this is frustrating

Pacemaker and afib

by Theknotguy - 2018-07-27 16:23:07

The pacemaker doesn't necessarily do anything for afib.  Sorry if they led you to believe that.  

There are two methods for afib control.  Rhythm control and rate control.  The usual medical answer to afib it ablation - either chemical ablation or physical.  Physical ablation is where they take you into the hospital and either freeze or heat the offending area of the heart that causes afib.  I don't know about rhythm control.  I'm on rate control and chemical ablation for my afib.  I'm in afib at 17-19% of the time.  Chemical ablation is taking heart drugs such as Metoprolol, Sotalol, Flecainide, Cardizem, or similar drugs.  

Most of the time I don't know I'm in afib because it lasts for a few seconds to a few minutes.  By the time I feel it, it has either stopped or my pacemaker afib programs have stopped the afib.  My EP says I'm not a good candidate for a mechanical ablation yet so I'm on chemical ablation.  I take Metoprolol and Cardizem for afib.  I'm on Apixiban and aspirin for possible blood clots.  My EP also started me on Magnesium and Calcium supplements to help with the afib.  However I would caution you to discuss with your EP before thinking of starting Magnesium or Calcium supplements.

You can feel pretty rotten after an afib session.  I would suggest you have a discussion with either your cardiologist or EP as to what can be done for your afib.  There are a lot of things that can be done but it does take time to get things under control.  

Because I don't have a better way to describe it, my heart had a temper tantrum at or about three months after I received my pacemaker.  It didn't like being ordered around and decided to have a temper tantrum and went into afib with RVR.  I was a pretty sick puppy and ended up in the hospital.  I also had quite a few more episodes of afib until my EP was able to get the meds changed around.  Then my afib sessions gradually decreased from one really bad afib session per month to (now at four years out) one about every nine months.  

So , yeah, you can feel pretty bad after an afib session.  But there are things that can be done.  Hopefully your cardiologist/EP will work with you and let you know what's going on.  The first year was really rough for me but now I lead a normal life.  

Hope everything works out for you.  

The KNotGuy

by AgentX86 - 2018-07-28 00:11:54

Rhythm control is what you're calling "chemical ablation".  It's not really ablation at all (and you're the only one I've heard call it that), in that it doesn't remove the offending electrical pathways. As soon as the drugs are stopped, the offending pathways start, well, offending again. Most of the drugs used for rhythm control slow down or "deaden" the heart's artial electrical systems so these paths don't produce the arrhythmias. These drugs are, by their very nature, nasty in that the heart tends to "learn".  Slowing down the artia tends to cause bradycardia and pauses.  These drugs also are hard on the other organs.  Long term use often results in further degradion of the heart and other organs. Amioderone is a classical drug used in rhythm control and also a classic for causing damage to the heart and other organs.  None of these antiarrhythmic drugs are "safe" long-term.  The heart tends to get used to these drugs, so more are needed to get the same effect, further exacerbating their side-effects.

As you note, (physical) ablation is used to eliminate these offending atrial paths permanently.  As you note these paths are "burned" by either heat or extreme cold.  This is a very tricky procedure and requires an outstanding electrophysiologist.  Anyone performing this procedure should be doing more than a hundred a year.  Only the large, usually teaching, hospitals will have the volume to have such an expert.  Even then, it's not unusual that this procedure fails and the arrhythmia comes back in a short time. If you go down this path, only the best of the best will do.

Rate control refers to medication that slows down the AV node, keeping the heart rate (defined by the ventricular rate) relatively low.  Afib and Aflutter can easily push the atiral rate well above 200bpm, often to 300bpm.  The ventricles can't sustain these rates and (ventricular) fibrillation may occur (and death shortly after).  Even if the AV node keeps the rate under 200ish, these rates cause long-term damage to the ventricles.  To keep either from happening, rate control drugs are used.  These include beta blockers and ACE inhibiters. These drugs do have potentially serious side-effects, too, but are much safer for long term use. That is, if you can tolerate the drug, it's generally safe to use long-term.

I completely agree that a pacemaker isn't a solution for Afib.  Often they allow the use of rhythm control drugs because a common side-effect of rhythm control drugs is sick sinus syndrome (SSS), for which the pacemaker is the perfect solution.  The pacemaker may allow these drugs to be used long term and/or in higher doses.  Pacemakers are also used along with AV node ablation (my situation).  The AV ablation removes the connection between the atria and ventricles.   The atria are allowed to flibrillate or flutter all they want and the ventricles are paced at their normal rate.  They tell me that I can no longer feel the arrhythmia but I'd argue differently (much, much, better though).  ;-)  AFAIK, this can't be done with a Micra.  I'm really surprised a Micra was used in this case but iI probably should do more research into the Micra.

confused!

by krista1 - 2018-07-28 02:32:58

hey all, 

thankhou so so much for your responses! wow i have soooo much to learn. i feel like i'm completely out of my depth and looking at the drugs mentioned i'm not sure how i feel about it all. 😐

just in answer to the question, i was fitted with a micra as i am an acrobatic dancer very heavy impact, i was recorded as having paraoxsmal afib with pauses that were lasting up to 8 seconds. 

they decided micra to allow me to carry on my extremely energetic lifestyle but informed i will prob neeed a dual at some point. as it was every now and then not perminantly it was happening they decided to go with micra as they were most worried about my ventricular standstill, 

i'll be honest i'm getting so upset because i don't understand now why my heart symptoms seem to be really bad .... my heart feels like it's flipping and flopping but my heart hasn't really gone above 89. so is this afib? or just my heart being very very irregular. 

i am seeing the arrhythmia nurses next week and the device clinic.... i'm scared about beta blockers as i already have low blood pressure. 

sorry for going on but as youncan imagine im so new to this i am on the brink of tears. 

Expectations

by Gotrhythm - 2018-07-28 18:20:45

It's understandable to get upset when discover our pacemaker hasn't fixed everything--understandable but it's never useful. Getting upset because your heart symptoms are bad pretty much guarantees they'll get worse. There's a reason so many of our terms for emotion include the word heart. Made my heart sing. Down-hearted. Chicken-hearted. Heart's desire. The heart is directly linked to emotional states.

Cultivate serenity and equinimity. Now that you have a pacemaker, you are not at the end the journey, you're at the beginning. You can and will find the resources, within you and outside you, to deal with what you have to, and to find the most fruitful path forward.

Learning is good.

by AgentX86 - 2018-07-29 00:53:10

Web searches helped me understand the mechanics of what I was going through.  If I understand, the emotions don't get away from me.  I understand there are no monsters under the bed so don't worry (much) about them.

"i am an acrobatic dancer very heavy impact".  and "pauses that were lasting up to 8 seconds". Yep, those statements answered my question perfectly.  However, the pacemaker isn't going to fix the Afib.

I know exactly what you mean by your heart flopping around.  I told people it felt like my heart was doing sommersaults in my chest when I was trying to sleep,  I couldn't, so I was basically a zombie for half of last year - not great on my work performance. 

I don't know a lot about the Micra pacemaker but it appears to be VVI(R) mode.  You don't mention anything about an AV ablation or AV block, so I'm not sure how this is supposed to work.  I can see it fixing the pauses but it's not going to do anything for your Afib.  Since it is VVI(R) mode, you will have AV dyssynchrony (atria and ventricles aren't synchronized) when paced and any atrial arrhythmia will be telegraphed from the atria to the ventricles.  I'm sure your EP knows what he's doing but I don't see that he's even trying to help your AF symptoms.

answering questions

by krista1 - 2018-07-31 13:26:33

thankyou all so so much for your responses x i'm going through them and just answering as much as i can x

agent x in answer to your question they used the micra for my lifestyle as you have commented and for the ventricular standstill x in my letter it says my 12 lead ecg showed an incomplete right brundle branch block.

on my recorder it showed i had an episode of paroxysmal afib aswell as two or three episodes of ventricular standstill due to brief complete heart block.

does this help in anyway? i'm trying to get my head around it myself. he said my pacemaker won't help the afib but will help with the ventricular standstill which is what they are very worried about.

because of my lifestyle we went with the pacemaker ... he informed if my susmptoms persist or this doesn't rectify then it may be i have to have a dual pacemaker at some point in the future. 

but these "irregular beat" episodes are making me feel awful. i totally agree with a comment made about it will make my symptoms worse worrying about it.. i definately am not doing myself any favours. 

agent x i was a little worried that i wasn't given any thing to help with my afib symptoms. it's horrible :(