pacemaker discomfort

[littli]

i am a 53 year old female suffering from atrial fibrillation since a few years. I had an ablation done in Mount sinai new york. For about 12 months after the ablation done i was feeling normal .after the completion of around 12 months i developed bradycardia resulting in the installation of a pace maker in end july 2008. Ever since the fixing of the pacemaker my pulse rates are now regulairized  between 70 and 130 . since installation of the pacemaker I am continously suffering from a heavy head 24 X 7 with a nausea feeling and discomfort in the head and shoulder region. I am also feeling very week and lethargic.
if any one can provide an answer to my problem i will be obliged. I am currently taking two tablets of Co-Diovan in the after noon one tablet loprissor and one table flecinide and one tablet diovan at night
awaiting some body to help me with my heavy head feelings. I am told this is a normal side effect of the pacemaker installation and goes with time but in the meantime i continue to suffer from lot of discomfort

[MARIE7228]

Hi,

I have had a pacemaker for 20 years(1st implanted when I was 19). I am  on my 4th one.  Had a lead extraction with my 3rd pacer.  I have never had to take any meds until now (coumadin for A Fib).  I never had any problems with nausea until I developed A Fib a year ago.  I also have the other syptoms you described, all related to the A Fib.  I have been set at 60-150 for 20 years. Maybe your syptoms are coming from the A Fib and how the pacer reacts to the A Fib.

[BLM_56]

If your atrial diameter is above 5cm then the odds are against an ablation helping you but since your size is from pathology rather than just being natural - I am a BIG guy with a heart to batch - it might help.  Your EP is the one to ask.  And do ask why he/she has never mentioned ablation.  But the fact that you have had a maze procedure (same effect as ablation but done with a scalpel and thus has to be done open-heart) that failed to correct the problem might be why.  Also, ablation is MUCH LESS effective at solving atrial rhythm problems than ventricular.

The only thing I ever got out of my 3 experiences with cardioversion was burns on my (fair skinned) chest and back.  The last cardioversion gave me about a minute and a half of normal sinus.  Even 4+ hours in the cath lab undergoing an RF ablation only game me 3 days of normal sinus.  I was going to have a 4th cardioversion but somehow my PT/INR was too low for cardioversion (1.4  BRRRR lucky thing I didn't have a stroke) but it WAS good for implantation and a tiny ablation to disconnect the AV node.  So I came home from the hospital without the burns.  Alas, I reacted to the pre-op antiseptic wash and the adhesive on the plastic they stuck down on my chest before they made the incision and I wound up with a huge rash on most of my chest.

Good luck to you both.  Jerry, keep us posted.  You, too, littli.

Bionic Bill

[Jerry_NJ]

From another AFib sufferer, who has had good results with electro cardioversion, I'm on my 4th, the others lasted about 18 months each.  After the third slipped back into AFib the doctor said my atrial was getting too large due to a leaky Mitral valve, which was repaired with open heart surgery last November.  The follow up to the surgery included an echocardio which measures my Atrial Diameter as 5.11 close but not as large as your 5.7 cm, Bionic Bill.  The range for normal is 1.5 to 4.0, which makes mine about 30% over the maximum.  This wasn't a show-stopper for going for my 4th electrocardioversion, which was done on August 29, 2008.  This put me in sinus rhythm and a rest heart rate in the low 60s.   But, suddenly last Saturday, the at rest jumped to about 100 BPM, and seems to be unaffected my light activity, i.e., I can walk around and even do light yard work and the heart remains at 100 BPM, +/- 5 BPM.  I'll take with my cardiologist about this change.

There has been no talk about a ablation, but from what I read on this forum, ablation doesn't sound very good and lots of down side.  I did have a Maze procedure while my heart was open, that didn't stop the AFib, well I was in sinus for about 30 days following my surgery.

[BLM_56]

I had a pacemaker after an unsuccessful ablation for a-fib in April.  I was in a-fib for about 6 months before the implantation.  They tried a cardioversion but all thit did was give me a nice burn (like a REALLY GOOD sunburn) front and back where the electrodes were glued on.  They tried an ablation but it got me back in normal sinus for a whole 3 days.  Because my atria are too big (5.7 cm left diameter) ablation is an extreme long shot to get me back into normal sinus - think a 300 lb NFL lineman winning the Olympic Gold in the 100 meter.  Knowing my atrial diameter was so large and knowing the odds (about like a NAIA college team trouncing the super bowl champs) I elected to have a final ablation to disconnect my AV node and have the device installed.  It runs 24/7.  It also test the voltage level needed to cause my ventricles to beat and only uses as much power as it needs.  Right now I'm running at 1 volt - as opposed to the 3.8 that they start at on other machines.  That alone should add years to the lifetime of my batteries.  Plus recently I had the EP shut the device off for a moment.  My ventricles stabilized at 44 beats/minute.  Not enough to do strenuous activity but enough to keep me conscious and coherent and allow me to get to a medical facility.

I am on no medication at all for my heart.  Rhythm control is out of the picture - I will be in a-fib till I die - and the device keeps me ticking.  Initially they set the rate at 80 beats/min but I got them to lower it to 70 and expect/hope to get it lowered to 60 in December.  I am getting some twinges in the area around my device.  Sometimes it approaches pain (according to the former Base Hospital Commander at Yokota AB, Japan, pain is when somebody smashes your testicles between a pair of bricks - everything else is just degrees of discomfort - not sure what his definition of pain would be for a woman) and I have discussed it with my EP.  He says we'll have to do a stress test.  Since my heart is disconnected electrically from my body that means the treadmill.  Oh happy, happy, joy, joy!  

I experience nausia when I initiate certain types of activity but it goes away when my pacemaker (which is a dandy one with 3-axis motion sensors and variable rate up to 130 as needed) goes into a higher gear that goes away.  

Bottom line is unless your EP is the one telling you that your feelings are "a normal side effect of the pacemaker installation and [will go away] with time" nod courteously and then see your EP.  If you EP is the one who is telling you that get a 2nd opinion - unless you are in a country with socialized medicine in which case all you can do is either come to the U.S. and pay out of your own pocket to get a 2nd opinion or shut-up-and-live-with-it.

Bottom line is if you have the option go to a 2nd EP and get their opinion.  If you don't know a good EP ask around.  Go to one that others speak highly about.  

Good luck.  You and I are awfully young (I am only 57) to be carrying around a microcomputer in your chests.  The good news is we stand a good chance of living 20-30 years with the things - plus the technology is always improving.  

Good luck,
Bionic Bill
Cyborg At Large