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I don't understand pace maker therapy

Posted by tsco 
I don't understand pace maker therapy
January 12, 2018 07:18PM
Admittedly I should know the answers (from experience) to the following but am calling on my experts out there for clarification. I am experiencing something weird again. Had pacs past week.they have subsided but upon exertion or an increase in heart rate, I have some palps until HR goes back down. Feels like Junctional or lbbb I have experienced years ago. Have no idea why it would start now. I'm on 12.5 topol (am), 50 flecainide (pm). Is the following true about a pacemaker?
- A pacemaker would eliminate the need for anti arrhythmia drugs like flecainide (used for afib)
- A pacemaker would resolve weird rhythms I have like Junctional and lbbb etc (I thought due to the use of higher dose of flecainide in the past just 50mg now)
- A pacemaker would aide in afib by always keeping the heart rate normal (speed and not erratic)

So if you are in afib with a pacemaker, do you still feel panicked? The atria are fast but the heart rate and cadence should be normal right? Seems it would feel better.

Is the protocol the same if you go into afib with a pacemaker? Pip, etc.

Thanks folks as I get older and more weary of the curve balls my condition brings I. Need to weigh options. Dealing with one issue is hard enough but sure didn't bargain for all the things it brought with it.



Edited 4 time(s). Last edit at 01/12/2018 07:27PM by tsco.
Re: I don't understand pace maker therapy
January 12, 2018 11:16PM
Quote
tsco
Is the following true about a pacemaker?
- A pacemaker would eliminate the need for anti arrhythmia drugs like flecainide (used for afib)
- A pacemaker would resolve weird rhythms I have like Junctional and lbbb etc (I thought due to the use of higher dose of flecainide in the past just 50mg now)
- A pacemaker would aide in afib by always keeping the heart rate normal (speed and not erratic)

So if you are in afib with a pacemaker, do you still feel panicked? The atria are fast but the heart rate and cadence should be normal right? Seems it would feel better.

A pacemaker only sets a floor on your heart rate - i.e. 60 BPM or wherever. It won't keep you out of afib. There is a very out of favor approach where they destroy your AV node and put in a pacemaker. This will give you a regular ventricular rhythm. It won't keep your atria in rhythm. It won't do away with the need for anticoagulation. It will make you depend on the operation of the pacemaker to stay alive. If it quits, so do you.

A pacemaker is for rectiflying heart rates that are too low, or have long pauses (several seconds).

George



Edited 1 time(s). Last edit at 01/13/2018 11:02AM by GeorgeN.
Re: I don't understand pace maker therapy
January 13, 2018 09:50AM
That's.........scary.
Re: I don't understand pace maker therapy
January 13, 2018 09:59AM
Excellent summary on pacers George as usual. And Tom they are not a substitute for AAR drugs at all. Some Atrial pacing algorithm programs were toyed with in pacers for a while in the mid 2000’s with the idea to help coax the AF heart back into NSR but were pretty miserable failures and you rarely see those promoted any longer.

Shannon
Re: I don't understand pace maker therapy
January 14, 2018 02:28PM
Hi Tsco,
In the fall of 2007 I had a few short afib episodes. At the beginning of 2008 I had an episode during which I feinted for a few seconds. Mass General
recommended a pacemaker in February 2008 (not a defibrillator) for 3 reasons: 1) to prevent a pause when converting back to regular beats, 2) to keep my normal 46 BPM rate a tad higher, 3) to have a chip recording of all my heart beats to be used in the future diagnosing and medicating.
Rightly or wrongly without a second opinion, I went along with the program.
I am now 71 and normal weight and just did well on a routine stress test I get every 5 years.
After trying other suff, I agreed to take medicine in the summer of 2008. Flecainide has worked and so far I have only had a short episode or two per year
except when I had either Lymes or the flu.
The pacemaker does NOT control afib. In my case, it may give me a little energy with my heart beat running slightly higher. It is set at 52.
Once a quarter the chip is read and will tell the dr if I ever have been in afib. I know when I am big time.
The pacemaker dies in 2012. The Dr gave me the choice of waiting for a month or two until the holidays were over or replacing it sooner.
Problems with a pacemaker. If you have leads, most hospitals will not do an MRI. Nobody told me that.
If I had to do it over again, I am not sure what path I would have taken. Maybe talked to a few more doctors and waited 3-6 months. There was no imminent danger. I think the feinting had the dr worried.
------------------------------
Re: I don't understand pace maker therapy
January 14, 2018 03:33PM
Ti bar,
Thanks for your input. I hope you continue to do well.
Re: I don't understand pace maker therapy
January 14, 2018 07:52PM
Can ablations be done on someone with a pacemaker?
Re: I don't understand pace maker therapy
January 14, 2018 08:22PM
tibbar:

You said that your pacemaker dies in 2012, is that a typo? If it dies in 2012 than it is already gone. I had a pacemaker implanted in about 1998, when I had AF and going back into NSR I would almost black out, it was caught when I was in my doctors office. My heartrate dropped to almost a flat line for a few seconds. I am glad I have the pacer as I no longer have any problems about my heartrate dropping too low, the pacer is set at 50 so I don't go below that. If you blacked out for a few seconds then that could happen while you could be driving, you are safer now.

When I first got AF, my regular doc. gave me beta blockers which put me into a first degree heart block, that is why I needed the pacemaker.

Liz
Re: I don't understand pace maker therapy
January 14, 2018 10:30PM
Quote
libby
Can ablations be done on someone with a pacemaker?

Yep, Shannon has had a pacer for a long time before his ablations (and still has it).
Re: I don't understand pace maker therapy
January 15, 2018 09:41AM
Sorry....it died (battery), even though it was supposed to last longer. That means you replace the whole pacemaker....which I did within a week rather than replace it in a few months.
Since after getting the first pacemaker in 2008, I started taking flecainde, I very rarely have had a few very short bouts of afib....knock on wood.
Thanks
Re: I don't understand pace maker therapy
January 15, 2018 11:28AM
Tibbar, Glad you are doing well, so if your battery dies it isn't as "Final" as mentioned above? You have time to replace it and continue livingsmiling smiley
Tim
Re: I don't understand pace maker therapy
January 15, 2018 11:56AM
It’s not so much a risk of the battery running out of juice, pacers will warn you (when working properly that is) well before you are true ‘dead’ (pun intended smiling smiley out of juice in plenty of time for replacement. It’s more the possibility of an outright malfunction, which though thankfully rare, occasionally does happen. That’s when you could be in a tough bind ... say when fishing deep in the Alaska forest or over a trans-Pacific flight though they might have a life-vest onboard modern airliners that might possibly keep things ticking until landing but not entirely sure about that. Still it’s not ideal.

There was a recent article in Medscape I believe it was discussing the very much under-reported by industry failure rate of pacers, ICDs and CRT devices.

Straight battery run down on an otherwise properly functioning pacer should not pose a real problem even for a pacer-dependent person. so long as the conservative battery management and reporting software is working properly.

Shannon



Edited 2 time(s). Last edit at 01/16/2018 12:45AM by Shannon.
Re: I don't understand pace maker therapy
January 15, 2018 03:43PM
yes, my bad.
The battery had dropped down into like a reserve mode after 4 years (sooner by a lot than it was supposed to). My current new pace maker is on track to last 10-15 years.
I dont pace all the time anyway. I think the one pause I had returning out of afib was the main reason Dr wanted.
But since then using Flec i have been in afib rarely...but it did flare up one weekend in 2015 for a few hours when I had the flu .....later I tested positive for Lymes.
Re: I don't understand pace maker therapy
January 15, 2018 04:03PM
Lol thanks Shannon I think I understand. I'm like you tho .....it is possible to find me deep in some remote area for whatever reason. This is all good information. appreciated
Re: I don't understand pace maker therapy
January 15, 2018 04:07PM
Tibbar:

Don't you go 2 or3 times a year to a pacemaker clinic where they test your pacer and they know how much battery life you have left? What kind of pacer do you have?

liz



Edited 1 time(s). Last edit at 01/15/2018 05:03PM by Elizabeth.
Re: I don't understand pace maker therapy
January 15, 2018 08:52PM
Quote
Shannon
over a trans-Pacific flight though they might have a life-vest onboard modern airliners that might possibly keep things ticking until landing but not entirely sure about that.

No way. Life vests (of the sort you're talking about) aren't in the public domain and won't be anytime in the foreseeable future. Some airlines carry AEDs (all US airlines are required to), but an AED can't substitute for a pacemaker.

The good news is that even for people who are PM-dependent, complete failure of the PM doesn't spell certain death as many people think. Even if your AV node is completely non-functional, you still have the Bundle of His below it, which serves as a pacemaker of last resort and will produce a heart rate of 20-40 bpm (usually more like 20 than 40). If you're halfway across the Pacific with 8 hours between you and the nearest hospital with a HR of 20, the chances of your survival aren't good, but in most places where an emergency landing can be accomplished in less than an hour, your chances are pretty good if somebody onboard that aircraft has even some bare minimum emergency medical skills.
Re: I don't understand pace maker therapy
January 15, 2018 09:27PM
I get pacemaker checked every quarter...2 times at hospital and 2 times remotely. They even give me the print out.
My pacemaker was showing many years of life left in it when it was last checked at MGH.
Then one day I felt a little odd. I was not sure if it was afib or not (the rare times I am in Afib, I always know because so far I have been VERY symptomatic) and went to hospital. The pacemaker -- a Medtronic brand had shifted into some kind of secondary low battery mode.
I ended up going to Tufts heart folks because I had switched GPs. I was conflicted about which hospital should replace the original PM. I like both hospitals and DRs, but the DR at Tufts was chosen because my GP is there. So, PM was replaced in 2012, It shows about 11 years to go. I do not pace all the time....I regularly exercise and get heart up to 120-130.
The second pace maker uses the original leads.
I believe some off the newer pacemakers may have a different lead situation allowing you to get an MRI more easily. For me getting an MRI can be problematic.
For me, rightly or wrongly, I always believed that if my pacemaker mal functioned or a lead connection was an issue (something not discussed much by drs),
that my heart would simply go back to as before and run at 46 beats per minute????? Something I lived fine with for many years before. But maybe I am wrong.

Thanks to all for the good info.
And I hope Tsco and others do well with their situations....each being so different.....Thanks Shannon.....and to all the regulars. I am not on the forum as much as I used to be....Good Luck to all.
Re: I don't understand pace maker therapy
January 15, 2018 09:54PM
Tibbar:

There is a hospital in CA.that has the capability to do an MRI for patients that have a pacemaker, I forgot the name, its like Skripps maybe someone here might recognize the name. If they are able to do an MIR on a person with a pacer, hopefully more facilities will be able to.

I also get my pacer checked every 6 months and quarterly send it in by phone. My pacer is a St. Judes, altho, they have been taken over by another healthcare co. Glad everything turned out ok for you.

Liz
Re: I don't understand pace maker therapy
January 16, 2018 01:23AM
You are welcome Tibbar and good to hear from you again. And as Liz noted It’s not only just a Scripps Green Hospital in La Jolla at their world class imaging center there that can do an MRI on a person with a Pacer but they pioneered the ‘Magna-Safe Protocol’ at a Scripps Green that proved you can very safely and effectively perform MRIs in people with even some older model pacers and leads.

I was part of the original 1200 patients who got an Magna-Safe Protocol MRI there after Dr Natake sent me there after I had that fluke late reopening leak 9 months after a fully successful LARIAT LAA ligation. This cause a minor stroke which was the first such late reopening embolic event from a LARIAT every reported in the US. Dr Natale had heard of one lady in Eastern Europe that also had a similar late partial reopening leak and stroke just 3 weeks before mine and thus Dr Natale was sure what had happened to me and he saved my bacon by override his very experienced TEE cardiologist in Austin who felt certain after performing a simple and standard 2D black and white TEE in Austin the day after my stroke when Dr N had me fly there pronto from Arizona.

Dr a natale was sure he saw a leak and a jet-like plume but it was not super clear on 2D B&W TEE . The next day he sent me to his top imaging center at Scripps La Jolla where he alsonused to do ablations a could days each month.

Once there thecfurst irdrrcif business was for me to get a 2.5 hour non-stop 1.5 Tesla MRI with me head crammed in first into this high power 1.5 Tesla machine that had a very narrow view tube, such that both my shoulders were rubbing on the sides of the tube and tip of my nose was about 1.5” from the top inner barrel of the tube. Truly packed in like a sardine.

As part of the Magna-Safe Protocol a Cardiologist has to turn the pacer into standby duty. Not totally off but almost. They then did a contest scan of my brain followed instantly by zither one of my heart with the MRI focused directly onto my heart and Boston Scientific 606S Dual chamber pacer (this was my second pacer that was 2 years old at the time). They did discover the smoking gun that I had a stroke,

And next day Dr David Rubenson, TEE Maestro extra-ordinarie who helped pioneer the 3D color Doppler TEE , used that 3D color TEE on me and instantly confirmed a 5mm diameter leak in the central pucker-like hole formed by the LARIAT and that had slighted reopened enough to allow blood flow to reconnect between my LA and my now mostly shriveled but still remnant pouch of my LAA ... a highly pro-thrombotic scenario!

Dr Natale’s Interventonal Cardiologist Colleague at Scripps, Dr Matthew Price, who himself had done plenty of LARIAT and Watchman installs, then plugged my Leaking LAA with a small Amplatzer Duct Occluder-II device, acting like a kind of mini-Watchman. And which worked like a charm completely finishing sealing my LAA good and tightly closed.

As such, I’ve been off all blood-thinners ever since! Not to mention off all AAR drugs since after my successful persistent AFIB ablations (2 total) by Dr Natale.

And a year later I got another Magna-Safe Protocol done at the only hospital in Arizona as of 2014 when I torn my ATFL ligament and badly injured imy left ankle. Both these MRIs were a breeze and did not damage my Pacemaker at all!

More and more MRI centers are now offering MRIs for people with pacers as a result these days.

Cheers!
Shannon
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