Afib

I've had my pacemaker a couple months.  Lately I have been in and out of afib.  I thought the pacemaker kept the heart rate normal--in perfect rhythm.  I seem to go into afib if I get overtired or anxious.  Anybody else have afib issues.


8 Comments

Nope

by AgentX86 - 2020-07-12 22:22:40

A lot of people here have Afib.  I did before, well, before they made it even worse.

A pacemaker does nothing for Afib.  A PM can only make the heart go faster.  It can't stop something that's already started (ectopic beat).  As we say, it's an accelerator, not a brake. Now, a pacemaker can countertact the effects of drugs antiarrhythmic drugs that, as a side effect, slow the heart.  This allows larger doses which can hold off Afib but the PM is just making the heart go faster.

Pacing *can* help avoid AFib

by crustyg - 2020-07-13 04:57:24

AgentX86 is correct that having a PM doesn't force you out of AFib - it's not like an ICD for the atria (external DC-cardioversion is a recognised way of getting patients out of AFib and back into sinus-rhythm, but the effects are often very short-lived).

There is *some* evidence that atrial pacing helps reduce the transition to persistent AFib in those with a tendency to atrial-based tachyarrhythmias (excluding accessory conduction pathway disorders like WPW) who have a very high vagal tone and persistent bradycardia, i.e. those with an athletic heart who often present in AFlut, or have paroxysms of AFlut/AFib.

The heart is influenced by a lot of factors - nerve input (sympathetic and parasympathetic), circulating hormones (fight-and-flight) and plasma electrolytes - especially potassium and magnesium.  It's entirely possible that when you are tired, perhaps a bit dehydrated, your body responds to the demands that you make by driving your heart just a little bit harder and you have a burst of AFib.  Could you avoid this?  *PERHAPS*, yes, but it's not easy to prove.  Lack of blood supply to the heart muscle itself (aka coronary artery disease, ischaemic HD) is a very common cause, or contributing factor in AFib.  Pacing with a PM is unlikely to have any effect on AFib under these circumstances.

ATRIAL FIBRILLATION

by Gemita - 2020-07-13 06:10:34

Hello Jude,

AgentX86 and crustyg have both made some excellent points already. Here is my contribution.  

Yes many of us suffer from atrial fibrillation (AF) and I too seem to go in and out of this pesky little arrhythmia at breakneck speed some days but I have found that my pacemaker really does help me to feel my AF less generally, or even to pace me out of some of my arrhythmias like a premature atrial contraction which would otherwise develop into AF.  So all in all I am well pleased.  What is your heart rate set at Jude ?  Mine is set at 70 bpm and the higher heart rate certainly suits me.

No a pacemaker is not a treatment for AF unfortunately although as I mentioned above it can help some of us.  Treatment for AF would be by way of anti arrhythmic meds and rate control meds and/or an ablation and then a pacemaker might be implanted for some patients who cannot tolerate these treatments because the treatments might cause their heart rates to drop too low for example, but still need the treatments nonetheless.  The pacemaker then would be implanted to allow their doctors to give them the medication they need to treat their AF and then set their heart rate at a certain level to prevent bradycardia from occurring.

For example my heart rate has always been low even when I am in perfect normal sinus rhythm.  I have AF with both a slow and an extremely fast ventricular response rate at times. It really cannot make up its mind what it wants to do.  A pacemaker cannot help to slow my heart rate down, only medication and/or an ablation might be able to stop the tachycardia and then only a pacemaker will be able to prevent my heart rate from falling too low with these treatments.  So we often need a combination of treatments to treat AF.  At the beginning it can be so trial and error and I know, frustrating !  But you will get there, it is still early days.

Yes tiredness, anxiety/stress, infection and many illnesses like hypertension, diabetes, ischaemic heart disease, thyroid dysfunction, sleep apnea for example can all be triggers for AF, so try to get plenty of rest and take care of any health problems you might have.

 

Pacemaker with afib

by Theknotguy - 2020-07-13 08:51:37

All three comments have very valid points.  i.e. the pacemaker doesn't stop afib.  

I had bad afib sessions before getting my pacemaker implant.  I'd get an afib attack and be in a recliner for up to three days while waiting for my afib sessions to run their course.  Also had a really bad afib session with RVR just after getting my pacemaker.  I don't recommend getting afib with RVR as death is a viable alternative to living in the condition with RVR.  Three things did help.  

One:  A change in my heart drugs.  As indicated in a post above, they can give you a higher dose of a drug that slows your heart.  Currently I'm on a dose that would slow my heart below life sustainable levels and they use the pacemaker to keep my heart at a "normal" rate.  

Two: I have a Medtronic pacemaker and my Medtronic unit has afib programs.  These programs can identify an afib session and change the pacing to mitigate the afib.  I have two programs running on my pacemaker.  One works about 10% of the time, the other about 80% of the time.  In the final 10% I'm on my own and have an afib session although they aren't as bad as before.  Criticism of the afib programs running on pacemakers is they don't fix afib, they just treat the afib symptoms and eventually the afib sessions may get more frequent or worse.  

Three: Surprisingly enough my EP suggested I get an over-the-counter daily dose of magnesium.  You can pick it up in any grocery store.  And even more surprising it does seem to work.  My afib sessions went from being really bad to where I very rarely feel them.  It's not a cure, but it does help.  I strongly suggest you consult with your EP or cardiologist before you go out and start taking the over-the-counter pills.  The over-the-counter pills are not a cure all - so don't get the idea they might be.  And some people have told me their effect is mostly mental. i.e. you think they make you feel better but they really don't do anything. Caveat emptor.

A combination of the heart drugs, over-the-counter pills, and the pacemaker have reduced my afib from knocking me down for three days to leading a "normal" life.  I'm in afib about 40% of the time but the sessions last anywhere from a few seconds up to a few minutes.  Most of the time I'm not aware I'm in afib and life goes on.  I have had the occasional session of afib that has lasted up to 48 or so hours but that's only been one or two sessions per year for the past six years.  

As one heart doctor told me the only cure for afib is ablation.  Either mechanical or chemical.  While my EP and cardiologist have indicated I can go in for them running the wire up into my heart and killing the areas that cause afib, they have also suggested I hold off for as long as I can.  I have other issues and they don't want to risk further damage to my heart.  Currently I get along OK with what I have.  

Hope this helps and hope you have a good adjustment to life with your pacemaker.  
 

Afib

by Heyjude19 - 2020-07-13 09:09:51

Thanks to all for your comments. Very reassuring.

Afib

by Old_Mainer - 2020-07-16 13:54:53

I have had idiopathic (no obvious cause) paroxysmal afib for 50 years.  I was being cardioverted every 2-3 years initially, then steadily more often until every month in late 2019.  So I got a pacemaker to prop up my HR so they could use more flecanide to stave off the afib.

So, I think I qualify as an afib expert.  Over the years I have found my triggers to variously  included low potassium, low magnesium, alcohol, dehydration, altitude, stress, exercise, meals and sleep. 

So my afib is sometimes andrenergic and sometimes vagal - ie, stemming from various conditions that slow down or speed up the heart (and do lots of other things, as well).

Every heart is different.  Since afib is caused by defects in the normal electrical pathways in the heart it is logical that changing almost anythng might have an effect on afib.  My EP told me yesterday that sometimes increasing your night time minimum HR can decrease afib frequency.  Go figure.

As part of the PM decision my EP said that if the afib continues to get worse and worse, a long term option is to simply discinnect the natural pacing entirely and let a PM do it all.  That is the ony PM "cure" for afib.

Hope this general background is not more than you want to know.

 

 

Afib

by Heyjude19 - 2020-07-16 14:57:38

I keep trying to figure out why I go into afib since I have only had it for a couple years. I had two sessions of radiation for breast cancer in 1999 and 2009 and figure that did some damage to my heart.  If I get really tired I get it.  I'm almost afraid to drink wine anymore since not sure about what it will do.  I don't feel bad in afib. My pulse stays around 70 so EP is okay with that.  I've had one ablation in 2018 and they suggest they could do that again if I wanted to treat this aggressively.  Usually I flip back into sinus on my own so I just try too relax and wait.  Wow lots of cardio versions.  They don't seem to last unfortunately.  Encouraged that you have survived 50 years of afib.  I'm going to be 79 next month so hopefully I can survive a few more years with it coming and going.  Thanks for your response. 

Afib triggers

by AgentX86 - 2020-07-16 17:13:30

Low potassium, magnesium, or to a lesser degree (rare in a Western diet) sodium will certainly trigger Afib. It'll cause arrhythmias in "normal " people. Dehydration is the #1 trigger. There is a lot of debate whether there are other true triggers (or if it's just coincidental).

The "disconnect" is called an AV ablation. It's the *last* resort and only if you're highly symptomatic. The AV ablation is essentially an intentional 3rd degree heart block, where the don't reconnect the atria with the ventricles with a two chamber PM. Instead, the ventricles are paced directly. There is no lead in the RA (no need because the atria don't do anything anymore). You become not only pacemaker dependent but also lose AV synchrony. It's a lot to give up but it may be the lesser of evils. If there is no way to have anything close to a normal life, it's a possible choice.

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