recommended for pacemaker

Recently cardioverted from about a 90 day stay in slow rate afib (70ish bpm). Long story as to why the extended stay (old EP left and had to find a new one is part of the story) but it's done and back in NSR. Does staying in afib for long periods of time damage the heart in any way? 73 years old. Diagnosed about 3 years ago which required my first ECV. Two other previous episodes where I self converted with additional flecainide but the last which was persistent. Currently on 5 mg eliquis 2x and 50 mg flecainide 3x. Tried 100 mg flecainide 2x for about 1 month prior to ECV hoping it would help me revert but no luck. Also, developed some dizziness issues related to the 100 mg 2x flecainide. Now seeing if I can tolerate the current 50 mg 3x. Other than feeling a bit tired or winded I'm feeling ok. Felt myself breathing a bit harder on parts of the walk this morning but it was very hot and humid. Got a bit gassed on the last 5 holes of golf yesterday but then again so were others in my group as it was sunny and upper 80's by 9:30 am. Following current ECV, EP mentioned that he would strongly recommend I consider having a pacemaker. Currently, my heart rate is in the high 40 low 50 bpm range. Walked 3 miles this morning (19 minute miles) and afterwords Karda registered 55 bpm. As far back as I can remember, I have always been on the bradycardia side--usually in the 60 bpm range. Got the usually athlete heart spiel as I have always been active and sports oriented. But, new EP is concerned. I was taken back as pacemaker has sort of a "death knell" sound to it when it perhaps should have more of a positive connotation in that the intent is to help not hurt. Now the word ablation was also mentioned but not in much detail as much as that is something we perhaps should think about also. So, am just wondering about thoughts related to this course of treatment. Can a pacemaker be done without an ablation? Are pacemakers done in tanem with certain types of ablations. Can pacemakers be done without an ablation and, if so do, does the pacemaker interfere, preclude, or make ablations more difficult or tenuous? Are there certain types of pacemakers (good, better, best) and placement? ECV's and pacemakers????? I am also one of those with a lot of inflammatory issues and whose day is notably better when I take the occasional aleve. Discussed this with the EP also and said the only way to get off the eliquis would be to do the watchman or some other procedure so eliquis was not necessary. So, it was a lot to take in and left me a bit down or slightly depressed as to the seriousness and impact this condition can have/is having on one's psyche, well being and quality of life--if not longevity. Sorry for the long post. I did search "pacemaker" in the forum but did not find the information or answers to some of the questions I am asking. Thanks for any input. If there are links to other places in this forum that will help I would appreciate if you could direct me to them. Stay safe.

There is a procedure where they ablate the AV node and put in a pacemaker, for afib. From what I know, this is very old school and not recommended. If the pacer fails, you are done, too. This does not solve the stroke problem as the atria are still in afib, just not sending their signals to the ventricles.

A pacer is usually put in anybody to put a floor under the heart rate (if needed). Generally for those who have long pauses (in their heart beat) at times. This procedure is not a big deal, if you need it. I'm a guy with a resting heart rate in the 50's and in the 40's during sleep, without any issue.

Staying in AF for long periods is harmful if the rate is over 100. That can lead to heart enlargement and eventually heart failure. But a rate in the 70s won't do any serious harm. What it will do, however, is make AF more likely to continue or worsen. There's an old saying that "afib begets afib." That's because the heart actually undergoes electrical remodeling when you're in AF for prolonged periods, and that remodeling is favorable to the development/continuation of AF.

It's not clear to me why your EP thinks you need a pacemaker. Is it because of your low heart rate or did he mention heart block or pauses or anything like that? But whatever the reason, don't view a PM as a death knell. Millions of people are walking around with PMs and you'd never know it by looking at them.

Having a PM has nothing to do with an AF ablation. They are completely separate things and they can be performed in any order, or both done at the same time. Having one doesn't mean you need the other.

There is a site about people with pacers, you might find your answer:

[www.pacemakerclub.com]


I have a pacemaker since 1998, no problems, I got it because when going from AF to NSR my heartrate would drop to almost a flat line. The pacer prevents this from happening, anything below 50 BPM and my pacer kicks in. I do everything that I always did, golfing, roto tilling my garden etc. I have had an ECV, no problems.

Have only had two meetings with my new EP. Once for the initial office visit and once at the ECV. Former EP left for practice in another state. I scared him away I think.


GeorgeN, Think I read about about the procedure you mentioned in another thread when I searched "pacemaker." His conversation just mentioned ablation in a general way. But, I will remember what you have said and keep and eye out for it.

Carey, EP just mentioned pacemaker in reference to the bradycardia to both me and my wife (by phone as she waited in the parking lot as she was not allowed inside). I do have sleep apnea (mixed) and use a CPAP machine but that was not mentioned in relation to the pacemaker. But, that could be the type of "long pauses" you refer to. No other heart issues. Sound like you and I, particularly pre- afib, share some similarities. Can flecainide reduce heart rate?

Elizabeth, I visited the link you posted and was amazed at the different types of PM's and PM procedures-more complicated than I thought. Of course some of the posts were related to side effects, poor/difficult results, and complications which were concerning but whadda gonna do. I am amazed that you can ECV with a pacemaker in place. I am so very glad to hear your success story and am so happy for you. If I get to the point of needing one and make the decision to have the procedure perhaps you and/or others could give me more information on what I should ask, look out for etc.

I have a follow up with the EP's office in about a week that I think it will be with the PA who will also be new to me. But, I will pursue more specifics about the "why" of his PM recommendation. I know he mentioned something about wearing some type of monitor so I can explore that also. In my initial office visit I thought the new EP was a bit abrupt, impatient and perhaps a bit insensitive-for me-in some of his wording- not what he said but more the "way" of what he said type of thing. Doesn't seem to mince words and gets to the point. Perhaps has a my way or the highway or what you see is what you get manner. Has about 30 years of experience and was very thorough in going over my records. I saw he had many pages highlighted and referred to those sections with comments and questions. At the ECV, however, he seemed my relaxed, empathetic, and sensitive in answering questions and put me at ease. His communication/interaction with the staff was also good. Maybe he just doesn't like being in the office and was marking his territory.
Don't know why I'm mentioning this other that he is new to me and vice versa so there is a "feeling out" stage in progress. Funny, but with my last EP I only saw him once (actually several times as I was in the hospital where I was initially diagnosed and treated). In the following three years or so I dealt exclusively with the PA. I'm thinking that's quite common so I hope my upcoming PA appointment is a good one.

Sorry for the rambling post and thanks for the great information which I will put to good use. Stay safe.

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walt
I do have sleep apnea (mixed) and use a CPAP machine but that was not mentioned in relation to the pacemaker. But, that could be the type of "long pauses" you refer to. No other heart issues. Sound like you and I, particularly pre- afib, share some similarities. Can flecainide reduce heart rate?

Sleep apnea doesn't cause pauses, but if your EP didn't mention pauses it's probably just the low rate he's concerned with. Yes, flecainide can reduce heart rate but that's an unusual side effect. What will definitely reduce heart rate are beta blockers such as metoprolol and calcium channel blockers like diltiazem. Are you taking either of those?

Sorry Carey but I swear I posted a response earlier but no. I just take the flecainide and eliquis. BPM's now typically in the 48 to 55 range with the 55ish reading noted following my morning walk of between 3 to 4 miles. For my follow up meeting next week I am hoping to have a clarifying list of questions to which I hope I can get clarifying answers. This forum helps. After reading the "Yes or No" thread recently posted by Elizabeth I'm wondering if I just should have stayed in afib with bpm's mainly in the 60's/70's. I think the idea of staying in afib was presented at my initial EP meeting. I know I replied that I would prefer to get back into NSR. Thanks. Stay safe.

A few years ago they talked about a PM because I had frequent pauses (9-11 squares on the ekg) but the EP was just exploring the options and wanted me to wear a holter monitor before he based his decision. He wanted to rule out sick sinus syndrome...which I didn’t have then. My current ePatch holter results showed some 3.3 second pauses during AF. Probably what made me lightheaded.

Did your cardiologist ever mention SSS?