A-Fib

My Husband is 71 years old. Just got a Pacemaker this past July. He has had issues w/ A fib since. After the PM placement...In August due to the A-Fib..he went to an EP Dr. & had a Heart Ablation...Still in Sept ...still in A-fib so on Set. 22 , he had Cardio version. He stayed in Regular Rhythm until Nov. 14. A few weeks before Nov. 14, He developed Acute Bronchitis and cough so very deep & hard to get mucus up...I think it may have cause him to go back into A-Fib? Now his EP want to go in surgically and disconnect the lead to the upper chambers so he will not feel the A-Fib but will still have it ...But leaving him w/ just One Lead ...his Heart will be totally dependent on the pacemaker. This scares me to death. Has anyone ever had this done or heard of it? His Regular Cardiologist wants to try Cardio version again w/ help of extra Rhythm Medications before going to this extreme. Can someone please help me out here?

6 Comments

Tough decisions

by Theknotguy - 2014-11-27 11:11:29

You've got some tough decisions ahead of you.

Some facts: There are different kinds of afib caused by different parts of the heart. So what works for me may not necessarily work for you.

I go into afib frequently. My sessions of afib last anywhere from seconds to over 24 hours. For most people, if they go into afib they go to the hospital. If I go into afib, (most of the time) I take extra medication, and relax in the recliner. I'm one of the rare individuals who can feel my afib.

Based upon what I feel and what has happened I have three different kinds of fibrillization. (This is my non-scientific opinion.) One kind is what I call benign. (Although afib isn't benign, so please don't misunderstand.) With the benign type of afib I can take extra medication, and relax in the recliner.

The second kind is afib with RVR (Rapid Ventricular Response). If untreated, even with the PM, it will kill me. For this type of afib I have a set of steps I can take, if they don't work, I get the EMT's and go to the hospital.

The third kind of fibrillization killed me. i.e. my heart stopped in the ambulance, and my heart stopped in the ER. It's the reason I have my PM. I think it was a ventricular fibrillization but since the doctors called it an "undefined event" I'll never know.

After I got my PM my heart didn't settle down for about three months. After my heart stopped twice, the doctors got it under control with medication and the PM but, because of everything that happened, I had a bad session of afib with RVR. That made another trip to the hospital necessary. So some of the trouble I had with afib may have been caused by both the trauma to my heart and the extra stimulation from the PM. My other choice without the PM was to be dead so I didn't have a choice.

We have a lady in our church with a PM who went into afib they couldn't control. They left her in afib for over a month while they mapped out a procedure that (in their estimation) would help her. I don't remember the procedure, but it involved a medical procedure and they have resolved her afib for the immediate future. We also had a close friend of the family who was left in afib for about the last two years of his life. So it sometimes does require that a person be left in afib. No other choices, no other options.

As far as being dependent upon the pacemaker, that is scary but we have quite a few people on this forum who are dependent upon their pacemaker. I'm almost at that point as I pace anywhere from 80 to 100% of the time. I don't like it, but my other choice is to be dead.

Not being a medical person I can't really go into details about different things that cause afib and what to do to stop them. Unfortunately heart disease isn't a one stop, one cure, problem. And, as I said before, what works for me may not work for your husband. I hesitate to say what has worked because, at this time, I don't want to give you any false hopes.

While your EP may be correct in his medical opinion, I feel it would be a good time to have a consultation with several doctors involved. Was there a medical team that worked on him at the hospital where he got his PM? If so, I'd go back to that team. Is he in with a group of doctors? If so, I'd ask for a consultation with several doctors in his group. This is assuming, of course, that your husband doesn't have to have an immediate intervention to save his life. If you have the time to take a deep breath, find out what are the courses of action that can be taken, then chart that course, that would obviously be the best.

Unfortunately doctors are human. They make mistakes and sometimes can't see the forest for the trees. Based upon your description it probably feels like the doctor has taken quick steps without consulting anyone else. Maybe your doctor did consult with quite a few doctors at the hospital and this was the best charted action. In any case, if I were you, I'd like to take a step back, carefully review what's going on, and map out a course of action. You'll feel a lot better about decisions made if you know there aren't too many choices and this is currently the best way to go.

In my case, decisions were made in an emergency situation. There was irreparable harm done, but for the medical teams involved, there was no other way to go. So I'm not angry about the irreparable harm because my other choice was to be dead. Fortunately I survived.

From someone who has afib, I really understand your problems. I wish you and your husband the best. Please let us know what happens.

Afib treatment

by golden_snitch - 2014-11-28 02:11:01

There are guidelines/treatment schemes for Afib, and usually the recommendation is as follows:
1. Try a betablocker and at least one antiarrhythmic drug,
2. try cardioversion, if drugs and cardioversions fail,
3. try pulmonary vein isolation (PVI = ablation).

From what you reported here, your husband's doctor decided to try an ablation first, then a cardioversion, and what about drugs?

An AV-node ablation - disconnecting the electrical conduction between the atria and ventricles - is a last resort therapy that should only be performed in patients who have been through the whole treatment scheme I mentioned above, and in whom all therapies failed.

It is possible and often necessary to do two or three PVIs. Success rates after one PVI are around 60%-70%, after a second or even third procedure you get to 80%-85%. Just because one PVI failed, you do not have to do an AV-node ablation next.

If I were you, I'd seek a second opinion. Or talk to your husband's EP again and discuss all treatment options.

Inga

P.S. I have had an AV-node ablation as a last resort therapy, though not for Afib. I have had 7 catheter ablations before that, been on every antiarrhythmic drug that's on the market.

A-Fib

by bhyde1454 - 2014-11-28 08:11:49

Thank you so much for all your input and information. We do not know very much about Pacemakers due to the fact he just got his July 22, 2014. I Love this site and so very happy I found it. Thank you so very much. All considered we are going for a 2nd opinion.

AV ablation

by RonW - 2014-11-29 10:11:50

i was in a-fib for 3 months (very irregular heart beat with an average pulse of about 40 beats per minute) and had the AV ablation and a PM installed with one lead, so I guess I'm totally dependent on the device. I've had my PM for only 2 months now, but was told by the PM tech that if the device failed, my heart would revert back to its bace rhythm of about 40. Was I told this just to make me feel good, or is this actually what will happen? I was told that since I only have a single lead PM, that I still have a-fib, but that the PM is controlling the ventricles. I will have to continue to be on blood thinners to prevent blood clots for the duration. But since I got my PM, life is good, and I have lots of energy. This site is a wealth of information! I didn't realize that one could get their PMrepost from the tech. I will definitely ask for it on my next visit in 6 months.

Pacemaker Lead

by bhyde1454 - 2014-11-30 03:11:02

Mt Husband has a Boston Scientific Pacemaker w/ 2 Leads. Due to his ongoing A-Fib Issues...His EP wanted to go in surgically and disconnect the One Lead to the upper chambers so he will not feel the A-Fib but will still have it ( Which is still leaving him @ Risk of A-Fib) ...But leaving him w/ just One Lead ...his Heart will be totally dependent on the pacemaker. This scares me to death. Has anyone ever had this done or heard of it? After postponing the Surgical Procedure to Disconnect the One Lead from the Upper Chambers....I learn that Boston Scientific Representative can easy do it by simply touching a program button during a PM Device Check and can Deactivate the One Lead...Just that simple without going through any surgery? She said that she could also re-activate it back that easy also if ever need be. I have not went back to ask the EP about this or if it would be the same as the procedure and the out come as what he wanted to do? So confused...why would a Dr. want someone to go through a surgical procedure if.... it can be done so easy and also have the option of re-connecting it back so easily if needed for any reason??? Please help me if you can? And also what does pacing mean...Or what % of pacing is the pacemaker doing mean? Thank you all so very much...this is all so new to us and a little scary also.

Wondering

by 0300hours - 2018-05-30 22:45:56

What did you and your husband decide to do?  Is he feeling well now?

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Yesterday I moved to a new place in my mind and realized how bad I felt 'before' and the difference my pacemaker has made.