OK Guys Just saw the EP Again.

Just read several threads hearing people are nervous but getting good advice and comments from the familiar names. I am still nervous, but set for last week in January for insertion. I am still steady as a clock at resting rate of 40 and speeding up over 100 when I exercise. I have no pauses. Got an Apple Watch for Christmas! I have narrow QRS junctional rhythm and slow aFib with complete heart block just to remind ya'll. 

Now that I will get the low heart rate fixed I asked him a few questions. Just like several have said, he acted hurried and looked at his watch but here is what I got. 

1-Will I feel better? I get a little more winded now but basically asymptomatic. "I can't tell you for sure you will feel better. But you will not be as vulnerable to Sudden Cardiac Arrest anymore."

2-Where will you put the ventricular lead tip? "In the interventricular septum just below the Bundle of HIS. There is a small risk of perforation and possible blood clot."

3-What will it do for my chronic atrial fibrillation? Will it be possibe to make my atria beat at normal sinus rhythm (NSR) again and restore the physiological beating pattern? ( I have a Fib with slow ventricular response because of complete AV heart block). "Lets deal with the bradycardia first."

Then the nurse came and got him. 

So I ask you guys - anybody know someone who got a pacer also with slow afib, and were you/they ever able to get back to a normal sinus rhythm?

Thank all of you and Happy New Year, FG



AFib and pacemaker

by MaryD - 2023-01-06 15:46:15

Hi.  I am new to being wired, pacemaker on 12/05/22.  My pacemaker was inserted due to Syncope/preSyncope episodes.  However, like you FG, I have AFib and prior to the pacemaker my resting heart rate was below 50 bpm.  The first thing my surgeon told me, and my Cardiologist confirmed this, the pacemaker dies not treat the AFib.  Hope this helps.

Keep your spirits up

by Gemita - 2023-01-06 17:00:30

FG, firstly I am sorry you didn't have such a good meeting with your EP and that you felt rushed.  That is not nice at all.  I don’t ever recall you mentioning AF?

Unfortunately a simple pacemaker is not a treatment for AF or for any arrhythmia/high heart rate.  It will only treat bradycardia or a heart block.  Only an ablation, cardioversion or medication can attempt to fix AF.  However, my pacemaker has certainly made a real difference to my QOL and has improved my symptoms during my paroxysmal AF, making episodes more tolerable and often outpacing the slower, pausing atrial premature beats which frequently lead to AF.  Even so my success is certainly not the norm.  I have been extremely fortunate to have responded so positively.

Yes my husband, like you, has AF with a slow ventricular response rate which is fairly persistent/permanent.  His pacemaker was implanted in 2018 and he still has AF.   As we get older, AF can be common unfortunately.  He is definitely helped by his single lead RV pacemaker though.  Previously he was prone to collapse.

Can you confirm how long you have had AF and whether you have been told you have long term paroxysmal AF (intermittent episodes that terminate spontaneously), persistent AF (episodes that usually last more than 7 days) or Permanent AF (Episodes that are ongoing and long term for more than a year and usually cannot be stopped).  However, some members have still been successfully treated with an ablation with all forms of AF.  So if you have long standing AF, you may still feel symptoms after your pacemaker implant.  On the other hand if you have only intermittent episodes of AF, you may be surprised just how much a pacemaker can help to ease symptoms.

When you are healed from your implant, your doctors may speak to you about getting an ablation unless your AF is felt to be permanent.  Doctors are generally not concerned though about slow AF but they are concerned about AF with a fast ventricular response rate.  I have the latter and they generally treat with rate control medication.  Once you have your pacemaker pacing you at a steady higher base rate, you should feel so much better and after the healing period of up to 3 months, you can re-assess how you feel and whether you still feel the need to improve your symptoms?  If so, at that stage you may wish to talk to your doctors about options for treating your AF.

If you keep asking yourself if you really need a pacemaker, just keep reading your EP’s answer to (1) and that should re-assure you that the pacemaker is needed to protect you.  There is always a risk with any procedure and they need to tell us about this, but the percentage risk is usually quite low with a qualified, experienced EP doing the implant.   AF cannot be cured with your pacemaker but your pacemaker can certainly make an arrhythmia like AF more tolerable and help to ease your symptoms.  I hope this re-assures you

Hi Gemita!

by FG - 2023-01-06 17:40:16

Hi Gemita your comments are always courteous and explanatory!

I have had slow AF with complete heart block since it was discovered in 6/22. I have no idea how long before that it began because I did not really have symptoms. I was exercising and working and not getting dizzy or fainting or anything. I was being worked up for neck surgery and it was incidentally found on EKG. Now the neck surgery is all but forgotten as they are concentrating on the heart. My new Apple watch shows 37-40 at rest. I have very few symptoms. I do find it very uncomfortable to lie flat on my back as I get a very full and congested feeling in my head with headache when I do that. I think this is because of the buildup of venous pressure because the atria are no longer pulling blood out of the vena cava and pushing it into the ventricles. Perhaps the pacemaker driving my heart rate a little faster will help with that? I was cardioverted in June which lasted 3 almost 4 months. Then silently without warning I got the AF back and I never know if its in or out since I have complete heart block. I think it is permanent AF. I have never been monitored over time. 

I am hoping that I can be cardioverted and go back to approximately 70 NSR, and possibly with cardiac medications suppress the chance of recurrence of AF while the pacemaker maintains good atrial and ventricular rate and physiologic sequential beating relationship. Do you know anything about how that might work?


Thanks, FG

I am surprised your EP didn't discuss this before

by Gemita - 2023-01-06 17:43:58

FG, on reflection, I am somewhat concerned that so close to your pacemaker implant you didn't know that your AF couldn't be treated/helped with a pacemaker.  This should have been made clear at the outset.  It seems your EP has spent a great deal of time talking about a natural means of pacing for you and yet he has failed to discuss the limitations of a pacemaker in treating AF and restoring NSR.

I would still want further discussions with him and I certainly wouldn't want to be rushed without knowing what to expect FG.  

Sorry I see on your Bio you did mention AF but in all your posts, we have mainly focused on left bundle branch pacing.  We should perhaps have focused on AF too

Most important comment

by Lavender - 2023-01-06 18:17:44

From your EP:

"But you will not be as vulnerable to Sudden Cardiac Arrest anymore."

That says it all. SCA can be the E N D

He's prioritizing your care. 

I suggest another meeting with the EP

by Gemita - 2023-01-06 18:31:19

FG you clearly need your pacemaker but you also need to know all the facts before you proceed and it seems to me that you do not. 

In response to your questions, if after your pacemaker you can successfully be cardioverted and restored to NSR, then this will definitely help with any adverse symptoms.  However if NSR cannot be restored, then you may still feel the irregularity of your atrial rhythm.  I am uncertain how your LBB physiologic pacing would be affected if you stayed in AF and NSR could not be restored, unless your EP intends to carry out a pulmonary vein isolation ablation some time in the future or to try medication to restore NSR?  These are really questions for your EP to ideally answer before your implant, although I feel you are still better off with LBB pacing than being paced in the Right Ventricle alone.

EP's intention

by AgentX86 - 2023-01-07 00:32:06

The EP should have mapped out all of the treatment options and a plan for the future, with each branch explained (there aren't all that many). You deserve it.  You can't give informed consent without all of the information.

A bit more info on AF

by Gemita - 2023-01-07 10:46:46

You still have time before the date of your implant to get some more information from your EP/clinic if you wish, although I appreciate there may be a certain reluctance from your EP to say much more at this stage until he can assess the results of LBB pacing.  

Thank you for your kind wishes on my own thread.  Yes we both still need some answers, but that is the nature of AF.  It causes mayhem wherever it resides but it is important we continue to find ways of controlling it and that we work with our health professionals to find the treatment that works best for us.  This is often trial and error with all treatments on offer, especially with medication, before we find something that works well for us, hopefully with minimum side effects. 

I will do my best to get the answers I need to decide on the best way forward.  With AF it is important never to be in a hurry and to consider all our options carefully, although I appreciate in your case you have AV Block which needs treating with a pacemaker as soon as possible.

Pacemaker and medical treatments like medication and ablation can work well together to control our symptoms but it may not be enough to stop AF and maintain NSR.  I had three cardioversions which didn’t work and I eventually needed an anti arrhythmic medication as well as my pacemaker.  One year after implant, I was able to drop the anti arrhythmic medication and now I am only on a daily rate control beta blocker for high heart rates when AF episodes begin. However my AF still frustratingly continues intermittently with rapid in and out attacks which can be destabilising but at least episodes always terminate on their own and I am getting some periods of respite between episodes,  For example since last October my episodes have been few, but from July to October last year, I had daily AF episodes at high heart rates.  I really needed to see my EP at that time and had to go on one occasion to A&E, but the earliest appointment to see my EP was 6 months!  So my crisis has past, but it is still important to see my doctor because AF can pop up any time again and I need to be better prepared for when it happens.

I do sincerely hope for the very best for you FG and that everything will go smoothly.

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