Pacemaker implantation for atrial fibrillation

[nosmarbaj]

Has anyone any knowledge or (ideally) experience of pacemaker implantation to treat atrial fibrillation? I’ve been offered this and need to make up my mind, though there’s no great rush to do so. It’s not a cure but would probably improve symptoms and allow reduced medication. It seems the important downsides are

1) The part of the heart that controls heartbeat must be destroyed so that the pacemaker can control the rhythm – so if for any reason the pacemaker fails, my heart stops
2) It’s not guaranteed to alleviate symptoms

I’ll discuss further with the cardiologists but would be interested in any views others may have.

Background: I was diagnosed with persistent AF in 2016. Since then I’ve had cardioversion and 3 ablations, the end result of which is the AF is now paroxysmal, affecting me about 35% of the time - and that percentage is gradually increasing. I get weak and breathless when in AF so I’m reluctant to go on long cycle rides or to tour, in case I can’t make it home or to my destination. It has a definite adverse effect on my quality of life.

[Jdsk]

Have they already given you the relevant background information, Patient Information Leaflets for the procedure, etc?

Jonathan

[nosmarbaj]

Have they already given you the relevant background information, Patient Information Leaflets for the procedure, etc?

Jonathan

Yes they have. I believe I'm reasonably well aware of the theory, but it's always useful to know others' actual practical experience.

[Jdsk]

Thanks

Jonathan

[Pinhead]

1) The part of the heart that controls heartbeat must be destroyed so that the pacemaker can control the rhythm – so if for any reason the pacemaker fails, my heart stops
2) It’s not guaranteed to alleviate symptoms

In your heart I believe you have already answered your own questions

[nosmarbaj]

1) The part of the heart that controls heartbeat must be destroyed so that the pacemaker can control the rhythm – so if for any reason the pacemaker fails, my heart stops
2) It’s not guaranteed to alleviate symptoms

In your heart I believe you have already answered your own questions

Thanks, but I certainly haven't decided already, though I'm leaning towards having the procedure.

Regarding point 1), people die suddenly for all sorts of reasons especially as they get older (I'm 72), and pacemakers are well-established and reliable technology, so it's not likely to happen (finding the exact failure rate is on my list of things to do).
On point 2), the consultant I spoke to was of the opinion that in my case it would help, but there are cases where it doesn't.

Another factor to consider, relating to cycling, is that modern pacemakers adjust the heart-rate according to demand (i.e. exercise). Apparently they determine this by detecting vibrations in the body. This works well for running, and rather poorly for swimming. Cycling is somewhere in the middle, plus I could stop taking beta-blockers with their negative effects on exercise.

[cc1085]

I'm 72 and have Afib. I have had a cardioversion and am on medication. I was asymptomatic and the condition was discovered in a routine medical check for driving licence renewal. It has never affected me and I carry on as normal as is possible for my age. Your choice is not an easy one but if you think it will improve your quality of life then go for it. My close neighbour lived to be 94 and had a pacemaker for twenty of those years and had a great life.
Thom

[rualexander]

I don't think it is necessarily the case that if a pacemaker fails your heart stops.
The heart muscle has an intrinsic contraction rate that is independent of the natural pacing area, I think it's about 30 BPM.

[axel_knutt]

I don't think it is necessarily the case that if a pacemaker fails your heart stops.
The heart muscle has an intrinsic contraction rate that is independent of the natural pacing area, I think it's about 30 BPM.

"in the majority of patients, the heart will not simply stop if the pacemaker malfunctions but may be so slow that it does not achieve adequate blood flow to the body’s vital organs. It may also result in a blackout or collapse. In the remainder of patients who don’t have an escape rhythm, the heart would stop if the pacemaker malfunctions"

[Jdsk]

Please note the advice that the OP has been given about the specific procedure that has been offered.

Thanks

Jonathan

[Audax67]

I wouldn't worry about the device malfunctioning: they're mature technology and very reliable these days. I'd be asking about battery life, response during intense exercise and susceptibility to the fields generated by power tools. And how soon after the op could I get on the bike again.

[bikes4two]

My own situation is very similar to the Op's with the exception that my current episodes of paroxysmal AF do not lay me low (although I'm guessing that will gradually change for the worse over time).

Personally if I were faced with either cycling with an outside risk of dropping dead vs no cycling, I'd likely opt for the former.

Right now I'm laid up with a double pelvic pubic ramus fracture (had an 'off' a couple of weeks ago) but give it 2-3 months and I'll be back on the pedals - waiting that long is bad enough but the thought of never cycling again fills me with dread hence I'd take the chance with a pacemaker.

[nosmarbaj]

Sorry for not acknowledging all responses - I haven't been here for a while. Thanks everyone.

I've done some more research and asked my cardiologist some questions - assuming nothing negative in his answers I'll go ahead with the process. I was told NHS waiting time is 2-3 months which seems very good for what in my case is an elective procedure. We'll see if that's true...

For anyone interested, I'll update as and when there's progress.