DDDR Mode Switching Pacemaker

Hi there, I have only joined today and am hoping to learn all about my up and coming Pacemaker implant because of 12 years living with Atrial Fibrilitation. I have no idea what to expect and have no idea what the intended Pacemaker is likely to do. There is a waiting list of 10 to 16 weeks here in Truro so I have plenty of time to prepare for this op.
As I am 77 years old, my cardiologist/EP told me that after all the different medications I have been on over the years which do not seem to work any more, my only course of action is a pacemaker. What is involved, how long before I get back to my normal "full of life" self? Is there anything I will not be able to do after the op and for how long? I assume I will be briefed before the op by someone from the hospital/doctors?
At the moment I am completely in the dark! Any help and guidance will be much appreciated.
Thank you.
Angelcat

9 Comments

Hello Angel

by IAN MC - 2014-02-27 06:02:49

I hope that Truro has escaped the flooding which has hit the South West.

I really do think that you should ask some questions of your cardiologist before going ahead with a PM, unless there are things you haven't told us.

If your only problem is atrial fibrillation then the usual treatments are :-
- drugs
- cardioversion
- cardiac ablation

It sounds as though drugs haven't worked for you, so I'm surprised that the other 2 courses of action are not being considered.

The main reason for getting a pacemaker is bradycardia i.e. a heart rate which is too slow ,with the resultant dizziness, possibility of fainting etc

I assume that you have had ECG's. What have these shown ?

Best wishes
Ian

Hello Ian

by Angelcat - 2014-02-27 06:02:57

I have been hospitalised several times over the years regarding AF. I eventually had a 7 day monitor on which showed Bradycardia and very fast And erratic HR. I at last saw an EP who told me that because I am over 75, Cardioversion and ablation would not be successful! My AF episodes are either 4 to 12 hours or up to 5 days so it has been difficult to have a Cardioversion, I have been booked for 3 over the years but each time I go back into SR.
The EP did say that if I was his mother, he would give me a Pacemaker.
I have been on Warfarin for 16 months now, I was on Flecainide for 9 years, then on Sotelol which I reacted to, so when they had the results of the 7day monitor, I was put on Amiodarone which made my AF worse and I felt so ill while taking it. I am now on Bisoprolol which seem to have stabilised me but make me very tired all the time!
I have also had 2 TIA's, one before being prescribed Warfarin and one at Christmas.
Sorry this is an epic message but hope it makes it clearer for you.
Angelcat

Pacemaker for Afib?

by golden_snitch - 2014-02-27 07:02:29

Hi Angelcat,

I don't understand this either. You seem to be having paroxysmal atrial fibrillation. If you want to treat that - and Afib in general - with a pacemaker, you need to ablate the AV-node first. And that would NOT cure the Afib: your atria would continue to fibrillate, but the irregular impulses could not travel to the ventricles, the ventricles would instead be paced. No more antiarrhythmic drugs, but you will still need blood thinners. Now, that AV-node ablation with pacemaker implant would be a very radical approach. It's actually a last resort therapy when all other options have been exhausted.

Only putting in a pacemaker, without touching the AV-node won't help. As soon as you go into Afib, the AV-node would still be able to pass those irregular impulses on to the ventricles. A pacemaker mode switch cannot prevent that. A mode switch works only when the you have a complete block in your AV-node, either caused by ablation or congenital or acquired. If that's the case, and you go into Afib, the pacemaker switches from a mode where it senses and paces atria and ventricles to a mode where it only senses the atria, and paces the ventricles. It ignores what the atria are doing, and just makes sure that the ventricles are beating at a nice and steady rate.

I understand that you have been on a few drugs, but with paroxysmal Afib cardioversions should be worth a try, too, and also so called pulmonary vein isolations. PVIs are a special catheter ablation to directly target the origin of the Afib. While a PVI is not necessarily always effective in the first attempt, two or three PVIs lead to much better success rates. In some patients Afib is completely gone afterwards, in others the episodes happen less frequently and/or are much shorter, and in others a drug that hadn't worked before the ablations, works afterwards to control Afib.

Best wishes

Inga

sdgsdg

by boxxed - 2014-02-27 08:02:18

Are you having pauses? It's not uncommon to put in a PM for AF if they're experiencing tachy-brady. It also allows doctors to increase dosage of beta-blockers without worrying about the patient becoming too bradycardic when they in normal rhythm.

Hello Again Angel

by IAN MC - 2014-02-27 08:02:43

I am intrigued that your EP believes that cardioversion and ablation would not be successful because you are aged over 75 ! I would love him to explain to me why they may work at the age of 74 , but not a year later !

I have a friend in his early 80s who has had both procedures with some success but your EP is the expert and is treating people with arrythmias every day of the week so he should know !

That apart, I wonder if the Bisoprolol is causing you to have bradycardias and a PM would take care of that and allow more aggressive dosing if need be ?

Let us know what the outcome is.

Ian

Good morning boxxed

by Angelcat - 2014-02-28 07:02:40

I have just read the monitor report again and, yes, I do have pauses. Thank you for your comment as I now understand why my EP wants me to have a PM.

Makes sense

by golden_snitch - 2014-02-28 09:02:31

Hi Angelcat,

that makes sense. If you are a slow fibber with pauses, the pacemaker can help with that - however, without doing anything about the actual Afib. It will just kick in when your heart rate gets too slow.

The reason why I came up with this long explanation of Afib and AV-node ablation and pacemaker implant, is that your topic was "DDDR mode switching pacemaker". So, I thought this mode switch was going to be used to help with your Afib. And, as I explained, that just doesn't work as long as your AV-node is working properly.

Inga

Makes sense

by Angelcat - 2014-02-28 11:02:21

Dear Inga,
I am seeing my Dr next Wednesday, I have also contacted my EP's department to clarify why he recommends a PM. As you say, it will not help the AFib unless I have had an ablation.
Thank you for your help.

Date for PM

by Angelcat - 2014-03-29 06:03:43

I am listed for pace and ablate on the 30th April, so not long to wait now. Since my last posting I have had a colonoscopy because they thought I had a bleed due to low haemoglobin levels, I have not got a bleed. Two days later I had the Norovirus which, of course, left me very poorly and with AFib which has been with me for 10 days now and still counting. INR readings all over the place but I am now in the required range of 2.3 instead of 6.9!
I realise that a PM will not cure my AFib but at least it will help to stop me fainting!
Thank you all for your help and comments.
Angelcat

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