About to go bionic

First post.
68 years old in good shape. Run, ski, hike. Still working.
Have 2x aflutter and also slow rate sometimes in the 40s.
Aflutter is generally under control with beta blocker but also take Xeralto blood thinner. Doc says I am stable so no rush but my HR will probably slow to an unacceptable rate in a few years.
So what do I do?
Doc recommends ablation and PM when I am ready.
The upside is I get off the drugs, esp the blood thinner.
He makes no promises that I will have more energy but I would hope so. I get a bit tired in the afternoon but seem to get over that later.

Anybody have experience with this situation?

6 Comments

Pacing options

by Terry - 2014-08-15 11:08:03

Even though you may get an artificial pacemaker, you can still get a healthy, natural ventricular contraction. More and more doctors are able to do this, starting in 1999. Google PacemakerPatientAdvocecy.
Blessings,
Terry

Atrial flutter

by golden_snitch - 2014-08-16 02:08:52

Hi Jack!

Usually, atrial flutter is very easy to ablate (been there, done that), and catheter ablation presents a permanent cure for atrial flutter. So, once it's cured, you will no longer need the Xarelto and the betablocker. And without the betablocker, your heart rate will probably no longer drop to the low 40's. No need for a pacemaker then.

If your doctor wants to do an ablation and put in a pacemaker this sounds more like an ablate & pace approach that is sometimes used in atrial fibrillation patients. But after that procedure you'd not be able to get of the blood thinner. Ablate and pace means that the AV-node is ablated, not the atrial fibrillation itself. So, the atria keep fibrillating, but the the ventricles are pacemaker stimulated at a steady and appropriate rate. Since the atria keep fibrillating, you need to continue the blood thinning medication.

Inga

A few more details

by Jackw - 2014-08-16 04:08:03

Thanks to Inga Terry and. Ian for the helpful comments.

Inga: It is definitely aflutter not afib. I had a low rate before the flutter started last November. Doc said if he did the ablation to fix flutter my rate would probably drop. The flutter actually kicked my rate up some so when it is gone my rate may fall too low. Doc thinks the flutter may have been partly due to my heart reacting to the low rate and trying to pick up the rate.

Ian: thanks for the encouraging words about getting active again. I am fortunate to live in the Boston area and my doc is part of an experienced team who do nothing but arrhythmias at one of the great teaching hospitals so I am confident about the level of care. Ian debating just having the ablation to see how low the rate goes. On the other hand I would rather not have two stays in the hospital if it is highly likely that I will need the pacer anyway.. Doc wants to set the low rate and wait to see if I need the adaptive part turned on the help with getting my rate up for exercise. Any thoughts. Need to get in shape for ski season and the holidays!

Go for it !

by IAN MC - 2014-08-16 05:08:37

Hi Jack

Ablation is now considered to be the treatment of choice for atrial flutter with permanent cure rates of around 95 %.

But do make sure that the doctor who does it has lots of experience and a good track record.

When I had atrial flutter it was reasonably well controlled by drugs and my main motivation in having an ablation was to come off blood thinners (which I did immediately afterwards)

If you only have atrial flutter chances are that you will just need the ablation and not the pacemaker,

If your slow HR worsens you may end up having a PM but it really is no big deal ! You will still be able to run, ski and hike !
You could end up like me; having had a successful ablation , having a PM for bradycardia and not taking ANY drugs !!!

Doctors will never promise that you will end up with more energy but certainly the combination of your atrial flutter, your drugs and your relatively low heart rate could all be contributing to your tiredness in the afternoons.

Best of luck

Ian

Pacemaker indication

by golden_snitch - 2014-08-17 03:08:59

If your heart rate is only sometimes (how often is "sometimes"?) in the low 40's, I'd definitely wait and see what happens after the ablation and when you come off the betablocker. If you had the low rates already before the betablocker, and they were causing symptoms, you should have been quite miserable while on the betablocker as it lowers the rate even more. You do not mention any symptoms, and you seem to be very active, so rates in the 40's could be normal for you. What is your average heart rate over the day? Also, does the rate drop to the 40's when you are awake or when you are asleep only?

From what you are writing here, I would not go as far as saying that it's "highly" likely that you'll need a pacemaker. Also, if I were you, I'd rather take two hospital stays, but be 100% sure that a pacemaker is what is needed, instead of one stay with an ablation and pacemaker implant, when the pacemaker indication isn't that clear. Once it's in, it's in. And even though the surgery is no big deal, why get a device implanted that you probably do not really need? I'd try to live as long as possible without the device.

But that's just my opinion. Good luck with whatever you decide!

Inga

I agree with Inga

by IAN MC - 2014-08-17 04:08:53

Although I have never found having a PM to be particularly traumatic either physically or mentally; I certainly wouldn't agree to having one unless I was experiencing symptoms.

I know you want to be a fully-fledged member of the PM club and if you have to join us we will all be delighted !!

If you don't have to join - great !!

Good to hear that you have some experienced ablation guys in your area.

Best of luck

Ian

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