiety. It’s not fun. It’s like being in a big black hole. If you know anyone with it, please be kind. We cannot snap out of it.
this site is fabulous knowledgeable people with all kinds of information for us and some of the greatest people I’ve met. I wish we were neighbors.
dont go with pacemaker ,thats what i did and a year later i got an ablation that fixed everything and now i am stuck with a pacemaker that has don e nothing but give me problems and having g it removed is very dangerous i hear .
I don't understand the reluctance about ablations I see here. Perhaps I'm missing something, but the ablations I've had worked great and there was minimal pain and discomfort involved. Save for one ablation during which I regained conciousness, the worst part of the ablation was the IV to get started and it was minimal. Even being conscious during part of the ablation wasn't all that bad in retrospect.
Honestly, though the pain from the ablation wasn't insignificant, it wasn't really that bad. I could have easily endured it much longer than I did. And I told the docs that. I woke up in the middle of the ablation and the docs yelled, "Don't MOVE!". Then a bit longer, they asked me if I felt pain and I answered something along the lines of "yes, but I can handle it." It was a burning paid with a strange buzzing sensation. The docs then said "Stay still. We're going to give you something for that" and shortly there after I was out again. In fact I consider experiencing it a blessing because I now know exactly what heart pain feels like without having to have a heart attack. Nobody should let my experience deter them from getting this miraculous treatment if they are eligible for it. Because what happened to me was creepier than it was painful. I am also guessing they had me all doped up with benzodiazepines or similar too.
I too had awful pain during my first ablation. I was sedated and couldn't do anything, I remember thinking 'this is unbearable', like being crushed but from my back, not chest. They must have noticed because I then was put under. When I woke up I was told they had to stop the ablation, had a second one later under general anaesthetic. Don't want to put anyone off having ablation though, I got my quality of life back.
After being checked out with all the various gearthey found my left atrium to be 75 ml which is to large and cannot be ablated successfully. I was a good candidate apparently for av node ablation..The pacemaker was put in 4 years ago and ablation was denied by the cardio i was handed over to. For most of the years since ive had to put up with a miriad of drug trials. Short story is i have now had the node ablated 2 months ago and now most symptoms are reducing. Its great for me so far. Regards Colin from nz.
I have Afib and take medication and had a pacemaker installed because of low blood pressure and low heart rate (which I've always had) When I started having Afib they put me on medication and I ended up in the emergency room when my heart rate went so low that I blacked out. They code blue'd me so decided I needed a pacemaker. Finding the right amount medication has taken me at least a year but my Afib is in check at the moment. I think Flecainide has different reactions to different people . I don't think my pacemaker can stop my Afib but it might help. If they ever suggest ablation I will say YES because I have always had reactions to new medication , (I'm not a very big person). Again for Afib I don't think a pacemaker would be a cure-all,
I know this might sound strange, but if you are with an EP who has a LOT of ablations under their belt with a good success rate, then I would give it a shot… while the pace maker helps if you are in permanent Afib, it is still far better to be in NSR… a pace maker should be the last measure taken generally. But this is a procedure that requires a lot of experience from the EP doing it… it is particularly nuanced, don’t be afraid to ask the doc how many he has done! Thousands would be preferred!!!
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