AFIB and Pacemaker

Hi

I was wondering if people in this group have permanent afib|flutter and a pacemaker and how you live with that.
I'm 33 yo and I have since nov 2017 at least 1 episode/month of symptomatic rapid afib (BPM around 200 +). At the emergency I got some pronestyl and came back to NSR with a lot of PAC's and PVC's. I also have WPW and some level of SSS but never fainted. My heart beat at night is around 30-40 BPM. First we tried Propafenone 150mg 2 times daily to stop Afib épisodes. Was fine for a month or two then I had a rapid atrial flutter (BPM still 200+) probably induced by the propafenone. My cardiologist, who's also an excellent EP, stopped the propafenone. He said my options were now limited. He said that I have to have a pacemaker installed so he can give me an antirythmic and some betablockers (like bisoprolol, metoprolol...) I'm not a god candidate for ablation and he says that considering my age it's more risky than the pacemaker and the meds. (hun!!) If I understant correctly, I probably will be end up in permanent flutter or afib... and that's ok????? I can't put my head around this. And the pacemaker not being a big deal...? Any advice and opinions would be grately appreciated! Thanks a lot in advance

Hi HikerGirl, welcome to the forum. Sorry you're having to deal with this, especially being so young.

You're a complicated case. Your EP is saying the propafenone is causing the 200+ flutter so the usual answer would be to add a beta blocker, but with the SSS and a resting heart rate of 30-40 that would be a very bad idea. I'm not sure why he thinks an ablation would be risky but I'm not going to question him on that. Finding a solution other than a pacemaker is way above my pay grade. It sounds to me like you're getting pretty solid advice. The only useful thing I can suggest is a second opinion, and the second opinion needs to be at least as experienced as your current EP and preferably even more so. What part of the country are you in?

Will he at leaste ablate the WPW? I would suggest Andrea Natale, if you can do it: <[tcaheart.com]

I had a local friend of a friend (Denver) who had what they thought might be vfib. Hence they had him on a defibrillator vest all the time. All the local EP's only had poor med solutions and said it could not be fixed. I put him in contact with Dr. Natale last summer. He fixed it. My friend was in disbelief after the fact as everyone (EP's) else had said it could not be done.

I just heard from him a month ago and he says he's doing great.

I'm guessing Natale could fix the afib, flutter and the WPW at the same time.

You may still need a pacemaker sometime, if you are having long pauses.

George

I second GeorgeN's opinion regarding ablating the accessory pathway. WPW will make AF potentially more dangerous. Beyond that, a pacemaker for the sick sinus syndrome makes sense to me. That kind of gets you back to a safe starting point for medical AF treatment where the anti-arrythmics won't risk v-fib and the beta blockers won't risk passing out.

That being said, what you've described is a REALLY complex case. You should seek out the topmost expert, as George said. You sound like someone they'd be very interested to see.