Pacemaker with Afib

Pacemaker and Atrial Fibrillation (AF)

by Gemita - 2024-10-30 01:17:25

Brian,

You are not taking up our time and duplicating posts because each one of us will have our own unique brand of Atrial Fibrillation (AF).  I am so sorry to hear about your lacunar stroke but happy you seem to have made an excellent recovery.  Yes a tachy arrhythmia like AF or Flutter can certainly be responsible for a stroke which is why if we have risk factors, our doctors will always strongly advise us to take an anticoagulant.  However AF can be so difficult to detect, especially if we are not symptomatic which is why AF is so dangerous.  It would appear your AF has progressed and is now persistent/permanent.  

From your report description, your AF burden (total time you spend in AF) is shown as 100%.   I do not know the period this covers (say for example 3 months) but 100% burden is “total” and would therefore be regarded (to use your description) as “severe”.  However many of us can be in AF and not even know it.  When we are in AF and providing our heart rate is controlled and we are anticoagulated if we have risk factors, our doctors may not be too concerned to leave us in AF.  If on the other hand we are symptomatic with breathlessness, chest pain, dizziness, weakness etc., then our doctors will usually offer further treatments like anti arrhythmic meds or an ablation.

You are clearly not feeling as well as you would be feeling if you were in normal sinus rhythm, but you are still able to exercise and function well enough even though you are in AF 100% of the time.  AF can be exceedingly difficult to stop, especially if it becomes persistent/permanent and more than one ablation may then be necessary.  

I would advise having that all important conversation with your EP/Cardiologist asap about all your options, including a pulse field ablation, because being in AF long term is not entirely risk free and may lead to other serious health conditions in the future.  I don’t think you should just accept this as your new normal, although with 100% AF burden, your AF may be difficult to stop at this stage.

I have intermittent (paroxysmal) AF which is still thankfully low burden (since 2016).  I am no longer taking anti arrhythmics but am on anticoagulants for life + a rate control med (Diltiazem, calcium channel blocker).  I have been very lucky and my pacemaker appears to have helped my mainly bradycardia induced arrhythmias.

Your final statement about your resting pulse consistently being in the 70s bpm range whereas prior to AF it was in the 60s bpm range makes perfect sense.  Yes be assured that your pacemaker is working to help protect you from those high atrial rates.  There is a Mode Switch setting that stops tracking your high atrial rates and steadily paces the right ventricle at a higher lower rate  (in your case 70 bpm).  If your AF were to stop, you would automatically switch back to your original pacemaker mode setting and the lower base rate of 60 bpm.  The fact that you are remaining at 70 bpm is an indication that you are pacing in the right ventricle because of persistent/permanent AF.  Your non atrial tracking mode is clearly working as it should to prevent the high atrial rates from reaching the ventricles, your main pumping chambers, and pushing them too fast which would of course be dangerous.

Good luck Brian.  AF is not an easy arrhythmia to live with or to control but you sound as though you are strong enough to face this and will do whatever is best for you.  I know many members who have successfully stopped their AF for long periods with an ablation or a combination of other treatments, so why not you?

Hello Brian

by piglet22 - 2024-10-30 06:27:56

Gemita has given you a pretty comprehensive run down on AF.

It sounds as though you've been through the mill, but recovering. You have a lot going on.

I wonder if you could give a bit more information in your biography as it can be helpful in answering questions.

I can't add anything to Gemitas answer but would be interested to hear where you you had your treatment, not necessarily with detail, region and nation will do.

Best wishes 

Atrial Fibrillation

by Selwyn - 2024-10-30 17:42:10

Hi Wiredup22,

It does not matter whether you have mild, moderate or severe atrial fibrillation for the stroke risk. Anticoagulation is imperative ( unless contraindicated). There are various risk aids on line to help your doctor to decide whether anticoagulation is indicated. 

I have had two ablations for fibrillation and two for flutter, and one electrical  cardioversion. Nothing is without risk, and these procedures include a risk of stroke. I am left with atrial flutter. The risk of a further ablation ( given that I have an area of atrial fibrosis) is more than the risk of being in permanent atrial flutter. I will ask at my next cardiology appointment whether /cardioversion with electicity followed by medication  is worth while.. At present I am able to exercise ( I have increased my swimming a mile by 5 minutes with the atrial  flutter). There does seem to be a reasonable quality of life  - that is the most important thing - QUALITY OF LIFE. Ablation has a stroke rate, a open heart surgery rate, and a death rate. The more ablations you have the more chance there is of  'a happening'.. Only you can decided whether it is  worth' throwing the baby away with the bathwater.'

I remember talking to an ex-soldier who had a carotid endarterectomy and woke up from the operation with a dense half body paralysis. He said he had taken his chances in war, took his chances again, and this time his luck ran out.  I had his car modified so that he could drive with one hand and one foot. He was not resentful of the surgery decision. Sometimes you make the right decision and the outcome is not what you expect. You have to be prepared to live with the consequences.

I do not get any lead  sensing information from my fluttering atria. I am 100% paced.  I suspect you are in the same situation.

Thank You!

by WiredUp22 - 2024-10-30 21:12:48

Wow!  Thank you for the informative responses Gemita, piglet22, and Selwyn, and helping me understand what my pacemaker is doing while I’m in afib.  I’m going to let my doctor know how I’m feeling and see what options he presents.  As I have been in afib 100% of the time since October 2023, the chances of another ablation being successful are probably lessened, but still something to consider.  Selwyn is correct that the chance of “ a happening” increases the more procedures you have, as I know of situations where that has occurred.  As a result, I will definitely consider the risk of a bad outcome versus my quality of life and potential negative effects of long term afib.

Piglet22 - I am 63 years old, and have always lived a healthy lifestyle as I didn’t want to have any health issues when I retired.  Well, that plan didn’t work out!  My procedures took place at Long Beach Memorial Hospital, Long Beach, California, United States.

Thank you again, for the information everyone shared.  You have helped me think a little clearer through this process.  

Brian

Seconded

by Nemo2 - 2024-11-01 09:53:50

"Thank you again, for the information everyone shared.  You have helped me think a little clearer through this process.  

Brian"

Full agreement with Brian's comment above.....at 82 I'm (finally) realizing that being a "Yeah, yeah, whatever..." type of individual, (especially in this area), has left me sadly underinformed on this life affecting topic.

Guess I've always adopted a naive 'onwards & upwards' approach.......I'll attempt to do better.  ;-)