Pace Makers - Anyone with experience/thoughts?

Following up on my earlier thread about my 75 year old dad who had an extensive Natale ablation about 3 years ago and has recently been experiencing consistently high heart rates in the 150s and sometimes dropping to the 40s (sometimes afib sometimes not).

In cases like this, are pace makers usually a last resort, after trying medications? Or are they used with good success for regulating this type of thing? (Without cutting down on the lifespan of the patient, etc.) For those of you that have had a pacemaker, or have some experience or knowledge with this, could you please share your thoughts so that I can help my dad make an informed decision?

He has always preferred not to take any medications and is not currently on anything. I just want to give him the best chance of success with this.

Thanks in advance for your kind feedback.

I have a pacemaker. It’s not a substitute for an ablation or drugs, but mine (Medtronic) has settings that convert my afib (not 1:1 flutter). Each interrogation report (download) shows my success rate of burst therapy zaps and list each episode I had. My ventricles HR is controlled to have a set HR. It also has a minimal setting (mine is set to 70) so it can’t drop lower.

I will say it’s not perfect (my last interrogation showed only a 27% success-down from 60s). I was hospitalized (some of it in ICU) 23 days out of 30 with five admissions (with a pacemaker!) in one month after my 190+ heart rate couldn’t be converted. I ended up with an AV node ablation, which is a drastic last ditch permanent non reversible procedure. My heart rate now is 100% controlled…but it came with a price but I no longer need ER intervention.

Yesterday I had a MRI and a technician from the pacemaker clinic had to assist the conditional MRI by turning on a Sure MRI setting before and after the MRI.

My pacemaker didn’t give me my life back after conventional ablations, ECVs and drugs failed to control my >190 hr flutter until I had my AV node ablation, which required a pacemaker, which I already had

I don’t know if your father is there yet. He had a great 4 years. Maybe he only needs a touchup ablation.

Your father may need to wear a holster to see about his 40s heart rate. Dr Natale would know what to suggest



Edited 2 time(s). Last edit at 12/19/2024 04:56AM by susan.d.

A pacemaker is last resort. A PM can't control afib. All it can do is maintain a normal heartbeat after destroying the AV node, which is a permanent decision for life. And destroying the AV node doesn't control afib either. It just disconnects the atria from the ventricles so the afib going on in the atria is no longer transmitted to the ventricles. I think your father is far from reaching that decision point.

Susan, my heart goes out to you. Thank you so much for sharing your personal experience. I do hope that you can experience some relief.

I appreciate your insight Carey, as always! Very insightful.

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Carey
A pacemaker is last resort. A PM can't control afib. All it can do is maintain a normal heartbeat after destroying the AV node, which is a permanent decision for life. And destroying the AV node doesn't control afib either. It just disconnects the atria from the ventricles so the afib going on in the atria is no longer transmitted to the ventricles. I think your father is far from reaching that decision point.

At times when I was in the ER ,they called for a Medtronic tech who adjusted my pacemaker and converted me. A pacemaker cannot control Afib, as Carey had mentioned , but it can cut down the episodes by burst therapy. It’s hit and miss successful. I started out (before my AV ablation) being successful 67% but now it dropped to the 20s- which doesn’t mean anything because an AV node ablation only disconnects the atria from the ventricles so I may have a peaceful 70hr, but my chest feels the vibration of wild monkey palpitations which isn’t as serious but still symptomatic.

A PM cannot convert 1:1 so it will not convert flutter. It is useless to convert PVCs too.

Your father may also be required to get a pacemaker (SSS or low HR) without an AV node ablation —but once your AV is nuked, or if your sinus node is heated and damaged , you need a pacemaker.



Edited 2 time(s). Last edit at 12/19/2024 10:13PM by susan.d.

Thanks for the information Susan!

Here is a thread about having a pacemaker after an AV node ablation :
[www.afibbers.org]

I received a pacemaker because my heart would pause every single time that I converted to NSR This happened to me daily for months and it was finally caught on a ER visit EKG. My pauses during that visit were 9 seconds long and 1 pause was 18 seconds!
I received the pace maker the next day. It completely stopped all pauses and was set for 60 BPM.
This was 1/1/2 years ago. 6 months ago I had an ablation and have been in NSR ever since.
So my experience with the pace maker has been positive and at my yearly pace maker check up I will find out if the pace maker has been pacing at all since the ablation.

Calvin:
*
I have a pacemaker for about 24 years now, I too had to get it for the same reason that you got your pacer. I am now in permanent AF for the last 3 years, never got an ablation, which I should have. I have no problem with my heart rate being high, my pacer is set at 50, so my heart rate cant go below it, my heart rate usually is in the 60s., my pacer has been good all of these years.

Liz

Thanks for all of your input Calvin, Liz and Susan! I really appreciate hearing the various experiences!

Susan, I'm so very sorry for what you've endured. It is very helpful to see your information on pacemakers, although I'm sorry you directly experienced it. I hope things are much better for you now.

If anyone reading is planning on getting a pacemaker, I recommend you find a surgeon who will perform the 3DE guidance technique discussed below. It shortens your QRS. Mine is wide because I didn’t have this 3DE technique performed but only fluoroscopy instead. I also have to get frequent echos for life to check for pacemaker-induced cardiomyopathy, which 3DE would had reduced the risk.

[www.practiceupdate.com]

Thanks for your kind words Drummer.

You didn't mention whether your Dad is going into AFib or just getting intermittent tachycardia and bradycardia. If he isn't going into Afib, it could be Sick Sinus Syndrome which is why I was given a pacemaker. As far as I know, a pacemaker is a first line treatment for SSS. If he is getting Afib, that is a different scenario.

Most pacemakers are given without the dreaded AV node ablation that Susan.d. had. My pacemaker made life much easier and went without a glitch. I am not even aware of it--which, if it is adjusted correctly, should be the case. The only precautions are to avoid close contact with magnets (you use your cell phone on your right ear as cell phones have magnets), you avoid metal detectors and only get MRI's with a tech there to adjust your pacemaker for the MRI. Wishing your father good luck with his decision.

P.S. I also had and extensive ablation with Natale a few years after getting my pacemaker.

my PM surgeon must had been very lax, not as cautious as Daisy's surgeon. My PM surgeon put his iPhone pro max [big one], right on my PM and said "see, no problem"... I asked about dangers of being near a microwave and he shrugged and said no problems unless I climbed in. He is no longer in practice.

I also used my left ear when talking on my phone. I may switch to my right now. I found that when I carry a lot of packages, I put my iPhone under my left armpit when I walk [small purse-can't fit a phone] automatically. Maybe I will think twice now. Thanks Daisy.

I am super cautious when at the airport's TSA machines. I will wait and get a pat down grope then go through the machines. Having an AV node ablation I should be more cautious. My worst concern is using the buses. Once upon entering the bus, the two metal bus doors slammed on me, like a vise, and half of my body [luckily not my neck] was hanging outside the bus and my pacemaker was slammed in the vice. The bus didn't stop until the next station stop. I went to get an X-ray to see if my leads were ok. I also adjust my seatbelt so the strap is not over my pacemaker. I used to use a small kiddy pillow but if I can't fit a phone in my purse, a small pillow won't fit.


I am procrastinating at my age. I bought a motorcycle silicone protection padding and thought to cut it up and use it for my seat belt or wear it under my jacket when entering a bus. It is still in my closet collecting dust. The pacemaker club does sell a padding one sticks into a pocket of a t-shirt they sell to protect one's PM. Some people have their pacemaker under their muscle to give some padding. Having cancer, I only have ribs and skin so my pacemaker is just under a thin layer of skin.

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Some people have their pacemaker under their muscle to give some padding.

Mine is embedded in the muscle. My pacemaker tech told me that the iPhone 12 and newer models were more of a problem as they have MagSafe charging.

I still use my power tools including a chain saw . Most of these tools are used away from the pace maker location. I was told not to worry about occasional use and to keep on living as usual, so I have. It is a bit of a bother when laying in certain positions and I can feel it most of the time, its like a big old pocket watch under the skin and I can feel the leads with my fingers where they leave the pace maker. Have to just put it out of my mind most of the time!