purpose of pacemaker

Greetings,

I read Tech's post on this, and the wonderful responses to the post. I still have a hard time understanding why I actually have a PM... I often wonder if meds alone would have been the way to go before actually having the implant. But, I was in the hospital, and several cardio dr's recommended the pm.
so, now I have it and I'm ok with it. But, on my last visit with my cardio, I expressed concerns about the meds I'm taking. I take 300 mg diltiazem every morning, and 2 1/2 mg warfarin at night. I was on flecainide, 100 mg twice a day, but dr said if was my choice whether or not to continue taking the fleck... I have been off it now for about 1 month, and see no difference what-so-ever...however, I'm wondering about the afib and whether or not I should be on meds...seems that since the pm does nothing to control the afib, I should be on something that can control it... so far, I'm feeling fine... still a little sore shoulder, but working on it...
I guess my main concern is blood clots and possible strokes.
cardio does not seem too concerned... just says to go about my business and not worry about it... Now, I know there are no paneceas out there, but I'm having a tough time deciding whether or not to add meds to my routine... I hate meds, and I'm sure like many of you, would rather not take them unless necessary... But, I can't help but wonder about the strokes and should I be on meds to control the afib...
Most of the time I'm not even aware of the afib eipsodes.. sometimes I feel it, but most times not...
Last time I had the PM interrogated, I was told I was in afib about 28 % of the time...Had the PM put in the 1st time on Jan 13th... then had to have corrective surgery about 1 month later... So, I was on the flecainide for about a month, then now off for about a month or so... feel no difference whatsoever...
I'm hoping for some feedback about meds or no meds when it comes to afib...My dr said lets take you off it and see how it goes... but what criteria does one use here? The 2 interrigations I had for the pm showed little difference in episodes... except one episode where I was in afib for 21 straight hrs...this concerned me, but I don't know if there are meds which can "control" this sort of thing... Just trying to decide where to go with all this. Still a newbie here, and I've learned sooo much from the wonderful, caring people who post responses here in the forum... I guess I'm just looking for advice on whether or not to try different meds or just get on with things and not worry about it... I'll see my cardio in another 2 months and discuss this with him... Just fishing for opinions here on meds or no meds... I tolerate the meds ok... no problems with the coumadin or diltiazem...just wondering if it is riskier to not take any meds which could control the afib or should I be trying different meds for control...all meds eventually have some side effects...but I'm still trying to decide the best course of action here...any and all opinions will be greatly appreciated...

Lou (Lubro )

4 Comments

Why you have a PM.....

by donr - 2013-04-26 08:04:59

....Hmmmmm! Good question. Now for a good answer, I hope!

PM's are not really the solution for A-Fib. That is a faster than normal beating of the Atria, & PM's cannot slow things down, only speed them up or cause them to happen if they are missing. To get to A-Fib requires meds and/or an ablation, where a part of the tissue near the SA node is burned away.

I'm not sure of why you are on Diltiazem - that is an anti-hypertension med (High BP), not a Beta Blocker, usually given for people who need arrhythmias controlled. Do you have Hypertensin?

The Warfarin (literally a rat poison) is ONLY to combat generation of blood clots when you have A-Fib episodes. Your cardio must think enough of your A-Fib to put you on the Coumadin. Do not fight the Warfarin problem - that protects your life from a clot generated during a bout of A-fib.

Flecainide, OTOH, is an anti-arrhythmic drug that iis often given for A-Fib. At 100 mg Flecainide twice a day, you should have seen an improvement in your A-Fib. You did not say how long you were on the Flecainide, just how long you've been OFF it. It usually takes several weeks to gain full therapeutic value from it, however.. It is a good drug for prevention of arrhythmias. It is tough to judge how many bouts of A-Fib that Flecainide prevented, so short of an event recorder, you cannot really tell.

You asked about the problem of strokes - that is very real & the Flecainide does, indeed, truly prevent the strokes. But - it mainly does so by reducing the number of A-Fib episodes you have, and it is almost impossible to stop EVERY episode of A-Fib! To do that would require enough Flecainide to zonk you out & turn you into a zombie. It is the Warfarin that really kills the potential for a stroke by stopping the clots from forming that cause strokes.

With the amount of time you spend in A-fib, I would NOT give up my meds, especially since you can tolerate them just fine.
Don

meds & a-fib

by lubro - 2013-04-27 02:04:51

thanks again don...

yeah, I have reservations about meds... but I'm pretty sure I'm gonna be on the coumadin forever... have not researched the "long term" effects of this as yet. I'm happy that I don't have any adverse side effects from the meds so far... Even the Flec... I tolerated it ok... But, I still wonder why my "other " cardio just prescribed it and never mentioned monitoring it or having me come back for an EKG... nothing... just go home... take this med.. see you in 6 weeks...
from what I've read, this drug should be monitored more closely... when I go back to see my cardio, I may discuss getting back on the flec or perhaps trying some other anti-arrhythmic... need to see what the pm interrogation shows... I suppose its all just a matter of choices huh...maybe I should try something other than the flec... Guess the doc & I have some talkin to do... thanks again for your comments and info...

Lou

thanks donr

by lubro - 2013-04-27 09:04:20

appreciate your info... I have been on the diltiazem since leaving the hospital...couple of months now... never had any high bp problems or anything like that...so I am also not sure why I'm on the diltiazem...I know of several others who are taking diltiazem along with antiarrhymic meds...
after having my PM interrogated the 1st time, the tech saw something in the readings that he didn't like, called in the Dr, who put me on the flecainide... "see me in 6 weeks"...not much of a talker, so I switched cardios...I want someone I can sit and talk with... the new cardio, who actually did the corrective procedure from the botched 1st implant, told me that if I wanted to get off the fleck that we could try that and see what happens...
so now I'm wondering why I'm on the anti-hypertension med and not a beta blocker or antiarrhythmic med...Dr said that some people just live with the afib... his advice was to just get on with living ... that sounds like good advice, but does not address the issues... I have my moments, but overall feel pretty good... getting used to the PM... the little twitches and tiny "shocks"...the sore shoulder... the minor discomforts...guess I have a few things to discuss with the cardio at our next meeting...thanks again for your input...

Meds & A-Fib

by donr - 2013-04-27 11:04:47

Lou: I only suffer occasional A-Fib & very short episodes at that. My problem is PVC's out the wazoo, & for that I take Acebutolol & Flecainide, plus the PM to stabilize everything.

Acebutolol is a Beta Blocker; Flecainide is an anti-arrhythmic. We have collectively titrrated my two Meds to a point where the PVC's are at a tolerable rate & I am not in a chronic Zombie state from the Meds - Zombie is the least miserable side effect of the Meds combination.

If you search the site for Flecainide comments, you will see a bunch of them. I have been very vocal about the indiscriminate use of Flecainide - BUT - I support it because it WORKS WELL! I have my attitude because I have read all about it & My Cardio/EP combo treat it like the dangerous drug it CAN be. My Cardio will NOT prescribe it - doesn't like it. My EP prescribes it all the time, BUT - takes precautions - like an ECG every quarter that he pores over like white on rice, looking for anomalies in my Q-T time & QRS complex. The day my EP prescribed it, he ordered that I come back for an ECG in 48 hrs - NOT 2 days. I did so & my Cardio's nurse pulled the strip from the machine & called him & he was just about to walk into an OR, but took her call & looked at my strip to see if anything untoward had developed.

But, I have digressed - it struck me as unusual - your Diltiazem & Flecainide combo, since the Diltiazem is not a beta blocker.

I'm on the rat poison because I had a TIA in 2002. My neurologist is a conservative coward when it comes to coumadin use. In theory, he could take me off the Coumadin, because it is not normally used following a TIA, but w/ the occasional A-fib thrown in, my cardio climbed on the bandwagon for its use, also.

I'd say that the A-Fib you described as running hours at a time would definitely warrant Coumadin usage.

I don't blame you for changing cardios; if they won't talk or explain, they are useless, no matter how good their skills may be. But, sounds like your first one did not even have that saving grace.

Don

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