Dual chamber pacemaker

Pacing shut off

by AgentX86 - 2023-08-16 01:12:49

I don't have exactly that issue but it's essentially the same thing as an AV ablation.

I've had an A/V ablation, which is essentially an intentional heart block, due to being in permanent flutter.  After all sorts of drugs with negative side-effects and three failed ablations, the only solution left was to electrically isolate the ventricles from the atria and pace the ventricles. The same situation you find yourself in, though through a slightly different route.

I don't even have an atrial lead, since my PM was implanted at the same time as the A/V ablation.  An atrial lead would have been superfluous. I only have a lead in each ventricle (CRT-P).  I'm thus paced VVIR, as I'm sure you will be. Since you started out with a dual lead, you'll stay with one and maybe they'll go with a CRT-P at some time in the future.

Yes, your (our) ventricles are now electrically isolated from the atria, thus useless. They were useless anyway because yours are constantly in Afib and mine in Aflutter.  We're better off because the ventricles are now free to beat normally.  The atria aren't pumps anyway, their job is to help fill the ventricles when abslolte peak performance is needed. Other than atletes, none of us need our hearts to deliver that much blood.  They're really a leftover from when we used to have to chase our food down, sometimes for days. You and I have lost, perhaps, 20% of our peak performance because we lack the atrial "kick". But as I said above, so what?  We weren't using it anyway.

No, you're not alone at all.  There are several here who have had A/V ablations and are in the same boat as are you.  It's done intentionally and having it creep up on you isn't any worse.

Hopefully this helps to answer your questions

by Gemita - 2023-08-16 05:15:26

Hello Clover, 

you state I have a dual chamber pacemaker.  The pacing was shut off to my right atrium because my providers said I was in Afib most of the time and it was not doing any good to pace the atrium and it was just using up my battery.  This is absolutely correct.  They don’t want to track the fast, irregular rhythm of AF.  (Please see my further comments below).

you state so now I only have pacing to my right ventricle.  This was confusing to hear, since I have complete heart block and thought the reason for my dual chamber pacer was to keep atrium and ventricle working together.   Again, you are correct.  Keeping the right atrium and right ventricle working together with a normal functioning right atrium would be important for maintaining Atrium to Ventricle synchrony, but unfortunately you do not have a normal functioning right atrium because you have a persistent, fast, irregular arrhythmia called AF.  (Please see my further comments below).

you state also thought the pacing to the atrium was helping my afib, since I was actually told once that I needed it on to control Afib.  You are correct, atrial pacing can often help to control AF for many of us.  It clearly works well for me since my AF hasn't progressed, but atrial pacing  doesn’t work well for everyone and will never be a cure for AF.

Further comments:

I see AgentX86 has already given good advice.  I have had intermittent Atrial Fibrillation (AF) since well before 2015.  Had my dual chamber pacemaker implanted in 2018.  I am currently paced in my right atrium close to 100% of the time, with only limited ventricular pacing (about 2%).  I have Sick Sinus Syndrome.  I note you have heart block.  

If I go into AF and my heart rate exceeds 171 bpm, my pacemaker automatically switches me to a non atrial tracking mode, switching me back to atrial pacing at the end of a fast, irregular AF episode.  This is to protect my ventricles from being pushed too fast by any high AF atrial rates which would pass through my AV Node since I haven't had the AV Node ablated.  

This “mode switch” works well if we predominantly have short, infrequent episodes of AF but when we develop persistent episodes of AF lasting weeks or longer, the benefits of having an atrial lead for atrial pacing would diminish.  Perhaps you are in this position now and your doctors see no benefit in having your right atrial lead switched on, potentially tracking any high, irregular heart beats of AF which could cause more in the way of symptoms for you?  

It is often the “irregularity” of rhythm that AF produces that affects AF patients so much because it prevents the heart from “effectively” pumping blood around the body.  

While right atrial pacing is preferred to avoid some of the dangers of a high level of right ventricular pacing, clearly an irregular, fast, arrhythmia like AF getting through the AV Node and pushing the right ventricle too fast would be more dangerous.  Turning off the atrial lead and pacing in your right ventricle only would be one way of controlling this problem and this is what your doctors have clearly decided to do.  By turning off the right atrial lead your AF can be isolated in the right atrium.  Your pacemaker can then be set to pace you permanently in the right ventricle at a steady and regular pace, ignoring the chaos of AF in the upper chambers, so you should feel better.  If you do not isolate your upper chambers (by switching off the atrial lead) even with automatic mode switches, and clever settings changes, you would still get some signals passing through your AV Node to cause more in the way of symptoms.

Should you ever develop adverse effects from right ventricular pacing (and not everyone will) they will upgrade you to a biventricular pacing system to preserve synchrony between your two ventricles, the main pumping chambers of our heart.  I hope this helps to answer your questions?

Dual Chamber pacemaker

by Clover - 2023-08-16 23:06:09

Thank you both for the explanations!  This helped me alot.  Thank you!

Lead turned off

by DiD - 2023-08-20 07:27:04

I too have had one lead turned off as I'm now in AF 100% of the time. It took them three goes to install top lead and two to install bottom so that was a waste of effort