Pacemaker Syndrome Q&A

Posted by Medical Board on August 12, 2015 in Question and Answer Last updated on August 12, 2015

Pacemaker Syndrome

Question:

I’m 66 yrs of age and was born with chronic congenital atrial fibrillation. There is nothing organically wrong with my heart–it just beats in an irregular irregular rhythm. I’m limited in exercise as there has always been a problem with cardiac reserve and fatigue as opposed to normal body fatigue. My cardiologist has taken me off all heart medicines (beta blockers), but says I may need a pacemaker some day. If my atria are fibrillating how will I avoid pacemaker syndrome; since any connection to the atria would be pointless?

Answer:

Your question is very interesting as it focuses on a major issue as more than 2,000,000 people have atrial fibrillation in the USA alone. Atrial fibrillation can make people feel unwell and in some is associated with the formation of blood clots. Recently research has found that blood clots are also associated with another condition called atrial flutter. In the end the most important question is whether or not a person’s blood should be thinned to avoid clots. The decision depends on your doctor determining if the risk of thinning your blood is justified as not all people with atrial fibrillation or flutter are at equal risk for forming blood clots. Aspirin probably has some protective effect but coumadin is better.
A pacemaker could be indicated if your heart rate does not increase enough with exercise. Implantation of a rate responsive pacer could make you feel better and increase your exercise capacity. It is important though to be evaluated with tests (for example an exercise stress test and a Holter monitor) to see if your heart rate is too slow or does not increase enough with exercise. The good news is that with atrial fibrillation a single lead is all you need and that you should not develop a pacemaker syndrome as the fibrillation protects you from conducting backward from your ventricle to your atrium (the most common cause of pacer syndrome).

Finally the medical community is launching a major effort to deal with atrial fibrillation. New techniques are been developed which include heart surgery and radio frequency cardiac ablation which have cured many patients of their fibrillation!

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