Atrial fibrillation & pacemakers.

AF and pacemakers

by Gemita - 2019-10-27 06:37:46

Hello Lizzie,

You should post more often !!  Anything we can do to reduce our AF burden the better I would say.  Really interested to hear that you have had paroxysmal AF since 22 and you are now 73. Goes to show that AF can remain intermittent and may never become persistent/permanent in some patients.  

I have a dual chamber Medtronic pacemaker for bradycardia, pausing, syncope due to several arrhythmias and AF with a rapid ventricular response rate.  Having my pacemaker set at a steady 70 bpm certainly helps pace me (at 71) out of many AF attacks and often prevents me from going into AF at this rate.

I have recently asked for a download of my last pacemaker check since I was unable to cover all the questions I had during a recent appointment with my EP.  I don't expect I will understand very much but I can always learn and like you, I do like to be in control.  

Thank you for sharing this helpful tip and I am so glad it has worked for you.  I will check out what is available to me although I note that you have a St. Jude pacemaker.  I had heard about this treatment (I believe it is known as Atrial Dynamic Overdrive Pacing?) for patients with sick sinus syndrome and atrial fibrillation, so it is great to read your success story.  What a pity you weren't told about it earlier, you could have had a much better quality of life !!

AF & pacemakers

by Lizzie - 2019-10-27 07:38:15

thanks Gemita. Would have been about 2 years after the PM was put in I found out about the algorythm, so it has been great. It is set at 60. I play croquet at top level and set at 70 was playing too fast! Coach said I was zooming round the court like a greyhound! You play to your  body rythm. Interesting creatures we are.

Atrial fibrillation & pacemakers.

by Theknotguy - 2019-10-27 17:39:03

Lizzie:

Just when you think you have all the answers, someone comes along and tells you some things you don't know.  

I have a Medtronic.  Two programs for afib.  One is APP (Atrial Preference Pacing), the other is Minerva.  Both are running concurrently.  

Like you, I asked to have the afib programs turned on.  Was getting along fine for six years, then started having problems.  Mainly running out of air when I walked about 1000 feet at one stretch.  Had to get some tests, then found out they could make pacemaker adjustments - which they did.  

Both programs watch 100% of the time to see if I go into afib.  APP works about 10% of the time.  I'll go into afib and it raises my heart rate.  This is something seen with guys who have afib.  They'll sense they have afib and take a walk.  Idea being that your heart can't continue being in afib and go at a faster heart rate.  Like I said, works about 10% of the time.  Minerva works about 80% of the time.  It watches for afib and if APP drops off, it will change my pacing and pace me out of afib.  Sometimes I can feel the effects of the programs.  With APP I'll get a hot flash.  With Minerva I'll get a stutter-step feeling.  I'll be expecting a heartbeat at a particular rhythm and Minerva will hold the heartbeat just a little longer to stop the afib.  Sometimes APP will kick in, run for a while, then switch over to Minerva.  I volunteer at a hospital and the nurses are amused to see me walking down the hallway muttering, "Would you just make up your mind!!!" It's annoying to feel the switchover of the programs.  

Anyway, started running out of air after walking 1000 feet at one stretch.  Prior to having the afib programs I'd get afib and spend the next day and a half in a recliner until the afib sessions would stop.  With the programs running I haven't really felt any afib symptoms in about a year and a half.  So I'm leading a "normal" life with no interruptions due to afib.  However two things happened.  I was doing more activity and my afib sessions increased.  The pacemaker settings were set too low and it wasn't compensating for the increased activity and increased afib.  The pacemaker wouldn't raise my heart rate enough to compensate and I wasn't getting enough air.  So....

Two changes were made.  1) My rate response was changed.  It was at the lowest setting of about five levels.  Now I'm at level two.  The Minerva program for afib was changed.  It was at the lowest setting of five settings and now I'm at level two on that.  Am getting along fine.  However, my overall afib sessions have jumped from 18% to about 40%.  These programs don't cure afib, they just compensate for it.  So the next question for my EP is at what level do I go for an ablation. 

So, for you, the next set of questions is if there are several settings for increased afib activity and at what point may you still need an ablation.  Maybe, like me the programs will hold off an ablation procedure for six years, but you'll still want to be aware that you might have to go in for an ablation in the future.  Also, does your afib program have several levels and what will be the trigger to change you to another level?

This isn't a note to tell you to be concerned, just a note to let you know there may be some more adjustments and fine tuning needed in the future.  

Hope everything continues to go well for you down under.  
 

Af & pacing.

by Lizzie - 2019-10-27 20:46:13

Morning,

I think my pacemaker, a St.Jude Zephyr which was put in early 2009 is not as fancy or advanced  re programs as yours. I still have a couple of years on the battery so will see.

i will not have an ablation unless my AF episodes increase and are not easily manageable. I only take medication PIP ( pill in pocket) when in AFib. I have had it now for 50 + years, so doing pretty well.

The Sick Sinus Syndrome was much harder to cope with and the pacemaker has fixed that problem.

wonderful inventions! 

Cheers from Lizzie “Down Under” 

Afib and Ablation

by AgentX86 - 2019-10-27 22:35:51

Note that the longer paroximal Afib continues, the less the chance that an ablation will be successful.  Afib begets Afib. At the other end of the spectrum, if you're asymptomatic there's no reason to fix it. Manage the side effects and be happy.

Afib & pacemakers

by Lizzie - 2019-10-27 23:30:11

hi,

I am an exception to the rule, that Afib begets Afib.  My cardiologist and E P are very interested in why that is. I have had paroxsysmal afib for 50 years.

It has not increased in the number of episodes or effects. While I continue to remain this way I would not consider an ablation and my doctors all completely agree. 

I am not asymptomatic during a bout but have learned over time to manage them well. Usually around 12 hours, rarely longer. My PIP medication works well. 

If I am playing in an important sport tournament I take Flecainide as a preventive measure. 

The best thing for me was discovering my pacemaker could help after I had been told it wouldn’t. Ask questions people, read everything you can and take some control, in conjunction with the best medical advice you can get.

cheers,

Lizzie