Arrhythmia Ablation vs bradycardia pacemaker

I have several arrhythmias. My doctor has suggested ablation surgery. He said that I will most likely need a pacemaker for my bradycardia. 

Is it possible for pacemaker surgery to increase the heart rate enough to fix some of the arrhythmia? The reason why I ask is that when I go to the mountains in higher elevation my arrhythmia's decrease because my heart rate increases. When I come back down, I get slammed again and my HR drops. 

Has anyone gotten a pacemaker and had their arrhythmia fix itself?


9 Comments

two different problems

by Tracey_E - 2019-09-24 17:58:18

Ablation will try to fix when episodes when it goes too fast.  Pacer will help when it goes too slow. It's a gas pedal, not a brake, so it will only watch when the heart goes fast on its own.  

It's sometimes possible to pace out of an arrhythmia, get the heart going faster and things smooth out, but there's a limit to how high they'll want to put your minimum rate. There's a limit to how high you'll want it, faster rates don't feel good.  How much faster do you go at altitude? 

You didn't give a whole lot of information about the types of arrhythmias you have so this is only a guess, but it sounds like the pacer might help with some but probably not all. They don't ablate lightly or when pacing faster will fix it. They'd try that first, then ablate later if that were the case.

Tracy

by Donabones - 2019-09-24 18:13:06

i have PSVT, PAC, PAT, And PAF. I also am bradycardic 45 awake, 30 asleep. In altitude it gets to 80. When I come down it drops to 40.  I am more concerned with my HR than my arrhythmia. I am on Rythmol so it works well for now. My heart is otherwise healthy and damaging it on purpose by ablation or multiple ablations is not really an option right now.  I am 50 yrs old so I would like to be at least 70HR. 

My doctor would rather me ablate before pace.

2nd opinion

by Tracey_E - 2019-09-24 20:58:35

Is your doctor an ep or a regular cardiologist? If not an ep, then that's where I'd go next. 

You will have considerably more energy with a higher resting rate. 30 is half where you should be, so your body is getting half the oxygen it needs while you sleep. That takes a toll. 

Could the rhythmol be causing the low rates? Sometimes the meds that control the fast rates slow us down too much and the purpose of the ablation is to get us off the meds that are causing the bradycardia. In that case you may not need the pacer and your rate may come up again on its own. Or other times we get the pacer so we can tolerate the meds we need to control the arrhythmia. There's no one answer for everyone so sometimes a second opinion helps see things more clearly. Just don't get that second opinion in the same practice, they will tell you the exact same thing. 

Many of us with electrical issues have structurally normal hearts and no sign of other illness. Electrrical problems can be isolated. 

Tracy

by Donabones - 2019-09-24 21:15:21

I have always seen an EP. I am bradycardic off meds as well as on. There is only a 10 point difference. Flecainide was way worse. Rythmol is way better. my sleep study stated that my lowest o2 was 83% but that I do not have sleep apnea. Theree are mornings when I can barely walk, my balance and brain fog are way off. I have issues oxgenating myself when exercising as well since my HR doesnt get very high. Usually around 100 after a hour of hard exercise its like my heart doesn't know what to do when I work out. Can't pick a beat. flutters, misses beats, etc...

I cant see burning my heart and damaging it on purpose.  If I only had one type than that would be one thing but about 90% of PSVT patients (part of Outsmart PSVT advisory board) have multiple ablations causing pacing or icd issues long term. The 80% success rate is not 80% although the drs all quote it. If i had structural issues than I wouldn't care as much. 

It's possible

by AgentX86 - 2019-09-24 22:07:14

It's possible that a higher heart rate will bury some arrhythmias.  After I got my pacemaker I had a lot of problems with bigeminal PVCs.  It's a long story but they started me out at 80bpm and a month later reduced it to 70bpm and the PVCs started up every evening.  The fix was to raise my heart rate back to 80bpm, at least during the day (it drops to 50bpm at night).  It might work with some other arrhythias but probably not with Afib and it's highly unlikely to help with Aflutter.

 

Agentx86

by Donabones - 2019-09-24 22:41:11

I have genetic markers for Afib and have only had 1 true episode. The others were PSVT.  I believe that if I ccan get my HR up alot of the arrhythmias will disappear. It happens when I go into higher elivation all the time.  My dr thinks that its not possible but I know my body and have tested it out many times. im not concerned about the aarrhythmia as much as the HR. If it does help then great if not then Ill just stay on the meds.

Higher elevation

by ar_vin - 2019-09-25 02:50:33

What is higher elevation? How high exactly? Where? And how do you get there? Drive? Fly?

While there's a known physiological response (increased HR) to going to higher altitude, it's unlikely one would experience a 20-30 bpm rise in HR that does not normalize over a few days at altitude.

I've spent a lot of time in the mountains at altitiude (hiking, backpacking etc) (around 10000 ft to 14000 ft) andI live at sea level. I also spend a lot of time with groups of hikers and backpackers who carry HR monitors as well.

 

 

outpacing an arrhythmia.

by Selwyn - 2019-09-25 06:27:22

You can outpace an arrhythmia and stop it. Some pacemakers  have a special programme to do this, eg. Atrial Preference Pacing.

see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476853/

as an example. Symptoms are experienced with the tachycardia pacing, although there is a a subset of folk that may benefit eg. those developing  paroxysmal atrial fibrillation as the heart slows down, as at rest or in the middle of sleep ( see results from the Minerva trial, Heart Rhythm. 2015 Aug;12(8):1717-25 ). Try reading:

https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/cardiac-rhythm/cardiac-device-features/pacemaker-features/reactive-atp.html

Pacing at different sites in the atria eg. dual atrial pacing may help stop some  fast atrial arrhythmias. 

So the answer to your question is yes, you are correct . A faster resting heart will prevent some arrhythmias. My personal experience was an increased frequency of atrial fibrillation (AF) just before trying to get to sleep, as my heart rate slowed, the AF became active. I am a lot better now having had two AF ablations, and rarely experience anything other than a few palpitations. 

Prior to my ablations I was advised by one cardiologist not to go to Tibet, and the other cardiologist gave me a letter of fitness to travel. I sent him a post card from Lassa. As I remember there is some evidence that AF may improve with altitude, in the odd person, though the reverse is more likely to happen.

( found the reference to that:     Taylor Smith V. Altitude and atrial fibrillation. South Med J  2005; 98: 130.)
 

 

PACING WITH ARRHYTHMIAS

by Gemita - 2019-09-28 08:34:55

Donabones, what a great name.  I haven't read all the responses to your post yet but I will since this subject is of immense interest to me.   I firmly believe that my pacemaker (dual lead) has been the best treatment so far for my paroxysmal AF since when my heart rate dips and  pauses this is a strong trigger for ectopics and ectopics are a strong trigger for AF.  My EP told me that there is evidence that for some patients with predominantly bradycardia induced AF, they may be helped by a pacemaker.  I got my pacemaker for low heart rates, pausing and syncope and also to be able to take a beta blocker to control a rapid ventricular heart rate when in AF but which would fall too low on a beta blocker when in normal sinus rhythm.  I can honestly say that since living with a 70 bpm heart rate my arrhythmias (Flutter, AF, Atrial Tachycardia) are beautifully controlled.  I feel less symptomatic, have fewer episodes and episodes are of shorter duration.  I tried anti arrhythmics Flecainide, Digoxin and they made the situation worse.  Now with pacemaker and low dose Bisoprolol I am doing well

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