pacemaker extraction

My Opinion

by Good Dog - 2023-07-16 20:40:32

I have no expertise and so I am hesitant to even render an opinion on your situation. The last thing I want to do is mislead you. However, I do think it is safe to say that you have nothing to lose, and perhaps everything to gain from a 2nd opinion.  Frankly, I do not understand why your doc would have turned-down your minimum rate to 45 bpm unless you are being paced so minimally that you wouldn't feel the difference. So I would also hope that he at least warned you that it may impact how you feel, most specifically, while at rest. Also, I have read about a lot of folks that did not need a pacemaker until after an ablation. Obviously, the doc is playing with your electrical system and sometimes an ablation to eliminate an arrhythmia causes irreversible damage to your sinoatrial (SA) node. Sometimes intentional and sometimes not. However, there is so much that I do not know, so please take this with a grain of salt. I am sure others will chime in.

Also, as far as a second opinion; I would insure that you find an EP that is out-of-town and one that practices in an entirely different hospital system. The most difficult thing to determine with a second opinion (maybe impossible) is to find a doc that is willing to contradict your current doc if it is necessary. You'll have to do your homework.

As long as you have the will; I am sure you'll find the info you need to make the best decision.

I wish you well,

Dave

Second opinion

by AgentX86 - 2023-07-16 21:58:38

I agree with Dave (perhaps with a few exclamation points), here. A second opinion is crucial in this case.  Removing a pacemaker is a huge step and without more testing I'd say "no", but that's me.  The fact that he turned it down and you feel worse tells me that it's doing something. The fact that he want's to both save the battery and remove it seems suspect, too. Sure, the change in how you feel could be a coincidental thing or even psychosomatic but it's too important to ignore.

As fae as not being paced much, in a 24 hour period there are around 86,000 heartbeats.  If you're paced at 99.9%, that still leaves a couple of minutes you're not being paced.  How are these "unnecessary" paced beats spread out?  I'd want some testing (at least a Holter) before removing a pacemaker.

"He has done over a 1,000 ablations all with great results."

If he really said this, I wouldn't trust anything that came out of his mouth. His bedside manner means nothing.  He may be a great guy to have a beer with but you're not looking for a BFF. By all reports, Jeffery Dahmer and Ted Bundy were charming people.

He's probably right in what he says but I'd absolutely want a second opinion on this one. As Dave says the second opinion should be from another cardiology group, hospital, end perhaps even state. There are full-time ablationists (it's all they do) who will consult remotely. The pacemaker complicates things but that's why a second opinion is even more critical. If he has any objection, well. any self-respecting doctor would welcome it.

Relax, you have all the time in the world to come to a decision

by Gemita - 2023-07-17 07:07:10

Hello Athena, a second opinion as Dave and AgentX86 suggest, would in my opinion too, be the best way forward for your well being.  Both an ablation and a pacemaker explant need to be carefully considered, the latter especially so.  I give my reasons below:-

Atrial Fibrillation (AF) that is Paroxysmal (intermittent) in nature can sometimes be managed perfectly well even on minimal meds, without a surgical ablation.  In fact sometimes going in too aggressively can make a benign intermittent arrhythmia like AF far worse, sometimes leading to other arrhythmias and further treatments.  “More” intervention, doesn’t always stop AF.  I sense your AF is now quiet again, so why do anything for the moment?  

An ablation is usually recommended when our symptoms like uncontrolled heart rate, frequency of arhythmia episodes are affecting our quality of life and causing us to seek emergency medical assistance on a regular basis.  If you are not experiencing difficult symptoms, then in my opinion a safer and better option would be to try gentler, more natural ways of controlling your intermittent AF first and we can discuss this in another post?

Athena, AF is very common and can start and stop for no apparent reason although there are some most definite causes and Sleep Apnea is a major trigger for any arrhythmia.  Do you know what your numbers were during the sleep study?  Might be worth getting a second opinion from a Sleep Consultant as well as an EP.

Pacemaker explant

I am assuming that at the time of your pacemaker implant you had a clear need for a pacemaker?  Because of this I would be very hesitant about taking it out now, especially as you are still having electrical disturbances, including AF, that may need to be treated in the future.  

For example if you needed higher doses of a rate control medication like a beta blocker to reduce your heart rate while in an arrhythmia like AF, this could be safely given to someone with a pacemaker without fear of causing it to fall to dangerously low levels.  Many patients with difficult arrhythmias have a pacemaker for this very reason.  That is one of the reasons why I had my pacemaker implanted Athena to treat my AF with a rapid ventricular response rate.  

My feeling is that your doctors may want to keep your pacemaker in place while you/they decide what to do about your AF, since after any ablation there is usually a healing period (up to 6 months usually) when things may get worse before they get better.  You may find if you have an ablation, you might need your pacemaker during the healing period until things settle down.  Additionally, an ablation for AF can sometimes cause sinus node dysfunction or other complications, so I would feel much safer having a pacemaker in place.

—————

So with all the above in mind my feeling is that you need to consider all your options very carefully and not to act too quickly and then to regret.   You have all the time in the world to choose the “safest” way forward, so relax, take your time and do seek a second or even a third opinion if you need to.   As always Athena, I wish you well and I know you will come to the right decision

ditto what Agent said

by Tracey_E - 2023-07-17 09:12:51

Turning it down is a good test to see if you need it. I would absolutely get a second opinion. Removing it is terrific if you no longer need it, but a huge step if you are not 1000% sure.

No way would I consider removing it unntil after the afib is treated, be that with meds or ablation. Ablations can fix everything, but sometimes they only fix part of it, or it's a temporary fix, and sometimes people end up with a pacer because it worked too well and made their rate too low. Don't be hasty. 

My gratitude to all

by athena123 - 2023-07-17 18:58:49

Thank you all for your opinions. I will get a second opinion and will consider each option with the utmost importance. thank again. ps. If anyone could recommend another EP i live in the Boston area. all my best,