abalation not right routefor afib?

Allan (41) edinburgh here three weeks today since pm implant

I spoke to my heart surgeon /doctor( on phone) about my racing heart and return episodes of afib.And he told me beta blockers maybe the next step and when i asked him about the abalation route he said that that would not be appropriate as having afib and sick synus syndrome with a pace maker it was more likely to be unsuccessful.

Only thing is i would really like to double check with my pm technician if my afib has increased past 1% as it feels like it has-but i dont like to go back as i have already been back twice since operation three weeks ago once for suspected pulled leads and once last week, and i dont want them to get sick of me and think i am a nuisance.

I am wondering if my racing heart and iregular heart rythmn which is mostly noticeable when i sleep is due to anxiety or is it that i actually need beta blockers.I have heard so many stories on here about people having there pace makers tweaked in first couple of months and then they feel ok,that it seems a shame not to give it a chance before masking everything with beta blockers the reverse side of that is i dont want to put my poor heart through anymore strain than i have to.

My uk technician also revealed to me that the reason the follow up services in uk are not so regular is that in usa it is a great money spinner for a lot of untrustworthy cash hungry specialists(not all i am sure) has anyone else heard anything along these lines

allan

5 Comments

A-Fib & SSS

by SMITTY - 2007-10-31 03:10:01

Hello Allan,

I’ll make a very uneducated guess about you’re a-Fib and SSS. First let me say, I’ve traveled that road with the same problems which started after my bypass surgery 25 years ago. I have had prescribed some 10 to 20 different medications for irregualr heart beat over those years. Many of these meds were beta blockers and without exception the BB provided no benefit whatsoever, but have, without exception, made me feel very tired and like I was trudging through ankle deep mud all the time I was taking them. NOW, LET ME POINT OUT beta blockers do help many people, but I am not one of those people.

I can understand why the doctor is considering a BB for you. I don’t pretend to know the mechanism by which a BB works, I just know that they tell me that a BB will slow down the heart and cause the heart beat to be more forceful. I don’t know about the increasing the force with which the heart beats, but I do know they will slow the heart rate. For those of us with a PM that is not problem as when our heart rate drops below the low set point on the PM it will come into play and maintain that minimum HR.

I have recently gone through a long siege (about 6 months) of what you describe for your self and again I was given a BB (Toprol) and as the doctor explained it to me again, the BB was to (among other benefits for my heart) to improve the heart rhythm by lowering my HR so that the PM could do its job and give the heart a more steady rhythm. As predicted the BB lowered the HR and my PM took over and maintained a minimum HR or 70 BPM but didn’t do doodly for my arrhythmia. I took the BB for some 4 months and decided to h--- with this feeling like I must have died and no one noticed and I stopped the BB. At some point Mother Nature stepped in and took care of about 90% of the arrhythmia, which is the same thing that has happened in the past. If you are wondering why I didn’t wait on Mother Nature this time, the arrhythmia was by far the worst it has ever been and my wife insisted that I look for help.

So what I’m saying to you is if your doctor is not concerned about your irregular heart beat, give Mother Nature a chance to help. If the doctor wants you to take a BB, by all means do so. Don’t pay any attention to what I, or anyone else, say they do for us that is not good. We each are different and as I said earlier, BB have helped many people as advertised.

I just noticed where you said “I don’t want to put my poor heart through anymore strain than I have to.” I say don’t worry about that. Our hearts are even more amazing than a PM. The a-fib and SSS is probably putting your mind and the rest of your body through more strain than it is your heart. It’s one of those things we can feel and knowing that it is our heart acting up tends to cause much more worry than necessary. By all means, trust your doctor.

Last things last. ”My uk technician also revealed to me that the reason the follow up services in uk are not so regular is that in usa it is a great money spinner for a lot of untrustworthy cash hungry specialists(not all I am sure) has anyone else heard anything along these lines” No I have heard this stated by anyone but if you take a look around it is very obvious that is true. I get at least 4 checkups a year (2 in office and 2 by phone) come hell or high-water.

In the hospital where I get my checkups, they have 4 to 6 nurse/technicians and several support personnel. In addition the facility itself and all of the electronics needed to do these checkups cast a barrel of money. So, yes, they pull us in as often as Medicare will pay. And I have noticed that anytime I have called with a question, it is automatic for them to say you should come in and let us check out your PM.

I have some very strong opinions about the pacemaker industry – by that I mean doctors, hospitals and manufacturers. But let me preface this by saying that I know pacemakers and defibrillators have saved many lives and/or have given many people a much better quality of life. However, I honestly think that at least 40% of the pacemakers implanted are not necessary.

My argument for this is I know the manufacturers have an enormous investment in the development and continuing research in PM and Defib units. Also, these companies are publicly owned and the stock holders expect a reasonable return on their money. Second, most of the time the doctor does not have to be certain the pacemaker is necessary. He can think one may help a patient and since the surgery is relatively simple and if the patient does not need the PM is not going to hurt the patient. It just sits there doing nothing and that patient goes in periodically to have it checked for which the doctor gets paid. In addition the cost of the surgery is not cheap. Do I think all doctors are mercenaries when it comes to pacemakers, no, but I’m sure there are more than just a few are?

I wish you the best,

Smitty

A Fib and SSS

by TOGUY - 2007-10-31 04:10:40

Hi,
I too have A Fib 38% of the time and SSS. My doctor has ordered a direct current cardioversion to see if the heart beat will return to normal. Just a though why not ask your doctor about this proceedure it may save you from going on BB.
Best of luck,
Gary

afib & ablation

by Vai - 2007-10-31 12:10:06

I think you need some clarification here. You mentioned you have afib and you implanted a PM for SSS. You seem to conclude that the PM will treat or reduce your afib. From what I have learned so far, the PM does not do that at all. It only helps manage your SSS. It does not directly reduce afib episodes unless your afib is directly attributable to SSS symptons.

In order to manage the afib, you will need beta blockers (most commonly prescribed). The beta blockers slows down and regulates the heart and manages the afib. If the beta blockers slows down the heart too much, the PM kicks in to support you so you don'r get dizzy or blackout.

Incidentally with 1% afib you will need blood thinners. Common adult dosage aspirin or sometime warfarin. The blood thinners provide some safeguards against stroke - a potential hazard of afib. Check with the the doctor.

I am in the same boat. I have a dual lead PM to manage the SSS, prescribed sotalol to manage the afib. So far I am trouble free with an average 2% afib load. Mostly never did feel the afib.

A fib

by ScottishTom - 2007-11-01 03:11:44

I had mine done in Edinburgh 18 months ago, and A fib was 0 for a while and all the problems seemed to have been cured. Then they started messing about with medication and the A fib came back, recent check ups and tweaking of settings have seen the a fib go to 5%, 7%, 9%, 10%, 12% and not looking any better over the last month. The specialist told me last time, that they could not do an ablation because of something else, the had tried cardio version at the start of the probs, and basically I would just have to accept it that I would have good days and bad days.

Good luck


Tom

Comment to Smitty

by ElectricFrank - 2007-11-11 05:11:24

Hi,
You hit it on the head about the money issue with PM checkups etc. I'm in the US and the best way I can state it is that the frequency of checkups depends on a persons insurance. If the medico is paid by the visit, then the only safe thing to do is check it every 3 months. If they are paid a fixed annual fee then there is no reason to check it more often than once a year. The same goes for replacement when the battery life gets iffy. I continually hear of patients who have reached the "elective replacement" point and the pacer goes to failsafe mode with many of the features turned off to conserve battery life. The patient feels lousy and I wonder about the effect on health where the organs aren't getting the blood flow they need, but they will try to get the last few months of use out of the pacer.
I recently had a loss of capture problem and as an emergency response we turned the voltage way up. That was OK, but now they are in no hurry to check capture and reset it properly. It has reduced battery life by quite a bit and in my case both the surgeon and PM manufacturer will benefit if they have to replace it sooner.

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