Afib & Pacemaker

Following the suggestion of a respected club member, (whose posts I have already found to be very helpful & informative), I'll attempt to clarify the situation I find myself in post pacemaker insertion:

I have Afib, (although I've never found it restrictive, and since getting the pacemaker just over two weeks ago the previously virtually non existent symptoms have almost taken over my day to day living); 'relatively mild' lightheadiness occurs when getting up from a chair, walking up stairs, etc.....feelings that started almost immediately after the pacemaker insertion.

 https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
"*Changes in the level of body minerals. Minerals in the blood called electrolytes — such as potassium, sodium, calcium and magnesium — help the heart beat. If these substances are too low or too high, irregular heartbeats may occur."

(*For me, without any indication of quantity range, (yeah, I know, "varies from person to person"), this reads like "How long is a piece of string".)


Again from the above link:

"Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation (AFib). Here are some basic heart-healthy tips:

1) Control high blood pressure, high cholesterol and diabetes.
2 ) Don't smoke or use tobacco.
3) Eat a diet that's low in salt and saturated fat.
4) Exercise at least 30 minutes a day on most days of the week unless your health care team says not to.
5) Get good sleep. Adults should aim for 7 to 9 hours daily.
6) Maintain a healthy weight.
7) Reduce and manage stress.

I don't smoke.  (As per my introductory screed entitled 'Newbie' I never, ever, eat a lot of salt, if any at all), and saturated fat, at most, is minimal.

Exercise (again, from Newbie:    "Almost 12 years ago to the day I was stair climbing and did the equivalent of 184 storeys in one session  -  and lately reduced to approx 45 min per day on an elliptical with varied resistance/incline").

Weight (I used to be 6'...but that was before I reached 82 years old).....weight around 166 lbs.

Stress:  Practically zero....until now.


 

8 Comments

Light-headedness

by piglet22 - 2024-11-03 09:59:16

Might have asked before, but do you check your heart rate or pulse when this happens?

It sounds very much like positional hypotension.

Coupled with the coincidence of your device fitting and the start of the problems, your best course of action is to get back to your pacing team.

I had very similar symptoms earlier in the year. Get up from sitting, either got that whoa feeling or didn't make more than two or three steps before hitting the floor.

The cause was ectopy, treated with higher doses and change of beta blockers.

There could be many reasons for those symptoms and it needs checking. The tips you included from Mayo are pretty universal and not specific. Sodium is important in the diet and I wouldn't change to a low salt diet without good evidence from a blood test.

For what it's worth, I asked a GP some years ago about sodium levels and hypertension and he said it would not be something that he would be worrying about at that stage. I don't add salt to my food, but presumably get enough in other ways as the annual blood tests show sodium to be in the normal range.

Pulse

by Nemo2 - 2024-11-03 11:21:08

@piglet:  I've just reinforced my supervisor's belief that I'm from another planet, (she's started calling it 'car syndrome'  -  you have a rattle or an engine noise....go to the garage and....nothing).

An hour or so ago I walked upstairs and had to lean against the door jamb   -  after reading your post I went up & down at least half a dozen times before I activated a (mild) reaction  -  pulse/BP normal.  Will try again later.

Even at its 'worst' though I have not, as you mentioned in your post, 'hit the floor'.

Salt:  as mentioned on 'Newbie' I seem to be somewhat 'salt averse'...which, I just found out two seconds ago, can lead to other issues: 

 https://www.ahajournals.org/doi/10.1161/01.hyp.17.1_suppl.i61

Quote:  "Furthermore, a minority of the population appears to comprise acutely salt-sensitive individuals."  I don't know if I totally fit into that category, but it certainly has the potential to fit into my wife's 'other planet' theory.

We will attempt to contact our local cardiologist tomorrow in the (likely vain) hope that this can be resolved without another ~150 mile return trip drive.

Appreciate your input...thanks!

 

Atrial Fibrillation (AF)

by Gemita - 2024-11-03 12:15:19

Hello Nemo2,

Thank you for making a new post, which I have to say doesn’t quite mirror your last comments made on your previous thread which I thought needed answering.  You seem to be saying that since your pacemaker implant, you are more symptomatic than ever with AF.  Often following a trauma or illness, AF may appear only to disappear once the trauma or illness has passed.  That is the nature of AF sometimes, although it can equally start and stop for no apparent reason too.

When you say you have AF, are you saying you are in constant (permanent) AF or do you have intermittent episodes (known as paroxysmal) AF?  I am assuming it is fairly persistent to permanent because you say it is taking over your day symptom wise - at least causing lightheadedness.  

Immediately after my pacemaker, all my arrhythmias worsened initially until my heart got used to being paced.  It might be the same for you too.  What I can say however is that increasing age seems to be a most definite trigger for AF and we cannot do much about the ageing process, can we.  Other health conditions like heart failure, coronary artery disease, diabetes, a thyroid condition, sleep apnea, COPD, high blood pressure, an infection, an inflammatory condition, drinking too much alcohol or caffeine, an unhealthy lifestyle, certain medications, any trauma (shock) to the body, or high emotional state like experiencing the death of a loved one, can all trigger an AF episode.  It is also true as you have read, that all arrhythmias can start because of electrolyte imbalances.

Picking up on your comments, I am afraid AF can be responsible for many of your concerns and I don’t think we can necessarily blame your problems on your pacemaker.  A pacemaker cannot stop AF or any other arrhythmia, although some settings may help to lessen symptomatic episodes if we get our settings optimised to suit our lifestyle.  However, blood flow during an irregular arrhythmia like AF is clearly not effective and can cause many symptoms so nothing you say surprises me.  Some lucky individuals can be in AF without knowing it, but we are clearly not so fortunate, are we?

What to do about AF?  Getting back to your previous comments on your last thread, when your cardiologist recommended a pacemaker, did he also recommend getting a regular ablation (pulmonary vein isolation ablation) or perhaps an AV Node ablation, or recommend taking any rate control or anti-arrhythmic medication and an anticoagulant?  Clearly you and your wife have started looking at possible treatments.  Personally I would try to relax and allow yourself time to get used to being paced, to get those settings adjusted first which might just help to ease your symptoms.  If say after three months of healing (I know it seems a long time) you are still no better, then you could consider more invasive treatments like an ablation.

I would certainly have a word with your doctors either face to face or over the phone to ask what they can do to ease your acute symptoms, especially if your heart rate is going too high, or you are becoming breathless as well as experiencing lightheadedness?  These symptoms will need treating.  

Response to Gemita

by Nemo2 - 2024-11-03 13:14:10

Hi Gemita:

In my defense I've never really paid a great deal of attention to health issues..always had kind of a "Yeah, yeah, whatever, next..." attitude.  (Apart from nearly dying of sepsis a few years back, and subsequently going through a short period of PTSD that is.)

So please forgive me if I'm not fully, (or even partially), conversant with terminology, etc; doctors here, (for those who can even get a regular GP), are very busy and even if someone knew what questions to ask it's unlikely that physicians would have the time to respond in detail.

The AF, basically never affected me previously, (even though I was informed, often in passing, that I had it); some 50 years ago when I was running ~50-70 miles a week a surprised nurse said my BP was 'borderline'  -  I always worked on the presumption that such things were congenital and beyond my control.

All that said....although I may have previously exhibited associated symptoms, (e.g. tiredness at different times), my current situation began coincidentally with the pacemaker implant.

Your comment "Immediately after my pacemaker, all my arrhythmias worsened initially until my heart got used to being paced" resonated with me and I'm hoping that is the case with my current situation.

To reply to your question "when your cardiologist recommended a pacemaker, did he also recommend getting a regular ablation (pulmonary vein isolation ablation) or perhaps an AV Node ablation, or recommend taking any rate control or anti-arrhythmic medication and an anticoagulant?", my answer has to be "None of the above".

Breathlessness:  Possibly, compared to many/most, mine may be trivial  -  but from my perspective, being new to all this, it's another case of "What NOW?"

I really appreciate your response and it's certainly enhanced my perspective.  

Thanks again!

Revisiting

by Nemo2 - 2024-11-05 07:04:07

Called them yesterday, and we're heading back up to the clinic today  -  to synopsize:  'Pretty much ANY activity post pacemaker leaves me feeling worse (minor dizziness, puffing, etc) than before the op".

Immediately prior to, I was using the elliptical at varied rates incline/resistance, and doing planks without issues.  Now?  Zilch, nada, zero...can't do anything.

Stay tuned....(actually you can go and get a coffee...it'll be a while).  ;-)

 

Revisiting 2

by Nemo2 - 2024-11-05 16:41:01

Home...and (currently anyway) feeling much better  -  Ventricular Intrinsic Preference has been turned off, as has sensor...whatever that entailed it seems to be working......(with my total lack of knowledge I'm unable to explain the process...but "I'll take 'Works For Me' for $500", Alex).

Future appointments will be about half the distance from home, which is a plus.

The nightmare continues

by Nemo2 - 2024-11-06 11:30:18

Spoke too soon....felt superb all afternoon/evening.....went to bed...didn't last long.....it's back....worse than before.

My 'supervisor' called an ambulance to take me to the local hosp......(they don't have Pacemaker facilities)......after X-Rays (to see if the leads had become disconnected  -  they hadn't)...they placed a hockey puck sized magnet over the pacemaker to make it temporarily inoperative.  Nothing else they could do.

Then the local hosp wanted us to drive back to the 90 mile hosp...(sounded like a bureaucratic tennis game......A) "We passed him over to you, so he's your responsibility"  vs  B) "But the paperwork hasn't arrived yet, so he's still yours".

My wife had no sleep and is/was unable to drive in that condition.....the B) must've been out bluffed and they're going to see me this afternoon.

Now, my wife's daughter's husband is taking time off work to drive me.

The wonders of 'free' health care.

Sheesh.

Forgot to mention...

by Nemo2 - 2024-11-06 12:08:26

The paramedics who picked me up last night said that the pacemaker was 'firing constantly' and my heart was being pushed into overdrive.

You know you're wired when...

You play MP3 files on your pacer.

Member Quotes

A pacemaker suddenly quitting is no more likely to happen than you are to be struck by lightening.