AF Suppression Therapies

For over a year my heart rate was stuck at 80.  Even though my original settings were 60 resting and 130 max, all I got was 80.  Resting was 80 and if I tried to exercise my HR would not excelerate more than 80.  Everything I liked to do was gone--pickleball, hiking, gym workouts, and even housework like mowing and vacuuming.  I was constantly breathless.  My cardiologist (who is history how) said patronizing things like "you aren't an iron woman" and "you aren't in danger" when I complained.  He never told me he saw some Afib and applied a type of Atrial Suppression Therapy.  When I had an in-person interrogation yesterday with a new cardiologist they could see historically that my heart rate was at 80 a huge amount of the time.  When they removed the suppression, I am functioning much better, back to 60 resting and 130 max.  What a relief!  

However my Afib burden is up to 7% and I'm wondering if the Atrial Suppression might have caused that since my Atria was unable to beat normally.It was less than 1% before.   I have a complete heart block and usually my atria would beat some of the time, but this past year it didn't beat at all because of the suppression.  

I am not very trusting of Western medicine.  My heart block was originally caused by a drug, Armour Thyroid.  I couldn't get a confirmation of this because they don't do a differential diagnosis and my sinus node might have been failing and the drug was the clincher.  

Since I am almost 100% paced, would a sinus node ablation fix the Afib problem or is that not likely?



Atrial fibrillation

by Selwyn - 2022-08-28 07:32:09

The sino atrial node is not functioning- you have atrial fibrillation.

The atrioventricular node is not functioning - you have heart block.

Nodal surgery is therefore not indicated.

Atrial fibrillation reduces the filling of the heart and therefore function.

Your pacemaker controls your heart rate via the exercise rate response function. This is never completely natural. My sympathy. I suspect I am in a similar position to yourself. I am still considering my finer tune up!

What you need is rhythm control . Talk to your  excellent, new cardiologist about this- the medications are not without problems.

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Ablation for Atrial Fibrillation

by Gemita - 2022-08-28 19:05:40

Hello Swangirl, I know you don’t like procedures, meds or intervention so I am not confident that you would be a good candidate for an AF ablation.  Edited:  Also I note you have AV Block (total?) so presumably your AF is not able to pass through your AV node in any event to affect your ventricles causing unwanted symptoms due to speed and irregularity of rhythm - the usual reason for an ablation to try to stop AF).

I am a long term sufferer of AFib.  I have a functioning AV Node.  I chose not to go down the ablation route because I was told I would probably need two ablations to fix my several atrial tachy arrhythmias. I couldn’t face going through two procedures, doubling any potential risks, so I chose to work with my pacemaker and with medication.  I tried Flecainide an antiarrhythmic first then added Digoxin followed by Bisoprolol, a beta blocker.  I did alright for a couple years then Flecainide started causing more arrhythmias and I decided to stop it, followed by stopping Digoxin.  Now I am only on a beta blocker and my arrhythmias are much quieter - AF less than 1% at last check although has increased in last few months again.

It is hard to say what could have caused your sudden increase in AF.  AF has a mind and a will of its own.  AF is usually not curable although it can be ablated and stopped for long periods.  I note you have paroxysmal AF with a 7% AF burden so you have periods when your atria are functioning normally.  An Ablation is more effective as a treatment for AF than medication but of course it is more invasive and may carry a higher complication risk than treating with one or more meds.  However since you have AV block you already have an effective treatment for paroxysmal AF.

If you consented to an ablation your EP would try to track down where your AF originates (they usually ablate around the pulmonary vein area).  We can chat more tomorrow if you wish.  The location of any ablation would depend on what the EP finds during an electrophysiology study prior to any ablation.  Has your EP actually suggested you consider an ablation even though you have a total block?


by Rch - 2022-08-29 02:29:02


Has your previous or the new Cardiologist start you on anticoagulation ( blood thinners) for the A fib burden noted on the pacemaker report? Given your age, you might be at a higher risk for stroke. 

Also, since you mentioned about being on thyroid medications, have you had your thyroid levels checked? The reason I am asking this because I had a moderately high thyroid levels with my A Fib episodes which abated once I lowered my thyroid dose. 

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