Pacemaker really necessary or rhythm control?

[DeltaDawn23]

In hospital after lung surgery resulted in afib.  TEE showed a clot, so cardioversion could not proceed.  Staff cardiologist prescribing rate control drugs in the absence of my electrophysiologist.  My doctor will be back tomoroow.  Today, staff doctor mentioned an av node ablation and permanent pacemaker.  I am not happy with that and feel like enough time has not been spent on rate control.  I am hoping for a cardioversion after the clot resolves.  Any input would be appreciated.  I am on Cardiazem 360 mg., digoxin .25 mg. annd Metoprolol 75 mg. (2 x per day).

[DeltaDawn23]

After waiting less than patiently all morning, a nurse practitioner came in and said my ep or his assistant will be in by the end of the day.  I expressed my bewilderment that the plan went from TEE/cardioversion to AV node ablation with no explanations at all to me, despite my repeated comments that I did not want an av node ablation/pacemaker.  The NP saidthe thinking was I had been suffering with this so long that this could take care of it.  Note, none of the drs. advocating this were eps or apparently in touch with my ep.  Anyway, the dr or asst should be in this afternoon and perhaps I can go home --been treading water and being prepped for a procedure I never wanted.I was starting to feel kind of desperate.  Will post outcome.  Thanks for your comments.

[DeltaDawn23]

Thanks for the clarification.  It is another of the staff doctors from the same cardio practice.  Apparently Iwill be seeing yet another doctor today, but I have a call in to my ep about my delemma.  Hoping to hear back soon.  Thanks for your help Jerry.

[Jerry_NJ]

Pressure from a hospital staff doctor (resident, or board certified something?), prior to consultation with your heart doctor seems very strange to me.

My HR is usually not a problem with light activity, say walking on the level ground at a resonable speed, say 3 mph or a little faster, normal walking.  I'd guess my HR is something like 125 for such light activity.  I do not feel anything, but working  a bit harder makes me short of breath and I suppose a HR over 135 too high for my age.  Nonetheless, I regularly do physical work, but if heavy work I have to stop often to recover normal breathing.  No doubt AFib slows me down, but it hasn't stopped me, yet.

[DeltaDawn23]

thanks for the input.  I'm feeling pressured by staff doctor whom I had never met before this hospitalization 3 days ago.  Seems like I should have some options.

[itdood]

It doesn't sound unreasonable to wait to consult with the EP.  

[DeltaDawn23]

Thanks for your prompt reply.  May i ask what your heart rate is when you are moving about, walking and such?  

I have always thought of the PM as a last resort, came in for a cardioversion, and after just 2 days on oral meds, a staff doctor is pushing for a pacemaker.  It had never been discussed with my electropysiologist.  I was taken aback.  My ep will be back tomorrow, so anxious to get his opinion - he's been my ep for 10 years.

The lung surgery went well -- upper lobectomy - and I was recovering nicely when the afib appeared.  Not unexpected, but I could have done without it.  

Thanks again for your input -  I'll post when I see what the next chapter is.

[Jerry_NJ]

I read the lung surgery went well... absence of any information, hope so.

I support the idea of rate control, temporarily, to give the clot to clear.  As you know, the longer one is in AFib the less likely a cardioversion can be accomplished.

I'd go for a pacemaker as a last measure.  Of course if there is a life threatening condition, that would be an important factor to consider.

A pacemaker will do nothing to resolve the clot, I believe so you have to run the risks associated with a clot regardless of the PM decision, I believe.

I am on rate control and have been for 7 years, but it works for me, if I had a ventricle HR that could not be controlled a PM would be a solution, so far I am not in that condition.  My normal in bed HR is 60s often higher 50s and my awake, like now sitting at my laptop I'll guess my HR is below 80, so no need for a PM for me, yet.