Pandora's Box

Hi everyone - I had a pacemaker implanted in February and an AV node abation in March.  This was because I have suffered from Atrial Fibrillation for 20 years and it was getting worse.  Admission to A&E every few weeks because my pulse would exceed 250 plus.  It was a difficult decision but I felt I could not go on as it was.  

All went well and for about 2 months after the pm took over, I felt really well for the first time in ages.   At this time I was still taking 80 mg Sotalol twice daily.  But then I went for my 6 week check and the pm was reduced from 80 to 70 and it was after this I began to notice PVC's, sometimes in runs of 3-4 missed beats.  The pacemaker was checked out and I was told not to worry about the PVC's.  After another week of this, one night I had a horrendous episode where I very nearly passed out, with the whole world spinning and my heart banging.  At first I thought the pm had stoppped, but after a few minutes of utter horror, I managed to get downstairs to phone an ambulance.

I was taken to the heart centre where I remained for 5 days.  I was told I had had a VT episode.  Sotalol was stopped and I was given 10 mg of Bisoprolol.  I had an ECHO which showed heart failure with an ejection fraction o;f 41%..My blood pressure had gone into the floor, so although I was given Ramipril, I have not been able to take it .

The bisoprolol has made me feel utterly ill and I have been advised to reduce it.  I have taken 1.25 today and feel better.

I have now been given an appointment for the pm clinic next week to have the pm turned back up to 80, although one of the doctors when I was in hospital there told me I should not do that.

I am at my wits end.  All the doctors are saying different things and I do not understand what is happening.

I'm sorry to go on like this, but I know that you people will understand how I feel. If anyone has advice then it will be most welcome.


AV ablation + pacemaker = PVCs + VT + HF

by AgentX86 - 2019-07-05 15:48:54

I think what you've gone through isn't uncommon.  I had all of that, short of the VT and HF.  Other than bigeminal PVCs, I've been pretty good since my PM.  Starting out at 80bpm is suposed to prevent VT.  I was on the same path, 80bpm to start, then back off to 70pm for a month, then to 60bpm.  I made it to 70bm but I couldn't stand the PVCs so my EP switched me back to 80bpm,  I did have them set my rate back to 50bpm at night so I could sleep.

What sort of pacemaker do you have?  The HF may be related to the pacing mode or they may have other settings they need to make.  HF is the reason the use CRT pacmakers.  Sotalol after the AF ablation confuses me too but the move back to 80bpm sounds exactly right.


Pacemaker implant

by Theresa52 - 2019-07-05 16:21:59

Hi - thanks for yur reply.  My pacemaker is a dual lead St Jude.  I don't know how long I have had the HF, but have read that long term use of Sotolol can cause if.  I feel totally confused as one doctor has said that 8o is too high for long term.  I must say that when it was previously set at 80, I felt very well and it did not bother me at night.  But I was taking Sotalol then too, so not sure if it is good to raise it again.  I really need to have a proper consultation with a specialist I think.


by Sgtsemperfi - 2019-07-05 22:23:30

hi Theresa,

i received my pacemaker after an ablation was performed in the same day on 6-10-19. My PM is set at 80bpm. Any time I do yard work my pulse stays in the 50's all day. I had my Pm checked and it tested ok. I'm scheduled for a 2nd ablation to catch these PVC's next week. Everything I read gives me the feeling that it is a hit or miss game. Does anyone else have that feeling?  Thanks for info.   Dick


Pacemaker Implant

by AgentX86 - 2019-07-06 00:13:11

When you say "dual lead", do you have one atrial lead and one ventricular lead?  This is what's normally known as a "dual lead" pacemaker. If so, I'm confused. The idea of an AV ablation is to cut the communication between the atria and ventricles.  This sort of "dual lead" pacemaker would reconnect this, making the AV ablation moot.  It wouldn't do anything for AF, either.

OTOH, if by "dual lead", you mean a "biventricullar" (a lead in each ventricle) or "CRT" (Cardiac Resynchronization Therapy), same thing, pacemaker, it makes a whole lot more sense.  This sort of pacemaker is used to treat or prevent heart failure.

Yes, you definitely need to be seeing a specialist.  You should be seeing an "electrophysiologist", a cardiologist who treats rhythm disorders.  Since you have HF, you probably also need a normal (or perhaps an interventional) cardiologist.


by AgentX86 - 2019-07-06 00:31:14

Sgt, your post isn't very clear.  Your PM is set to 80bpm but when you exercise (yard work) it's 50?  That doesn't make much sense.  It's also not clear what PVCs have to do with this.  You're having an ablation for PVCs?  They don't like doing those unless your PVC burden is very high (it's a far more complicated and risky procedure than an ablation for AF), in which case they're easy to find.  I'm confused.  Could you elaborate.


Hi Agent

by Theresa52 - 2019-07-06 15:07:50

Yes my pacemaker is a dual lead, one lead going to the atria and the other to the ventricle.  I too, thought this was odd, but it has been explained to me - sort of- that this helps with the synchronised pumping action.  The pm will allow the lead to use the atria as long as it is behaving normally, but if AF pops up it will immediately bypass the atria.   It is interesting to note that although I was plagued with AF episodes, very high pulse and lasting several hours, since I have had the pm, it has recorded only a couple of episodes lasting seconds.  

HI Theresa

by AgentX86 - 2019-07-06 22:42:11

That is interesting.  I hadn't heard of this strategy before.  Can you feel the AF before it detects it for the switch (I assume you're very symptomatic or wouldn't go this far)? That also explains the drugs.  Thanks, I learned something today.

Since you've developed HF, perhaps you should discuss a third lead, or perhaps His pacing with your eacriologist/EP.


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