First PM clinic post implant - Am I a hummingbird

A few initial thoughts

by Gemita - 2024-10-08 08:25:49

You are sounding very knowledgeable already Welshblood.  What’s next?  No one can really predict what is next because AF (atrial fibrillation) can start and stop for no apparent reason.  Possibly anticoagulation, a rate control, plus anti arrhythmic medication and other treatments like an ablation, but it depends on how symptomatic you are?  On a scale 1-10 how would you rate yourself during an episode of AF??   Risk factors for a stroke will determine necessity for anticoagulation.

Your arrhythmias sound as though they are progressing and fairly persistent when they start.  I see you are beginning to experience fairly long episodes (22 hours).  Mine tend to be mostly in and out episodes and rarely prolonged, although i can spend hours in AF too, like today unfortunately.

Your Atrial Tachycardia figure of 620 bpm may sound alarming, but it depends on how long it lasted - perhaps we are only talking a few seconds?  Your doctor is quite right to say that this is the atrial rate, not the ventricular rate. Conduction is automatically slowed by our AV Node to prevent the fast rates from the upper chambers of the heart from reaching the main pumping chambers, the ventricles, which would be dangerous.  Your mode switch too switches to a non atrial tracking mode so that these high atrial rates are not tracked to your ventricles, so you remain safe.  I have had these alarming rates recorded also.  

You do seem to be symptomatic with fatigue, some breathlessness and frequent urination due to the fast heart beats.  I note you sing in a band.  Loud, vibratory music can be a trigger for my AF unfortunately.  I visited the London Nottinghill Carnival a few years ago and my heart nearly took off.  I was very poorly and close to collapse.  Never again.

I am afraid treating AF will not be a quick process.  It can be extremely difficult to treat (cure) whatever we throw at it.  What is important is to “control” your AF if you can, followed by controlling the symptoms from AF so that they do not lead to other problems.  However sometimes these treatments are worse than the actual condition, so it is frequently a balancing act and trial and error until you find what works best for you?

Patience and calmness is required amid the turmoil/chaos of your heart rhythm during AF and other tachy arrhythmias.  Easier said than done, I know.  Will you develop the maximum heart rate of a hummingbird and live to tell the tale, no

Thank you..

by Welshblood - 2024-10-08 09:08:45

Far from knowledgable. Just good at repeating things 😜 I think my symptoms are more annoying / disruptive than debilitating. Being in a band it's difficult to avoid singing unless I stop I guess. My proper heart rate (as PM device measured against date/time) is going to 190 when singing which is bizarre. 

I am not in a rush to have anything done to be honest or any medication unless it necessary and on medical advice balanced against risk. Just need a bit of confidence that I can push things like I used to or not without croaking it. 

It seems a mixed bag of people on meds, thinners, having ablations and all sorts. I was planning on living to 110 so am only half way through and don't really want to be a slave to this pump with the faulty electrics. 

Welshblood

by piglet22 - 2024-10-08 10:39:35

I think it would be wise to get some reassurance from the pacing consultant.

With your device fitted, you are going to get more information and hopefully it gets run past the consultant.

I would certainly be collecting information myself and if you don't have any already have some kit, an oximeter (for pulse rate) and a decent BP monitor would be useful.

An upgrade to a Kardia device could be useful as well.

If you have a home monitor, send a transmission if you feel something is going on.

You sound well in control and not overly symptomatic

by Gemita - 2024-10-08 11:09:43

Welshblood, with that attitude, I think you will be more than a match for your AF and will do well in the future.  

I would push only according to “tolerance” when you are experiencing a tachy arrhythmia like AF.  Trust your symptoms to tell you when you are reaching your limits and then scale things back.  All the time you are “feeling” well, you should be okay.  

AF is usually progressive which is why some doctors treat it early and aggressively, but it doesn't always have to follow this route.  I have had AF since 2016 and actually with a pacemaker, my symptoms and episodes are fewer.  I am on an anticoagulant because of age over 65 and being female;   and on a low dose rate control medication.  My AF certainly hasn’t progressed so far - in fact it is well controlled. 

In my experience, many doctors don't worry about AF providing the heart rate can be kept under control and we receive anticoagulation if we have risk factors.  A maximum atrial high rate episode of 620 bpm sounds alarming, but hopefully will only have peaked to this level for seconds, but they may want to watch this carefully or to prevent this by treating with rate control meds immediately

Anticoagulants in A. Fib

by Rch - 2024-10-08 16:46:55

Welshblood

I echo everything others have commented herein. As to anticoagulants, the indications are guided by CHA2DS2-Vasc score. If you are under 65, male, with no hypertension, diabetes, vascular disease or h/o stroke or CHF, your score would be 0 and you would be a very low risk. Nonetheless, do discuss with your Cardiologist. As to being on no medications for the sustained episodes of AT, you should discuss that also with your providers. Betablockers would be a good choice if no contraindications now that you have a PM to protect you on the downside. About me, I also have a h/o A.Fib and AT, and I am on Metoprolol succinate 12.5 mg twice a day. I am much older than you ( 79 M), with diabetes ( well controlled), and  I am on Apixaban even though my last A.Fib episode lasting about 5 hours , was 9 years ago. My Cardiologist told me if my PM did not record any A.Fib for 3 more years from the date of Implant July 2022, he would discontinue the Apixaban. But I am not so sure I would do it as my risk only rises with age. My other suggestion to you is to check for sleep apnea if you have any symptoms. I am sure you have already had your thyroid checked. Try all lifestyle changes before jumping on to any invasive w/u.. I personally can not live without my morning Italian roast. but that is just me! We wish you well. Hope your AT would be under control on just conservative measures with minimal medications.