atrial fibrillation

Afib, etc.

by AgentX86 - 2024-05-13 00:01:47

A pacemaker isn't going to help you with Afib.  All it can do is speed up the heart.  The drugs that can be used to supress Afib tend to lower the heart rate, so it's possible to increase these because the pacemaker won't let the rate go too low.

As far as the FitBit goes, well, it won't do a reliable measurement of the heart rate, or anything else.  These things most often lie (like you see with your heart rate and ectopics) and pacing spikes will most often confuse them, resulting in an inconclusive reading.  If you read the disclaimers, they'll say that they're not to be used by those with a pacemaker.

Afib is pretty easy to detect manually.  Afib is an "irregularly irregular" heartbeat.  That is, it's chaotic. The time from one beat to the next is indeterminable. Most other arrhythmias are also irregular but are not "random". If you check your pulse manually, you'll feel the randomness. Afib will confuse some measurements but most devices will do a good job of measuring the pulse rate.

PVCs (Premature Ventricular Contractions) feel like skipped beats.  If measured in the wrist, you'll feel the "skipped" beats.  They're not really skipped, rather one comes early.  This can most often be felt in the neck.  Feel the carotid artery.  You'll feel the heartbeat, followed quickly by a weak beat.  When felt in the wrist, the second beat isn't felt.  This will cause the heart rate to be measured below the real value.

As far as feeling bad, you don't give enough information to say much.  Why do you have your pacemaker? What mode is being used? Your problems sound like poorly adjusted rate-response settings.  These can be a RPITA to get right.  I've had my pacemaker for over six years, after dozens of tries (at least eight this year), it's still not right.  When I walk, from the five-minute mark to ten or fifteen, I'll be short of breath or even have chest pains.  After that, I'm fine, even on the hills that originally caused problems. Stairs have always been really hard and doing work that doesn't involve moving can really be difficult. Ask if you have "Rate Response" (RR) turned on.  If so, get them to spend some time with you to try to get it tuned in. Insist on it. If RR isn't turned on, you'll have to look further.

Thank you Agent X86

by Ticketyboo - 2024-05-13 05:10:16

That's helpful. My reason for the pacemaker was Bradychardia.  I have had some adjustments   to my PM because of the symptoms previously mentioned. I really must ask what  the settings are! Interesting that you have similar symptoms. I do find them difficult to deal with especially the chest pain  and  get stressed before going out for walks with a friend who loves her walking and is not put off  by inclines.  !!

Ticketyboo

by Gemita - 2024-05-13 06:53:20

Hello from Kent.  I see we are more or less the same age.  I too have intermittent AF and sometimes plenty of active ectopic beats.  I do not tolerate my rhythm disturbances  at all well and am only really symptom free when my heart is beating regularly, in normal sinus rhythm - without pauses, slowing, racing.  A tall order, I know for a heart that is clearly electrically unstable at times.

No you are not expecting too much and yes, things can still improve.  Of course it feels disheartening when you were expecting so much more.  Many of us have been there, especially if we are going through some worrying family matters.  Stress can certainly trigger unwanted symptoms, including AF and ectopic beats and even cause serious illness if we cannot find some respite from our difficulties.  I hope they will resolve quickly for you.

I find it unhelpful when doctors tell me that it is impossible for our pacemaker lower rate limit to fall below the set rate and that ectopic beats are benign.  Doctors know only too well that ectopic beats are weak, ineffective heart beats/contractions that will not provide the same level of cardiac output/support as would a normal heart beat.  This is why so many of us suffer from symptoms during ectopics, particularly if the ectopic beats are frequent and persist for hours.  In addition PACs (premature atrial contractions) can be a trigger for Atrial Fibrillation (mine certainly are), so they need to be controlled.  I am on a low dose beta blocker.  Are you on any meds?

My doctors tried to explain that when I feel my heart rate slowing and dropping to levels lower than my lower set rate of 70 bpm (I usually feel my neck pulse to confirm this), this is often due to ectopic beats.  This results in the pacemaker not pacing me because apparently it accurately “senses” the weak ectopic beat and withholds pacing.  I feel these weak ineffective beats/pauses and when they repeat themselves multiple times without any pacing support, I can become very unstable.  They did confirm that because the cardiac output from an ectopic beat will be significantly less effective than from a normal heart beat, this would explain my difficult symptoms.  Furthermore, when the ectopics get sensed by the pacemaker, it can upset pacemaker timing.  Clearly, we have some way to go before our pacemakers can help with ectopic beats and other rhythm disturbances but some technicians are extremely helpful in my hospital and have given me lots of useful feedback.  I hope my future pacemaker will give me more control over all my electrical disturbances.

Both frequent PACs and PVCs can certainly lead to more significant arrhythmias like non sustained Atrial Fibrillation in the case of PACs or non sustained Ventricular Tachycardia in the case of PVCs, so we should really be taking notice of them.  We cannot cover up symptoms.  They are real and if you have symptoms from your ectopic beats, like breathlessness, dizziness, then this needs bringing to your doctors attention.  If you are symptom free then you may not need treatment, but with symptoms, you may need support, so don't be afraid to ask for help.

I wish you well Ticketyboo

Wise Gemita

by Ticketyboo - 2024-05-13 07:16:54

that was so informative Gemita , thank you   and it seems to fit my situation perfectly.  I am on Edoxaban blood thinners , blood pressure lowering meds , citalopram for anxiety  atarovastin and Lanzaprosal.   I do think I am a bit of a stress head and when I am distracted and busy I don't notice these symptoms so much. . I will definitely bring these up at my next check up.  

Go Well x

Doctors

by AgentX86 - 2024-05-13 11:19:10

I don't expect doctors to explain the minutiae of pacemakers, but when they give an answer, it really needs to be the whole answer.  In your case, he told you why your measured heart rate isn't to be trusted but didn't explain why.  It would have taken 15 seconds and put you more accepting of the answer, and at the same time more trust in him.

Your proper response to an incomplete answer is "why?". He may get put off by being questioned, but at least you know where you stand in his eye.  Find another, if at all possible. I saw my cardiologist two weeks ago. He almost always spends a half hour with me, answering anything I bring up. My wife goes with me and he answers her questions, as well. We end up BSing for part of the time. I see him at least two times a year and often four, and can get in to see him, usually within a week if I'm willing to go where he is.  His home office is about 40mi and is in a satellite office here one day a week. There are good ones.

When you talk about "chest pressure", he should make sure that you don't have something more serious going on. It's a sign of the heart not getting enough oxygen. This could be a sign of stenosis (blockage), but also just because your heart isn't keeping up.  The latter can be (mostly) fixed with settings changes.  It might never be perfect but an acceptable trade off can almost always be found.

Continuous Afib would explain everything. You're on an anticoagulant, so that's good. If your heart rate is under control (always under 100), you're in good shape.  Your Afib is being well treated and there isn't really anything else that needs to be done.  If you're symptomatic (can feel it), and you are (short of breath, SOB) is a pretty strong symptom. Then it needs to be taken care of, not because it's dangerous (it isn't), rather affecting your quality of life. That's just as important.

Strong antiarrhythmic drugs may be used, probably the first step, to stop Afib.  Don't go fishing for the right one too long because the longer this goes on, the harder it gets to treat. 

The next step is an ablation, where a catheter is used to snake a  tool, from the groin up into the heart to create scar tissue that will isolate the errant pulses so the heart doesn't respond to them. This is a simple procedure, not nearly as bad as it sounds. It's generally an outpatient procedure, though a pacemaker complicates things a little and they may want more observation time. Take a night off and enjoy the hospital cuisine and room service.

I'm sure this is more than you want to know.

Citalopram and the heart

by Selwyn - 2024-05-14 11:50:25

Unfortunately, citalopram needs to be used in caution with those having heart disorders. I would suggest you get someone with medical knowledge to at least reassure you. It can cause ectopic beats.

Fitbits are unreliable if you have any arrhythmia.  Perhaps try a Kardia device, thought these have limitations. 

Betablockers may help both anxiety and prevent atrial fibrillation episodes.

My last visit to the pacemaker clinic had me climbing up the three flights of hospital stairs until they got the settings right for my pacemaker. It is possible to get some pacemaker adjustments so that you don't have symptoms you describe.

Paroxysmal atrial fibrillation can be triggered by anxiety, tiredness etc.etc.  If drug treatment doesn't help the arrhythmia, consider ablation therapy ( I have now had 5 for flutter and fibrillation).

There is always light at the end of the tunnel, you just need to know where to look. I hope your difficulties soon settle.

Thank you Selwyn and AgentX86

by Ticketyboo - 2024-05-16 06:52:06

Both your comments were helpful I hadn't considered Citalopram as   a factor in ectopic beats my disease is quite low  I have only had one Fitbit  notification re  AFib in March   but when I do the manual ECG test on my fit bit it sometimes records AFib and also normal sinus rhythm. Both intermittent. Most of the time the readings are inconclusive I guess this confirms that my pacemaker and  fit bit are not best friends.I was told that my ectopic beats are PACs and I shouldn't be concerned but the shortness of breath on inclines or when starting exercise is a concern  I am thinking  these ectopic beats just make my heart less efficient. If I stop and pause for a few seconds I can carry on. Will bring up all these 'Why?' at my next review. Thank you again everyone x