'Pacemaker syndrome'

[Diane]

The focus of my longstanding atrial arrhythmia has not been located in 2 EP studies and I have not done well on drugs.  My cardiologist has mentioned the possibility of AV node ablation and pacemaker insertion. He said that some people feel "waves" in the neck after this procedure.  What do the waves feel like (e.g. painful, flushing), do they eventually subside and are they of any prognostic significance?   Thanks for dealing with my questions.

[Jo]

Dear Diane,

The first thing you DO NOT want to do is to have any EP doctor go in and just "BLAST" your AV node then place a pacemaker.  If you get to the right doctor they will try what they can to not do this.  All to often EP docs do this in order to get rid of the fast rates that they can't treat.  Then patients are left dealing with having their pacers not set right, and possibly causing more problems then there would be trying new meds to help with the rapid rates.  I don't know of many, if any patients that are happy after having AV node ablation done, then a pacer being placed.  My one doctor said that if the AV node is healthy why destroy it?  Certain fast atrial rates can't be reproduced on an EP study, so the docs say get rid of the AV node and that'll be the end of it.  Well, it isn't.  A pacemaker is not the same as a healthy AV node.  No one should treat it this way either.  You need to find and trust your EP doctor.  Get second opinions, and for God sake, get all the information and make sure you get all your questions answered concerning a pacermaker and it's implant before it is done.  Check out all the pacer sites.  Everyone tells patients how good you will feel after an implant and that this will help, but you never hear doctors telling patients about the bad side effects of a pacemaker.

Good luck to you !

[Cleveland Clinic, MD]

Dear Diane,

I would suppose you have some sort of atrial fibrillation or tachycardia that is intermittent with subsequent rapid ventricular heart rates.  An ablation of the AV node 'disconnects' the atrium from the ventricle and when the atrial arrhythmia occurs the pacemaker senses this and stops 'tracking' the atrium.  The pacemaker keeps the ventricle going at a slow and steady pace and the atrium kind of 'does it own thing'.  This may result in the atrium beating while the heart valve leading into the ventricle is closed.  The blood has to go somewhere so it 'backflows' into the veins leading into the atrium including the neck.    

Of all the potential complications of this procedure I would say this is not one of the major ones.  If someone even notices this it is not usually uncomfortable and has no prognostic significance.