Use of a pacemaker for a-fib.

My wife was recently diagnosed with a-fib. An echo cardiogram then revealed a badly enlarged left atrium and she was given a beta blocker to slow her heart rate. Not only did the dose not slow her heart rate significantly, but a 24 hour heart monitor disclosed that the drug was causing pauses in her heart beat. Her doctor has recommended a pacemaker to pick up the missed beats and a higher dosage of the drug to slow her heart rate adequately.

1) What is the (approximate) success rate for this treatment?

2) Is this a reasonable next step?

3) Depending on results, is ablation a possible next step?

4) What is the (approximate) success rate for the ablation/pacemaker treatment?

5) Where do we go from there?


This discussion is related to pro and cons.

[mwj_phx]

Oops! My wife's medication is Varapimil, a calcium channel blocker. She can't take beta blockers.

mwj_phx

[va_tony]

I'm not a doctor... just an afib patient who has done a lot of reading.  I'll try to answer your questions but you should also get answers directly from your cardiologist (or a second opinion from another doctor).

1) Your wife's cardiologist has proposed a reasonable treatment approach.  You haven't mentioned wheteher your wife is in persistent afib or sporadic. In either case, the doctor will generally start with rate control -- with either a beta blocker or calcium channel blocker. I personally take cardizem (a calcium channel blocker), which brings my persistent afib into a heart rate range of 60-90. Verapimil sounds like a good choice for your wife. Cardizem works well for me and I hardly notice any symptoms (and so don't need to consider a pacemaker). There are those where this doesn't quite work like in your wife's case.

2) Considering her need for a higher dosage and her occasional heart block, the combo of verapimil and a pacemaker is an appropriate next step.  As I recall, a member of this board, scouser costa rica, has a pacemaker like your wife's doctor is recommending and it's working out well for him (he also takes amiodarone to decrease the frequency of afib episodes and to lower his heart rate when it does occur)..

3) There are two types of ablation to consider.  One is an attempt at curing the afib  outright (no meds needed or pacemaker)-- for example, a pulmonary vein isolation.  However, if your wife has an enlarged left atrium, then the odds of this being successful are much lower than if her LA was normal (I also have an enlarged LA, 5.5 cm dia., and have been told that it isn't worth trying in my case).

If your wife is in continuous/persistent afib and, even with verapimil and a pacemaker , experiences symptoms like strong annoying palpitations, dizziness, being tired all the time then another type of ablation is considered.  In this case the afibbing atria is electrically disconnected from the ventricles by ablating the AV node.  Your wife would then be totally dependent on the pacemaker to control the ventricular beating.  This is a very common approach for many older people. The heart is still in afib but the patient doesn't notice and is able to experience a high quality of life.

4) It sounds like you are asking about the AV node ablation with pacemaker. It's my understanding that that approach has a very high success rate.... 100%. While it would be nice to avoid pacemaker implantation, that will eliminate negative symptoms and allow your wife to lead a normal life. She will also require prescription of anticoagulants like coumadin I believe.  I take coumadin myself.

5) I think if your wife has an av node ablation and pacemaker there is no need to consider anything further. But it's definitely worth her trying the med/pacemaker combo without the av node abaltion first.

Best of luck