Pacemaker and AFib

Welcome Nella. Atrial Fibrillation (AF) sufferer here too

by Gemita - 2024-09-15 04:58:50

Let me say from the start that a pacemaker is not a cure for an arrhythmia like Atrial Fibrillation (AF) that can come in at a slow, normal or fast heart rate.  However, a pacemaker is clearly another tool in the cupboard to successfully treat a slower rhythm disturbance (bradycardia) that may be triggering tachycardia.  This has been my experience overall and backed by evidence.

I am in the UK and my indication for a pacemaker was tachycardia/bradycardia syndrome (also known as sick sinus syndrome).  I was also suffering from frequent episodes of pre-syncope and actually experienced multiple losses of consciousness one day due to symptomatic Atrial Fibrillation with a rapid ventricular response rate.  

My EP explained that from my implanted Reveal Linq monitor interrogation, he noticed primarily bradycardia induced rhythm disturbances which appeared to be a trigger for arrhythmia episodes, in particular Atrial Fibrillation.  In his opinion if we could treat the bradycardia element with a pacemaker and keep my heart rate higher, it should also help to treat the onset of many of my rhythm disturbances.  He also said that if I had a pacemaker he would be able to safely give me rate control or anti arrhythmic meds to treat my tachy arrhythmias.  These work as you will probably know, by slowing conduction through the atrioventricular node.  The pacemaker would then be set to a safe lower rate limit, to prevent my heart rate from potentially dropping to dangerously low levels from the medication, so I would remain safe. 

We have clearly taken very different paths.  I decided from the start not to move forward with a pulmonary vein isolation ablation or an AV Node ablation for AF even though I was super sensitive and extremely symptomatic to the irregularity of rhythm and heart rate changes, sometimes slow, sometimes fast.  Instead I decided to get a pacemaker and have not been disappointed.  

After receiving a pacemaker in 2018, I initially took Flecainide and Digoxin for several years as well as Bisoprolol, a Beta blocker.  The meds certainly helped control the tachycardia element, but my frequent in and out episodes of AF largely continued.  I was then offered an AV Node ablation or Amiodarone, both of which I declined.  Instead we decided to trial coming off my anti arrhythmic medication, Flecainide and Digoxin, both of which by then showed signs of causing worsening arrhythmias (they were becoming pro arrhythmic).  I continued on low dose Bisoprolol only for rate control.  It actually seemed to help.  Fast forward to today, I am now less symptomatic and do not need to consider more invasive treatments at this time.  My total number of AF episodes is considerably lower now and when they occur they are mainly of short duration.  My pacemaker by effectively treating the “bradycardia” element (the trigger in my case for AF and other rhythm disturbances) has effectively helped to bring real relief.  I still cannot quite believe it.

Thank you for sharing your interesting history with us.  I am an AF flipper too, but as long as we flip in and out and don’t stay there for too long, we have a chance of stopping this condition.  Persistent AF will often lead to permanent AF.  

Ablation?  Unfortunately your experience is not unusual in that many AF sufferers may need several AF ablations to help stop AF, which is one of the reasons why I decided not to go down that route.   However, I do wish you luck with the Pulsed Field Ablation on the 28th October.  If you need a pacemaker afterwards, I wouldn’t fear it.  It could be another valuable tool in the cupboard in the fight against AF.   I have a super sensitive nervous system too and have even had episodes of swallowing induced syncope but a pacemaker has not made matters worse.

Pacemaker settings by the way can be finely adjusted as you will read from our sporting members.  In my case, by keeping a steady, higher lower heart rate setting, all my symptoms have vastly improved and I am most definitely getting fewer symptomatic arrhythmia episodes.  There are also, depending on pacemaker manufacturer, some specific settings that may help to control arrhythmias too, although clearly a pacemaker by itself cannot cure an arrhythmia like AF  

Pulsed Field Ablation

by sgmfish - 2024-09-15 21:42:39

Pulsed Field Ablation is the way to go these days. My next ablation (assuming I will need one) will be Pulsed Field Ablation for sure. The only downside is that your EP will likely have less experience with it. The big advantage with Pulsed Field Ablation is that it does not need excessive heat (or sometimes it is done with excessive cold) to create the scar tissue. Therefore Pulsed Field Ablation is much less likely to do unintended damage to surrounding tissue.