pacemaker

it it a good idea to have a pacemaker put in to hep control a fib

Hi Vincent

No, having a pacemaker installed is not common done, in the absence of deep bradycardia, for controlling early stage AFIB. Some less progressive EPs will default to an AV-Node ablation with many older folks, which will include requiring a pacemaker implant as well, since once the AV-Node is ablated the person is 100% pacemaker dependent for life! This scenario does not cure the AFIB or even stop it, it just makes the person less symptomatic not feeling their heart rate out of rhythm, but they will still be in long standing persistent AFIB and will need to be on permanent blood thinner therapy too.

Needless to say, this is NOT an ideal therapy for AFIB control, and the truly elite level ablation EPs rarely, if ever, have to resort to an AV-Node ablation plus pacemaker to manage an Afibber's advanced case of persistent AFIB most effectively.

My rule of thumb .. if your EP is suggesting you need a pacemaker strictly to control your AFIB (which it won't do very well in any event) or as part of an AV-Node ablation as their more or less cop-out solution .. tell him or her "thanks, but no thanks" and head for the hills!

That being said, please note there are some circumstances with very old Afibber's with multiple CVD co-morbidities where they are no longer a candidate for an advanced ablation process and may not have too many years left on their calendar as it is. In such cases, an AV-Node ablation plus pacemaker, mainly for symptom control for the remainder of the patients life, can make sense.

But it is not an ideal solution for other younger cases and/or those older folks who are still in pretty good health.

Be well,
Shannon

29Vincent.

Shannon will be spot on no doubt but I can't resist telling a tale about the possibility of having a Pacemaker fitted for my Afib back in 2007 if I remember correctly.

Without going into detail I got Afib back in July 2006 whilst I was living and working in Chinese Macau SAR which is a small ex-Portuguese colony of about 450,000 persons so as you can imagine the medical facilities were not state of the heart so to speak. The doctors there were very helpful however they did say that if I wanted top drawer treatment I would have to go to Beijing the capital city of China. I said thanks but no thanks as I was back to the UK on holiday in about three months so I would see the top doctor in the North of England no matter what the cost. By reading this forum I was well read up on my condition and was sure I could have a good quality conversation with the doctor as there would be no language problems as there were in Macau.

Fast forward to my visiting this top heart doctor in his luxury offices in Manchester England and my great expectations of words of wisdom coming in his thoughts on my condition. This 40 minutes chat was going to cost me GBP200 (approx300USD) so I obviously wanted to get my monies worth.

"Well first of all I would try Digoxin" says the doc to which I replied "a junior nurse in a Macau Hospital told me that nobody takes that any more for Afib" his faced dropped. ( I had initially been using digoxin as given by an old well respected private Chinese doctor in Macau)

"Well in that case I would put you on Flecanide" to which I replied "that doesn't work on me but it could be used in an emergency as Pill in the Pocket, I want to stop this Afib permanently" His bottom lip fell out.

Very put on the defensive by my polite replies he said " Ok if that's what you want I can put a Pacemaker in" to which my reply was "ä Pacemaker has no effect on the stopping of the Atria fibrillating". Eyes now bulging he almost snarled "well how long do you want to live" ( I was about 57 then) so I said "well I have a four year old son and I would like to see him aged 21". In triumph he then roared "in that case it will take three batteries". I then proceeded to explain about Afib which totally blew him away for about ten minutes before I left to go down and pay the consultancy bill to which the cashier said "No Charge"

This would suggest that treatment of Afib 10 years ago in the UK was miles behind the likes of Dr Natale and The Bordeaux Team.

My sister who had taken me to the appointment in her car was almost in tears laughing when we left the docs room and I still smile when I look back on that day - hence why I have written this post ;-)

Barry G.

Sadly, the Stone Age still exists in some reaches of medicine. I "fired" my first cardiologist for refusing to do an EP consult and suggest maximum doses of betas plus a pacemaker. I didn't know then what I know now, but it just sounded a bit more "hammer and chisel" than "pen" if you get my drift. Glad I trusted my instincts!