Is there a pacemaker that addresses slow heart rate and AFIB

Depends what you mean by “addresses”

by Gemita - 2022-01-04 12:14:48

A pacemaker will prevent our heart rate from falling below our set Base Rate thereby addressing our slow heart rate but it cannot stop (address) Atrial Fibrillation and prevent it from occurring.  

A simple pacemaker (without a defibrillator) cannot help with an arrhythmia.  However if your Atrial Fibrillation occurs at a slow ventricular response rate (that is at a heart rate below or well below 60 bpm), a pacemaker might help to address some of your symptoms which occur due to bradycardia.  My husband has slow AF and his AF symptoms are helped.  I on the other hand have fast AF with a rapid ventricular response rate and even with pacing I need medication to bring my heart rate down.  In conclusion, a pacemaker cannot slow a fast arrhythmia but it may help with slow arrhythmias including slow AF.  That has been my experience.

Unfortunately AF is usually progressive, with or without a pacemaker, although my AF has not progressed with my pacemaker.  In fact it has steadied and I am less symptomatic.  I have a Medtronic dual chamber pacemaker since 2018. 

No pacemakers are bad, although some may be better than others for active members.  I am sorry to hear about your pacemaker problems.  Are you saying that your particular model is on the recall list and will need to be changed?

Probably not

by crustyg - 2022-01-04 12:14:52

This is quite a contentious area, I believe.  The standard response you will receive is that PMs only accelerate the heart, but it's more complex than that.

For many, the underlying condition that produces the SA-node damage (and hence slow HR, and need for PM) is progressive, and whether you're paced or not, things tend to get worse over time.  This applies whether you have ischaemic heart disease, or atrial fibrosis (perhaps from too much exercise).  The progession of disease can often manifest as AFib.

There are some EP-docs who believe that the onset of AFib may be delayed by having the PM 'outpace' the natural tendency of some of the affected/damaged atrial cells to fire off without being activated by an electrical stimulation, which is how AFib often starts.

So, if anything, you *might* be wondering, 'could my PM have paced me fast enough to reduce the incidents of AFib.'  I can't answer that Q with any certainty, and in any case the answers, such as there are, may be particular to *you*.

Pacemakers and Arrthymias

by Marybird - 2022-01-04 13:14:33

Poolboy, I also have a St. Jude Assurity ( model 2272) pacemaker, implanted in June 2019 for sick sinus syndrome. It was implanted for bradycardia, but also so that I could take enough medication to control the tachycardia I have had for years, without driving the heart rate even lower. 

I recall asking the EP who chose, and implanted my pacemaker the same question you have asked about pacemakers controlling tachycardia, and essentially, he said no, pacemakers don't control tachycardia. He went on to explain that the pacemaker will prevent the heart rate from falling below the set rate, and this would allow the person to take medications to control tachycardia without fear of having the heart rate go too low from the meds. My tachycardias have since evolved ( or maybe added to) afib, and I take two rate controlling drugs to keep it under control. The drugs have done a good job, and my heart rate, even when afib is happening, apparently, is low enough that it doesn't feel that bad and I'm asymptomatic at least sometimes when it occurs. 

I've read about the possibility of setting the lower pacing rate high enough to "outpace" possible rhythms such as afib ( they also tried that years ago with my daughter, to try and outpace a recurring, then constant atrial tachycardia running around 170-180, somehow, but it wasn't very successful, that was with a dual chamber Medtronic). Thank goodness repeated ablations finally took care of that pretty well. In any case, that's an individual thing with varied results, so it'd be a matter to discuss with your doctor.

There is a "recall"`( more like an alert) for some of the models of the Assurity PM 2272 manufactured between 2015, and Feb 2019, I think they said. Apparently the glue used in the pacemakers was believed not to be mixed properly before using, possibly leading to moisture getting into the inside of the pacemaker, resulting in a shorter lifespan of the pacemaker, early end of service issues, possibly some lead issues. They took the involved machinery ( glue mixer???) out of service and I'd say if your pacemaker was implanted late in 2019, it's probably not involved in that recall, but if you are concerned you can contact your doctor, or Abbott's Customer Service. Issues were seen in a very small number of cases, Abbott sent letters to providers for patients with these pacemakers, not recommending the removal and replacement of the involved pacemaker, but recommending that remote monitoring ( which will pick up these issues if they occur) be done according to schedule. 

Pacing and atrial fibrillation

by Selwyn - 2022-01-05 07:14:05

There are some pacing routines that can be used for atrial fibrillation.

Back in 2016 the following was posted:

Re:  the Medtronic Advisa unit. In addition to being a pacemaker it has two software programs. First program is APP (Atrial Preference Pacing). 

APP is a simplex program. It watches to see if you go into afib. When you do, it raises your heartbeat rate. Sometimes that will throw you out of afib. However it only runs for a short time and it can't adjust to varying rates of afib.  This helps some people.

The second program ( Minerva has three subroutines).... The first subroutine watches for you to go into afib. For some people, after they've been in afib for a while, the afib will start to repeat a pattern. The first subroutine watches for the repeating pattern. When it sees the pattern it instigates a heartbeat pattern that will throw you out of afib. This subroutine works for about 30% of the people who have it. 

You would need to speak with a cardiologist with some experience of these programs. They certainly are not that well supported by the majority of cardiological departments.

Abbott 2272 Recall and PVARP adjustment

by pooolboy - 2022-01-10 16:59:33

Gemita, Selwyn, CrustyG, and MaryBird--Thanks for your help!

1. First, PVARP adjustment-My PM 2272 from Abbott Labs (St. Jude) appears to have been a significant cause of my AFIB events especially after my base rate was increased from 60 to 70 BPM but I have had increased AFIB problems since implant in Sept 2020.  I recently complained bitterly to my doctor, was called in and they said they needed to lower my base rate AND adjust my PVARP (Post Ventricular Atrial Refractory Period).  I detect a lot of you out there are highly technical I am not.  Suffice it to say that until my PVARP setting was lowered, my PM was causing AFIB events for the last 14 months.  Also this apparently is a well recognized complication of dual chamber devices.  (See Repetitive non-reentrant ventriculo-atrial synchrony induced atrial fibrillation terminated with inappropriate shock in the INdian Pacing and Electrophysiology Journal #16 pages 139-144) if you are technical. I have felt much better.  I was told by my doctor that 30 percent or more of the St. Jude/ABBOTT devices have this problem.  Wish it had not taken 14 months for them to LISTEN to my complaints and adjust the setting.  So, yes there is not a PM that will address AFIB but there appears to be ones that cause or at least don't help it.

2. Second, the Abbott PM 2272 (and others) "Safety Notification" due to possible improper glue sealing is called a Class I recall, the most serious type of recall, by the FDA.  Use of these devices may cause serious injuries or death.  In addition to that, Abbott has issued another Safety Notification in October 2021 that adds more Assurity and Endurity PMs to the list.  So you can look yours up at www.cardiovascular.abbott/pacemaker-lookup.  You can also go to FDA web site medical device recall database entry where you will find they have info on the March 2021 Abbott letter but not the October 2021 Abbott letter.  I called and left a message for the FDA about that. 

3. Third, thanks to this club for helping me find the info needed to motivate the experts to actually diagnose and fix the timing problem!  

Thank You

by Marybird - 2022-01-11 15:48:39

Poolboy, for the information. I'm glad you got the adjustments to your pacemaker and feel better.

As for the Abbott notification ( they aren't recommending prophylactic removal and return of involved units, but awareness and the usual surveillance, so it isn't really a recall), I'd read about it both on the FDA and the Abbott websites. Both the original and updated letters to physicians instruct them to ensure patients with these devices are compliant with their remote monitoring plans, ( either automatic wireless or manual remote checks, office visits, whatever applies) as remote monitoring device checks will pick up lead function issues, premature or accelerated battery life decline, premature EOL issues, loss of pacing. I also see in the November letter from Abbott that they have come up with some sort of a device (or program)- I'm not technical either- that they say will enhance the detection of aberrant electrical activity in the reports from those potentially involved pacemakers.

I wasn't worried about it personally as my cardiologist and staff have shown more than their due diligence in monitoring my remote reports ( wireless every 90 days) and have contacted me a number of times when the reports showed something amiss. I appreciate your posting the link to the Abbott  lookup site to see if a pacemaker is involved in this notification. I plugged in the model and serial numbers for my pacemaker and am glad to report it is NOT included in this notification.

I saw where the FDA only included the information for the March notification but not the November updates. I'd suggest maybe, since Abbott seems to be doing a good job at managing this issue, the FDA may not regard it as a priority- given all the covid testing, vaccines and related issues are keeping them pretty busy these days. Just my opinion. If you hear back from them I'd be very surprised.

Here is a link to Abbott's November updated letter:

https://www.cardiovascular.abbott/content/dam/bss/divisionalsites/cv/pdf/reports/assurity-endurity-102021-DDL-US.pdf