First Post

Hello,  This is my first post. 

First pacemaker fitted in 2012

I had atrial fibrillation and 3 failed ablations, so pacemaker was fitted.  I had a total hip replacement due and was in Agony but the surgeon wouldn't go ahead until I had an AV node ablation.  This made me pacemaker dependent.  This pacemaker was only replaced in 2023.  (11years 7months)  I experienced lethargy for months before it was  replaced.  Since my new box in November 2023   I have never known a minutes peace.  I have since changed hospitals and now have a cardiologist.  I was discharged by last cardiologist who said I only needed yearly pacemaker checks. 
I have now been told by my new cardiologist I need the pacing changed. 
If  I turn over when I lay in bed I have tachycardia which will settle after a couple of minutes but I am a nervous wreck and constantly aware of my irregular heart 


Arrhythmias are miserable

by Gemita - 2023-08-13 13:01:10

Zelda, firstly welcome and I am sorry to hear about your three failed ablations for Atrial Fibrillation which led to your need for an AV Node ablation.  Having an arrhythmia is miserable.  I also live with Atrial Fibrillation and other arrhythmias and they are not easy to tolerate and adversely affect my quality of life, so I can understand what you are going through. 

I see you have had a pacemaker since 2012.  You mention that you had a replacement device in November 2023 which cannot be correct although you mention elsewhere that your old device was replaced in 2023.   When did you actually have your device replaced?   Your experience with your replacement device has so far not been a happy one and I see you will need the pacing changed.  I am assuming that you mean you will need the Settings adjusted?  

Since you have had an AV node ablation, you shouldn’t be feeling your atrial tachyarrhythmias quite so much and you certainly shouldn't be getting any high atrial rates going through your AV Node to push your ventricles fast any more.

With so much going on I am glad you have a new cardiologist who is going to look into making some settings/pacing changes to make you feel more comfortable and to hopefully stop your runs of tachycardia at night.  There are some settings that could be responsible for this, so hopefully you will soon get help.  

When is your next appointment with your cardiologist?  If you feel that you are in trouble, do get in touch with your clinic and ask to be seen earlier.  Tell them about your short episodes of tachycardia.  They will want to know about this.  Explain that your heart rhythm disturbances are making you feel miserable and that you need help.  You could also visit your general doctor to see if there is anything he can do to help?  Remember we are always here if you need to chat as well.


by AgentX86 - 2023-08-13 13:56:37

If you really have tachycardia after an AV node ablation, I can only think of three things that could be wrong. Your AV ablation was failed, your pacemaker is a strange mode (should be in VVIR), or you have VT. As Gemita said, you shouldn't have any sort of atrial arrhythmia, since they're completely disconnected from the ventricles (in theory).

Reading your post again, you talk about tachycardia, then an irregular heartbeat. If you have both, the only thing I can think of is Vfib, which it obviously isn't (you wouldn't be here).

I'd be in my cardiologist's grille demanding an explanation. You really should be dealing with an EP. Something is wrong here.

Atrial tachycardia

by ZeldaShae - 2023-08-13 15:23:55

Thank you for taking time to reply

I have had an Echocardiogram then  a heart monitor for a week.  The result was that there will be some reprogramming of the pacemaker so that it doesn't track the tachicardia. The cardiologist said that although the episodes are unpleasant they will not kill me.  Tracking will be done on 30th August 2023.  Thank you for your help. 

Track the tachycardia?

by AgentX86 - 2023-08-13 21:42:43

From this, I gather that you have an atrial lead and the're pacing you DDD? You're only the second person I've seen with this setup. It sounds like they're going to lower the threshold for a mode switch from DDD to VVIR. Let us know haw that works out for you.

I have no atrial lead and am in constant VVIR mode. My atria are completely disconnected, which is how almost all A/V node ablation patients are paced.

AV Node ablation and a working atrial lead?

by Gemita - 2023-08-14 06:13:04

Zelda, thank you for your private messages. 

As I have said, it is unusual for the atrial lead to be active following an AV Node ablation when the whole point of this particular ablation is to prevent the atrial tachy arrhythmias from getting through the AV Node to push the ventricles too fast.  An AV Node ablation is usually the last resort when all other treatments have failed. 

It is unusual to do an AV Node ablation if the patient has “well controlled AF or asymptomatic (symptom free) AF”.  It appears you still have a working atrial lead and are symptomatic so they will need to isolate your atrial arrhythmias.  Perhaps they will turn off the atrial lead or try to use or adjust Mode Switch to stop the tracking of your high atrial rates when these occur.  

Mode switch works well but it rather defeats the purpose of the AV Node ablation so I would want to have a meaningful discussion with my doctors about where to go from here.  I hope your adjustments will go well on the 30th August and that your symptoms will be relieved.

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