Pacemaker and Atrial Fibrillation

I have been diagnosed with bradycardia and atrial fibrillation and will soon be given a dual chamber permanent pacemaker.  I notice that in the doctor's reply it was said that a pacemaker didn't treat AF.  This has confused me since my understanding of a pacemaker is that it gives you a regular sinus heartbeat and that arrhythmias would be a thing of the past.  If it doesn't treat arrhythmia, then what use is it?
Jo


This discussion is related to How can pacemaker help?.

[cindy707]

Hi JoKelly....a pacemaker is generally used to correct situations that involve bradycardia or a slowing of a heart beat to basically assist you in pacing your heart to be within normal limits and the doc is right ..... it has nothing to do w. atrial fib......atrial fib is in a whole nother world of its own and the only thing implantable to help out w. that if it is severe enough would be an ICD device that would basically shock your heart when it detects a shockable rhythm to reset the electrical activity of the heart when is begins misfiring on you.  In the world of hearts believe it or not severe cases of bradycardia fall more importantly on the scale of life where atrial fib would be second.  The doc obviously feels he/she cannot put you on a beta blocker to help you out w. the atrial fib since it drops your heart rate and b/p since you already have issues w. the bradycardia and it could be bad for you.  The pacemaker is simply an assist to keep your heart rate where it belongs....these are two different issues and sounds like your doc chose the best way to handle it to me depending on what your pulse rate is and if it is true bradycardia and has been confirmed by two docs.......

[JoKelly]

Many thanks and I understand what you are saying.  However, I have had hypertension for many years now and it is successfully treated with Co-Diovan which is a beta blocker which I take daily.  After a recent stay in hospital when the A-fib was identified, I was placed on a Warfarin program and also have 10mg Bisoprolol daily.  Following a week on a Novacor monitor, the doctor has now also diagnosed bradycardia with a resting beat of 45-50 pm which I don't think is severe rating.  For the present he has taken me off the Warfarin and on to low dose daily aspirin and says that if my palpitations become 'troublesome' he will implant the pacemaker and give me further anti arrhythmic drugs.  I do have almost daily very brief episodes of AF but had a two hour spell a couple of days ago.  I am unsure what would be the best for me and note you said to seek another opinion, which is not so easy here in UK on the NHS!  I am specifically wondering whether a permanent implant would be worth it now that I realise it will not cure the AF.

[cindy707]

Good morning JoKelly....it is a very personal choice that is made specifically by you because in the bigger scheme of things it will be you that has to live w. the decision that is made...if it were me personally i would look for importance on the scale of what is the most acute problem and what to deal w. first.  I would ask myself does the atrial fib look like its getting progressive, is the bradycardia getting degressive and your pulse rate keeps getting lower and lower...i always question everything and research as much as i can because altho we all know to listen to our docs and follow their advice it is best i think to do our homework because at the end of the day its us that has to live w. the decisions that are made and the docs move on with their lives as well.  I guess i am still a little confused as to the doc saying that if the palps become troublesome that he will implant the pacemaker....either i am missing something here unless what he is saying that the palps are popping up from the bradycardia and at 50 beats per min. i agree w. you JoKelly...if you are in pretty good physical shape and take good care of yourself it may very well be the norm for your heart rate to be at 50 in resting mode....i guess this falls under that old saying of question authority...with atrial fib as you know from seeing you on the other heart site the management of it is beta blockers but w. your low pulse rate it may not be possible since your heart rate is lowered on them or the cure which is an ablation...if your doc says that a regular sinus beat would make arrys. a thing of the past again i am confused because it is generally an issue with the electrical of the heart and the pathways in most cases but maybe this falls under which came first the chicken or the egg theory.....i suppose the corrolation between the sinus rhythm and the electrical would be the question....however again in the end its you by yourself alone who has to make the decision on your treatment plan...i would just be fully armed w. information and research as many studies as you can by renowned docs that are experts in the field of the heart...good luck JoKelly and i hope you have a happy rest of the weekend....these are just thoughts i am tossing out here....

[JoKelly]

Thank you Cindy for all the thought you are giving to me.  I was totally unaware of any question of bradycardia until the monitor was worn last month.  Up until then it was arrhythmias, first wrongly diagnosed as SVT and then in hospital, following a two day attack,  as AF which is when they started the Warfarin which was on 1st September.  It is only being sent a copy of the cardiologists report that the mention of brady and pacemaker has come up.

I guess my dilemma is, how risky is the AF.  My husband is in permanent AF and seems very well indeed.  And of course, it is very confusing to be on beta blockers and Bisprolol which I think lower the heart rate anyway - and now taken off the Warfarin program with an aspirin substitute.  I visit my GP tomorrow and will put this forward.  As you say, I would have to live with the consequences of deciding to have the pacemaker - so I have lots of questions to ask before I would agree to have this done, especially since I read the experiences of others who don't tolerate it too well.  Thank you for your good wishes and I will update from time to time.  Happy Christmas!

[rich1iam]

Pacemaker slow heart rate usually below 50bpm will pace you with very low electic shock to keep your rate from going too low.  ICD large shock 25 Joules to convert too fast of a rate, usually over 150bpm. Shocks 4 times trying to convert you back to normal rate 70bpm or better

[JoKelly]

Following a visit to the doc yesterday, we have agreed for the present just to see how things go in the future.  She reckons I am as safe from stroke on aspirin as on Warfarin, adding in the beta blocker and Bisoprolol.  If an AF attack lasts more than an hour I should visit the surgery for an ECG (not ignore it) or even A&E out of hours, especially if I feel unwell.  She agrees also that 45-50 is not severe bradycardia and doesn't warrant the pacemaker as yet.  Fingers crossed!