Can a pacemaker self-convert a person if they are in flutter.  A woman I know has had flutter episodes and said she has had her pacemaker convert her.  I didn't know a pacer could do that, so I am asking if that is possible.  I belive she has to go to a pacer clinc for that.  She has had 4 ablations and her heart rate goes high for her and she then get an ECV she has had a lot of ECVs they work for a while then she goes into flutter again.  Her doctor wants to ablate her node, she doesn't want to do that right now, she is having a lot of problems.



by AgentX86 - 2021-12-03 00:55:25

I've heard of a pacemaker outpacing Afib to stop it before it starts but the nature of flutter makes me very skeptical.  Flutter is very fast, usually 250-400bpm.  Even if a pacemaker could outpace this, it would be dangerous to try.  AF and AFL have similar symptoms but the cause is very different.

In general, a pacemaker can only increase the heart rate. A pacer clinic can't do anything for flutter, either.  She would need a "cardioversion", which has to be done in a hospital setting.  A cardioversion is essentially the same thing as the recovery from V-fib.  It's like you see on the TV.  They put the paddles to you (actually, they're "glued" on the chest and back before the procedure) and a huge jolt of electricity is passed through the body.  This stops the heart and allows it to restart on its own, hopefully without the flutter.  It's not a permanent solution.  It doesn't fixed anything, just reset the heart.  It'll almost always go back to the arrhythmia before.  I did have a cardioversion hold for seven years, then a day, and less than ten minutes.

Change a-fib

by Theknotguy - 2021-12-04 23:52:03

The answer is a pacemaker by itself cannot self-convert a person from a-fib, a-flutter. However, I have a Medtronic pacemaker that has the ability to run programs which can take action with certain kinds of a-fib / a-flutter. 

The first program is APP.  Atrial Preference Pacing.  Second is Minerva.  The pacemaker constantly watches my heart rate and if it sees me go into a-fib / a-flutter it will then make a decision based upon the type of a-fib / a-flutter I have.  The Minerva program can change my pacing sequence and it will sometimes pace me out of a-fib. APP works about 10% of the time.  Minerva works about 80% of the time.  The rest of the time I'm on my own.  

Discussions I've gotten into with pacemaker manufacturer reps and my EP is that the programs only work on specific kinds of a-fib / a-flutter and it isn't a universal cure.  Second type of discussion is that the programs only react to a-fib / a-flutter it doesn't cure the problem the way an ablation does.  And, for some patients, the programs won't work that long because their type of a-fib / a-flutter will change and the programs won't do any good.

The other trade off is the programs increase battery usage so I have to have my pacemaker changed out more frequently.  One person I know with a Medtronic pacemaker doesn't have the programs running and he's supposed to get ten years on his current unit.  I have to change mine out at eight years.  At this time I don't know if I'll get better results with my newer pacemaker. 

My a-fib used to knock me down for two to three days at a time before I got my pacemaker and they activated the programs.  I've now gone as much as a week while in a-fib and haven't even noticed it.  So I've been able to hold off on having an ablation for eight years.  Last discussion with my EP was that he didn't know if doing an ablation would give me better results than I'm already getting so we might as well hold off on doing an ablation.

So if this lady's EP says she needs an ablation, she probably does.  She might also have a Medtronic pacemaker similar to mine and with similar programs running.  But if they aren't working, the next best option is the ablation procedure.  My wife also has a-fib and when they found out she had a-fib, they immediately went for the ablation instead of using a pacemaker and the a-fib programs.  

immediately went for the ablation

by AgentX86 - 2021-12-05 11:20:47

KnotGuy is right.  Time is of the essence.  The phrase is "a-fib begets a-fib, which is also true of flutter.  The longer you're in these arrhythmias, the more embedded they become, and the lower the probability of an ablation being successful. Wait and see may not be the best idea.

Since she's already had four ablations, the probability of a fifth working is almost zero.  Flutter is generally easy to ablate but sometimes it's in a place that's difficult/impossible to get to, particularly if it's "atypical flutter" (in the left atrium or goes backwards).  My EP gave up on the third try. he knew it wouldn't work before he was done. He couldn't get to the electrical path to break it. A month later I had an A/V ablatoin and pacemaker.

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