Expirence with Azure XT Pacemaker

Treatment options for AF: a pacemaker can be one such tool in the toolbox

by Gemita - 2022-02-18 05:01:10

Ratcheva, Yes I have experience with this arrangement.  Many members have paroxysmal AF and a pacemaker can help doctors to prescribe "safely" higher doses of meds to control the arrhythmia without causing a dangerous fall in heart rate.  That is probably what you mean by "this arrangement" and is perhaps one of the reasons why your EP has recommended a pacemaker.  Because a pacemaker can be set to prevent our heart rate from falling to a dangerously low level during rate lowering medication treatment, our doctors can then give us higher doses of the same medication that would not have been possible without a pacemaker.  The higher doses of medication might just stop or better control your arrhythmia.  Additionally, in my case, a higher heart rate setting of 70 bpm helps control atrial ectopic beats which always trigger my AF.

I also have a Medtronic dual chamber pacemaker but not the exact model you have described.  AF cannot be cured by a pacemaker alone though.  In fact I would say that AF cannot usually be cured once it becomes established unless a cause can be found and eliminated.  AF can though be controlled for long periods and usually controlled well with an ablation or with medication or a combination of both, with lifestyle changes, elimination of any triggers - like alcohol, too much caffeine - and  of course treatment of any other health condition triggering AF (like hypertension, infection, lung, heart disease, thyroid disease, diabetes, autoimmune disease and so the list goes on).

Can you explain why an ablation is not possible for you, since med-resistant AF patients would usually progress to an ablation?

Treatment options for AF

by ratcheva - 2022-02-18 10:53:01

Thank you very much, Gemita for your detailed explanations!

To your question: My EP explained that he does not recommend ablation for my AFib because of my Bradycardia, CAD with 6 stents and my age (80 years). He said chances for success are maximum 40%.

I am asking about Medtronic Azure XT dual chamber pacemaker, because it has a special algorithm to treat AFib. It is called ATP (Atrial Tachycardia Pacing) algorithm. Medtronic claims "40% reduced risk of persistent AFib" with it. Please see the link:

https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiac-rhythm/pacemakers/azure-new.html

Best regards, Anton

PM for AF

by TAC - 2022-02-18 12:05:43

This is exactly my case. After a Cox Maze procedure I underwent in 2009, at the age of 76, my AF was fully controlled for 8 years. However, in 2016 I had one short episode of AF. In 2017, another episode, but this time it wouldn't go away on its own. Finally, it had to be stopped with cardioversion, but the AF came back after a couple of days. Then, my cardiologist gave up and referred me to the electro-physiologist. By this time, I was 84 years old. The EP told me that ablation was too risky, because of my advanced age and also because my previous Cox Maze procedure had left my heart full of scars. He recommended instead, an anti-arrythmic drug. Because I was also having bradycardia from an A/V block, the EP explained that the anti-arrhythmic drug would slow down my heartbeat to very dangerous levels. The only solution, was to implant a pacemaker that would keep my heart beating normally despite the slowing-down effect of the anti-arrhythmic drug. Therefore, I had a dual chamber St. Jude pacemaker implanted in June 2017. The anti-arrhythmic drug worked very well and the AF was reduced by 99%. I have been doing well since. Fortunately, I tolerate the anti-arrhythmic drug well without side effects. The PM is not curing my AF, but like Gemita said, it allows me to take an AF medicine that otherwise, I wouldn't be able to take without the help of the PM. 

ATP

by Selwyn - 2022-02-18 12:48:36

See (cut and paste in the browser bar at the top)

https://www.zenopa.com/news/801662613/Medtronic_pacemakers_shown_to_offer_atrial_fibrillation_benefits

Better to get cumulative experience!

PM for AF

by ratcheva - 2022-02-18 13:57:29

Thanks a lot, TAC for your comment!

Atrial Anti Tachycardia Pacing

by Gemita - 2022-02-18 14:35:45

Hello Anton,

Thank you for the additional information and link.  Clearly you would have a very nice pacemaker with many useful features with an upgrade, more advanced than mine which was implanted in 2018.

I do understand why your cardiologist has not recommended an ablation at 80.  My EP/cardiologist told me too that the cut off age for me to have an ablation was 80 years.  But I don't feel as though I need one now with my pacemaker.

I have seen a few posts here about anti tachycardia pacing features.  Some members have found that it helps, others have not had much success.   It depends on the nature of your AF.  Since your AF is still intermittent, it may indeed help as well as other adjustments that can be made to some of your settings to provide you with a comfortable "pacing" experience.  I don't have all the fancy pacemaker algorithms to control my AF, but the single most important setting for me Anton is the Base Rate setting of 70 bpm.  It works like a dream (for me at least) to keep my ectopics and AF under good control.

I hope you do very well and please come back and tell us how things are going for you whenever you can.

AFib

by AgentX86 - 2022-02-18 17:00:06

The previous scaring from the Cox maze was probably not the determining factor, rather age.  I, too, had a Cox maze that went wrong and put me into permanent AFL. Over the next eighteen months I had three ablations, all unsucessful, but I was only 64-65. I know of people over 80 who have had ablations but you're right, it isn't normally suggested.

Pacemakers don't fix AF but may be able to help.  Some respond better than others to the therapy but anything is worth a shot.  Since you have Bradycardia anyway, a PM will help even if it can't solve all.

Reading the Azure-XT manual,

<https://manuals.medtronic.com/content/dam/emanuals/crdm/M994942A001A_view.pdf>

,there are some interesting features that could help. I haven't read the whole thing but these caught my eye:

Atrial intervention pacing features – The system provides the following overdrive pacing techniques that are designed to counteract potential atrial tachyarrhythmia initiating mechanisms:
● Atrial Preference Pacing (APP) maintains a consistent activation sequence by providing continuous pacing that is slightly higher than the intrinsic rate.
● Atrial Rate Stabilization (ARS) adapts the atrial pacing rate in response to a PAC (premature atrial contraction) to avoid long sinus pauses following short atrial intervals.
● Post Mode Switch Overdrive Pacing (PMOP) works with the Mode Switch feature to deliver overdrive atrial pacing during the vulnerable phase following an AT/AF episode termination.

And:

Conducted AF Response – This feature regularizes the ventricular rhythm during conducted AT/AF by modifying
the pacing rate on a beat-by-beat basis to closely match the patient’s average ventricular response.

Expirence with Azure XT Pacemaker

by ratcheva - 2022-02-19 04:01:18

Thanks a lot, to AgentX86 and especially Gemita comments! They helped me to make a plan for the forthcoming discussions with my EP. I will raise the following proposals and questions:

1. Increase the current PM base rate from 60 to 65 or 70 bpm. Hopefully, this will not create any problem since I have CAD with 6 coronary stents implanted.

If it doesn’t work

2. Add rhythm control drugs Amiodarone or Dronedarone to my current Medication plan that already include a Bisoprolol beta blocker 2.5 mg daily

If it doesn’t work

3. Replace my current Azure S PM, which does not have the algorithm for the treatment of AFib with Azure XT PM that has that feature. Probably this will not be a very complicated procedure since current leads are compatible with both PMs and no need to be replaced.

Think about how your symptoms are affecting you ?

by Gemita - 2022-02-19 04:38:01

Anton, yes no harm in asking about your plan (1) and this might just help you too.  Since you have been offered (3), if Plan (1) doesn't help, then an upgrade might be helpful.  

I wouldn't perhaps consider Amiodarone, (Plan 2) since the safety profile is concerning and you would need careful monitoring of your bloods while on Amiodarone.  However, Amiodarone is one of the most effective meds out there to control arrhythmias, but personally I would only take it if my quality of life was poor or I had a serious ventricular arrhythmia that needed controlling.

I think the question you need to ask yourself is how symptomatic you are with AF before resorting to strong anti arrhythmic meds.  Are your symptoms affecting your quality of life.? Is your AF frequent and at high rates, or is it infrequent and only occurring at rates below 100 bpm (anything above 100 bpm for long periods of time would need better control).

I wish you well during your discussions and decision making and lots of luck controlling your AF 

Ameoderone and droneadrone

by AgentX86 - 2022-02-19 21:02:32

Raising your HR probably won't work but it's worth a try.  Raising mine to 80bpm did chase away PVCs but they're a lot easier to surpress than AF. It would probably work with PACs too but, again, it's worth a try.

Ameoderone is at the top of the heap for effectivity of antiarrhythmics but it's also at the top of the list for toxicity. It can damage any organ.  It's nasty stuff and enters body fat so may take many months to leave the body.  When I was put on it, the research I found didn't talk about "if", rather "when" side effects would appear. My EP would put me on it for no more than six months at a time.  Even then, it damaged my thyroid.  I fractured my pelvis (no idea how), which is how they got onto the thyroid problem.

Droneadrone (a.k.a. Multaq) is a cousin of Ameoderone (as its name implies) but it's not nearly as effective but also not as toxic.  There are a lot of drugs between these two (on both scales).  People react differently to all of these drugs.  Your EP should be able to put together a plan - if 'A' doesn't work, then we try 'B', then... It may take a while and none may or all may have side effects.

Ameoderone and droneadrone

by ratcheva - 2022-02-20 03:03:57

Thanks AgentX86 for your useful comments and suggestions!