Pacemaker Afib Settings

I've heard the same but

by AgentX86 - 2018-07-17 23:25:14

My EP is less than convinced.  I've had three (failed) ablations, after a full-blown Maze procedure, and still couldn't slay the dragon.  WHen I ended up needing a pacemaker (we'd discussed the options for a year) I went for the AV node ablation and ventricular pacing so I wouldn't need to be spaced out on drugs anymore.  My EP had no faith in the whole concept of pacing one out of arrhythmias so I didn't consider that option.  I'd had enough.

I have one.

by Theknotguy - 2018-07-18 20:52:07

I have the Medtronic Advisa DR MRI Surescan pacemaker.  It runs two programs for afib in addition to being a pacemaker.  

I'm in afib between 17 to 19% of the time.  My afib runs from a few seconds to a few minutes at a time.  Most of the time I don't even know I'm in afib.  Other times my afib will run from a few hours up to 48 hours at a time.  Worst case was going into afib with RVR.  That meant a trip to the hospital with some serious heart drugs.  I'm also one of the very unusual people who can feel when they're in afib.  So being in afib for hours is a real hardship for me.  My EP has indicated I'm not a good candidate for a mechanical ablation so has held off from doing that.  My EP's usual answer is that I'm not "sick enough" to warrant an ablation.  I'm also on Metopolol and Cardizem to control my afib. 

My pacemaker constantly monitors for afib.  When it "sees" afib it will kick off one of two programs.  Usually it kicks off one program, times out if I don't go out of afib, then starts the other program.  It will cycle through the programs for a determined amount of time.  After these programs time out I'm on my own as far as afib goes.  With one program I get a hot flash when it kicks in, with the other I'll get a "stutter step" feeling when it kicks in.  Sometimes I can feel the pacemaker switching between the two programs.  I'll be walking down the hall saying, "Would you just make up your mind!!!"

The first program is APP - Atrial Preference Pacing.  When it kicks in it works about 10% of the time.  When the pacemaker "sees" afib it will raise my heart rate.  I've heard of people who, feeling themselves going into afib, will get up and start walking rapidly.  It raises their heart rate which, in turn, forces them out of afib.  Apparently for some people the heart can't go at a higher rate and stay in afib at the same time.  I usually get a hot flash when this program kicks in.  If this program doesn't stop afib within an hour it times out and starts the next program.  

The second program is Minerva.  When Minerva kicks in it works about 80% of the time.  This program monitors the type of afib I have and "looks" for a repeating pattern.  When it "sees" a repeating pattern it changes my pacing - hence the "stutter step" feeling.  It then paces me out of afib.  It can work for a few hours but if I'm not out of afib it will also time out.  

I think there is about a two hour window where the two programs will start and stop.  After about four hours both programs will time out and I'm on my own.  If the afib is bad enough my first option is to take additional medication.  I've discussed this with my EP and we have a plan of action I am to take.  Otherwise I have to go to the hospital and get some serious heart drugs under controlled conditions.  

I've had this pacemaker for four years.  At first I really questioned the wisdom of my EP especially after a bout of afib with RVR.  He indicated the heart likes to repeat patterns.  The more afib you have the more you get.  By "training" the heart to go back into a rhythmic mode it has a tendency to continue doing that.  Based upon my four year experience my sessions of afib where I'm just lying in a recliner for 24 hours waiting for it to stop have gone down from once a month to zero.  I still have afib and my pacemaker reports I'm in afib about 17-19% of the time but most of the time I'm not aware of it.  Or, if I am aware of it, I'll just pop a pill and keep on going.  Now I usually just get the jumpy feeling of afib but it really doesn't stop me.  

My EP suggested I go on a magnesium supplement.  I did that.  And I'm also on a calcium supplement.  For me, they seemed to help.  I hesitate to mention that because I don't want people to leap to the conclusion that taking magnesium and calcium supplements will somehow cure their afib.  I don't know if they've helped or not.  I know there are wide differences of opinion with doctors.  Some say vitamins and supplements just give you expensive pee.  Others say if it makes you feel better, go for it.  So I would have to advise you to talk with your EP and come up with a plan of action.  

In spite of the afib I lead a fairly normal life.  I volunteer at a hospital two days a week and at a charity woodshop one day a week.  In the last week I've averaged 4.5 miles of walking per day.  Had my son's dogs last week and wore them out.  Thursday is "cut crew" day at the wood shop and we move about 1500 pounds of wood while cutting parts.  My wife and I took a tour and visited England, Scotland, Ireland, and Wales.  Got along just fine.  So while I am aware I have a pacemaker and afib most people don't know unless I tell them.  

My EP says he has given my type of pacemaker to other people with varying degrees of success.  I've neve met any of them and haven't run into anyone on the website so it's hard for me to compare notes.  I consider it a success but others may disagree.  

Hope this is a help for you.  

I have one

by xntriktq - 2018-07-19 00:43:28

KnotGuy....thank you so much for your response. It gives me those 2 possible settings to discuss with my EP AND Medtronic tech. Will also give the magnesium a shot as well.....it would certainly be interesting to know how many of us this may help.....after struggling with this for just 20 months   Or so now, I truly consider everyone I encounter on this site to be fellow warriors in a battle few people understand. Thank you again for your thorough post 🙏......Tom