First pacing appointment

Hi - I have AFib and a pacemaker fitted 5 weeks ago. My first pacing appointment / checkup is next week but apart from not really knowing what to expect I'm thinking about the kinds of questions I should be asking. There is the possibility of an AV node ablation. It would be really helpful to hear thoughts on useful questions. I am in the UK 




Welcome aboard!

by Lavender - 2023-10-13 21:38:07

I'm not sure about the process in the UK. Here in the USA, at that point, you would have an interrogation. They wave a wand over my chest where the pacemaker is. That connects it to a laptop. They can tell if you're having any adverse events, how much you're using the pacemaker. Sometimes settings are changed based on your symptoms. 

At my first interrogation they turned my beats per minute down. They usually turn it a bit higher when it's first inserted so the leads have good reception til they become a bit more embedded. 

They test each lead to see what your intrinsic heart beat is, if any. I have none. 

I would ask how much you're pacing, if you're having any events like tachycardia, and ask for a print out of their report. The whole check only takes moments. 

I knew nothing at all at my first check but Gemita here has taught me so much. 

AV Node ablation

by Gemita - 2023-10-14 03:52:14

Hello Trixie,

Welcome to the Pacemaker Club.  It is hard to know where to begin because you haven’t told us very much about yourself?  

It would appear that you have received a pacemaker because you may be heading for an AV Node ablation to treat your Atrial Fibrillation (AF)?  It may also be that you have a pacemaker so that your doctors can “safely” prescribe anti arrhythmic or rate control medication which could potentially lower your own natural heart rate causing bradycardia.  Having a pacemaker would clearly help your doctors to “safely” treat any bradycardia (slow heart rates) caused by medication.  The pacemaker would then be set at a steady, higher, safe heart rate to compensate.

An AV Node ablation is usually carried out when all other treatments like anti arrhythmic or rate control medication, cardioversion, a regular pulmonary vein isolation ablation or lifestyle changes haven’t helped to control your AF.  The AV Node ablation would effectively prevent (block) any fast, irregular signals coming from your AF in the upper heart chambers from passing through your AV Node to push your ventricles too fast.  Your ventricles are the main pumping chambers of your heart and uncontrolled high heart rates would be dangerous.  

An AV Node ablation should help you to feel better, since you would no longer feel your fast, irregular heart rates.  This should relieve your symptoms immediately since it is the fast heart rates and “irregularity” of rhythm from AF that can cause such awful symptoms.  

However an AV Node ablation is not a cure for AF, I hope you were told this, since your AF, although prevented from reaching your ventricles, would still remain active in the atria following an AV Node ablation.  The main benefits of an AV Node ablation is that you should no longer be symptomatic and in fact you should be able to come off some, if not many of your AF medication since an AV Node ablation will be an effective treatment to relieve symptoms.  You might still though require an anticoagulant if you have risk factors for an AF related stroke.  An AV Node ablation is a short procedure, lasting no more than 15-20 minutes I was told and it is usually effective at first attempt and rarely fails.

The main disadvantages of an AV Node ablation is that you would of course immediately become pacemaker dependent and the procedure cannot be reversed so you have to be sure it is the right treatment for you before proceeding?  Providing AF is well controlled (with rate control medication) and we are protected by an anticoagulant if needed, our doctors are usually not too concerned about AF.  However your "symptoms" should be the deciding factor about whether or not to proceed to an AV Node ablation.  If you are so symptomatic, have tried all other options and failed these, then an AV Node ablation can often be a good last resort.

Lavender has already given helpful comments.  Please let us know what concerns you specifically have and we will try to help further?   Many of us suffer from AF.  AF is difficult to cure but it can often be tamed/controlled with the right treatment.  What treatments have you tried for your AF so far?  When I know what your main concerns are, I can help provide some appropriate questions?

Tell them the physical things you like to do

by LondonAndy - 2023-10-14 11:23:40

Gemita and Lavender have already said lots of useful stuff. I think the only tip I would add is to let them know what sort of activities you like to do that work up a sweat - eg if you do any cycling, running, judo - as there are settings they can adjust to help the heart respond optimally.

First pacing appointment

by Trixi - 2023-10-17 04:46:54

Thank you all for your helpful comments and advice. 

I'll be suggesting an information leaflet re what to expect in those first weeks after implant up to iand ncluding first pacing appointment!

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