Surgery was yesterday, got a pacemaker

Thanks to everyone who made me feel so much better about getting this pacemaker. I was released today from the hospital after the A-fib incident. The surgery was fine, no problem. They put in a Medtronic MRI compatible unit which I was told was very good, hope so, I know nothing about them. Now, I have to keep my arm down for a month, so that is not going to be easy, but I will do whatever. Will be on Sotalol and Coumadin as well. This just seemed like so much for a one time Afib, but it is what it is. I had Afib for 12 hours, converted on my own while on a cardizim (I think that was the name of the drug) drip in the CCU. I converted on my own, but heart stopped for almost 8 seconds. I am definitely going to get a second opinion about the drugs, it's probably a good idea, but after reading some posts on this board, you are very comforting and knowledgeable. I am so greatful for all of you and I look forward to reading about all your experience.

3 Comments

Afib and drugs

by Theknotguy - 2014-03-18 09:03:48

It appears they're doing something similar for your afib as they've done for me. I've had afib, probably for all my life, but it was diagnosed nine years ago.

They have two methods of treating afib, rhythm and rate control. Rhythm didn't work for me so I'm not that knowledgeable about it. They have me on rate control.

Rate control is where they slow down the heart to help prevent it from going into fast afib with RVR. (Rapid Ventricular Response). Rate control won't stop you from going into afib but it will try to keep it to a manageable level. The Sotalol is to slow down the heart. Coumadin is for both the PM and to help prevent blood clots if you get one during an afib session. I think Sotalol works on the potassium side. Cardizem in your IV drip works on the calcium side.

Prior to the PM they would have to worry about slowing down your heart to where it wouldn't keep you alive. Post PM they can slow down the heart to below where it would sustain you, then use the PM to keep your heart rate at a living level. For example, they can give you enough drugs to where your heart rate would slow to 20bpm in a natural setting - which won't sustain you. But your PM will kick in and keep the heart beating once it drops below (probably) 50 bpm. Mine is set to keep my heart beating at 60bpm regardless.

You'll want to see if you have chance for going into a fast afib with RVR. That's what happened to me. Heart took off and I went from 80bpm up to 140bpm while sitting in bed. Wasn't a comfortable feeling. Had to go to the ER and get a Cardizem drip to slow it down.

You'll want to discuss with your cardiologist if the same can happen for you. I now have a procedure to follow if it happens again. I know what drugs to take, when, and when to call the ambulance to go to the ER.

You have a new Medtronics. Medtronics has a setting for afib called APP. (Atrial Preference Pacing) They probably don't have APP turned on yet. They'll want to see if just having the PM will reduce your afib sessions or if the PM alone will manage your afib sessions.

My cardiologist told me the jury is still out on APP. Not enough data to say it works very well or it doesn't. But after an afib session they turned on APP for me.

APP feels really strange when it kicks off. It feels like a counter-beat for your heart. So far APP has kept my afib at a lower level and has prevented me from going into the fast rate. Needless to say, I'm in favor of it. However, as I pointed out before, your doctor may not want to turn it on unless you have multiple sessions of afib. Mine were averaging one afib session every three weeks. Post APP I'm not sure what the average is as it hasn't been turned on that long.

Your doctor may switch your drugs around too. I was on Felcaniade prior to getting my PM. Post PM they only had me on Metoprolol. After a couple of sessions of afib they switched me to Cardizem (oral) and Metoprolol. So far that seems to have the best control of my afib on the drug side. I'm being controlled on both the calcium side (Cardizem), and the potassium side (Metoprolol).

Idea now is to use the drugs to keep the afib in check most of the time. Then have my PM and APP kick in when the drugs don't work. Worst case scenario is to head off to the ER if nothing works. Other idea is to push of ablation for as long as possible.

I've tried to get statistics on how long ablation lasts but there aren't enough reliable statistics yet. In the meantime I'm one of those guys going around saying, "If it ain't broke, don't fix it!" Ablation messes around with the heart and I'm not in favor of it. But if nothing else works I'll go that way. In the meantime, drug advances, technology advances, and time are on my side.

Overall things have gotten a lot better post PM. Both the drugs and PM have helped with my afib. The PM has regulated my heart beat and I'm feeling better. Hope the same happens for you.

Hope things go well for you.

Theknotguy
Hope this information helps


I had a flutter

by marnid - 2014-03-19 07:03:35

I noticed that I had a bit of a "flutter" then kind of a dizziness and then back to normal. I was laying on the couch watching TV. I have been so tired since I got home so maybe all this fatigue is not helping as well. I took my BP and it was pretty high, 197/93, then I took it again, a little lower then I had to eat dinner and then took it, 140/72, so I don't know if my BP had anything to do with it. My BP in the hospital was pretty low, 110/65. No issues with sinus rhythm going out of whack, but they had stopped some of the sotolol, and now I am back on it since getting home, I wonder about it, because it caused such a slow heart rate, and that is why I had to have the pacer. Is it normal to have these "flutters" with a pacemaker?

A-Fib

by Roys - 2014-03-19 08:03:13

Hi
I can't believe you got a PM after one incident of AF. I had AF for 8 years and all I got was sotalol, and I was getting AF up to 3 times a week, and up to 18 hours, when I converted from AF to SR my heart would stop for about 5 seconds, and the Cardio said I was not bad enough for a PM. Then I had a PVI ( ablation) and things started to get better, but thats a long story.
Cheers Roy

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