Asymptomatic A fib, and use of a monitor watch and starting eliquis

@marybird
Thanks for taking time and very helpful.

I don't think so many people know how life changing they can be and I say this also for medical professionals who have not suffered with them.

I cannot take any medications that are to lower my HR. My pacemaker paces me at 70 bpm because my normal rate with medications I am taking would be in low 50s.

You are right with Murphy's law. I had a Holter monitor for 48 hours and not one AFIB or VFIB. The problem I have addressed with pace clinic is the fact they had my theresold for reporting a tachycardia was set at 160 bpm and I had several at 140. So they did not see them on notification nor were they sent. So I said okay programming wrong or device not working because I know I had a VT.

Then they call back and say we checked the strips and yes indeed you had a VT but was below reporting so they changed the number. Then I have a ton of noise on one of my atrial leads. That causes the device to read AFIB. So they years ago lowered the sensitivity. So now when I was getting all those AFIB episode the device was not reporting even though I was having them. So I had they changed the sensitivity to report them only to cause another problem. When atrial are beating fast the device tries to bring ventricles up to match rate. That causes me to feel a racing pulse. So I can't find a way to solve both so have to live with it.

Thanks again!

@jc76 Sure sounds as though you have had a time of it! I can see where having a lot of noise in an atrial lead would result in a lot of maybe erroneous or confusing readings- it'd be hard to tell if the signals came from your heart activity or that lead!
I just wanted to comment on your saying you can't take any medications for heart rate control, is your reason for saying that because of the pacemaker or for other reasons? Actually, taking rate control drugs for tachycardia which lower the heart rate way too low is one of the indications on the American Heart Association (AHA), and the Heart Rhythm Society guidelines for pacemaker placement. The recommendation is classified as 1A ( everybody agrees it will help) when medications for which there is no replacement and re required to treat a patient's condition lower the heart rate to unacceptable levels. In these cases the medication would continue to lower the heart rate, but the pacemaker will kick in to keep the heart rate at the levels for which it is programmed. This happens even when the dosage is increased. So if you were to take a rate controlling drug, it wouldn't drop your heart rate too low as it would have done before you had your ICD/pacemaker, your pacemaker would continue to pace your heart as needed for your activities.

I have taken metoprolol for many years to control my SVT ( the Afib and flutter came along later), and over time I developed bradycardia. This became symptomatic, got worse, but stopping the metoprolol caused a great increase in the tachycardia and when it wasn't tachycardying, the bradycardia was still there. The EPs and my cardiologist determined I had an underlying problem ( sick sinus node) anyway but this was exacerbated by the metoprolol- which otherwise did an excellent job of keeping my tachy under control. We felt the best option was for me to have the pacemaker, and take the metoprolol for tachycardia control. It's worked fairly well for a number of years, I've had increases in the metoprolol ( 150 mg/day now) and the pacemaker still keeps my heart rate where it should be. That's me, I know everyone is different but your pacemaker will still pace your heart rate to where it's needed even if you take a rate controlling drug.

I'm glad they've at least lowered your alert settings to where your tachycardia actually occurs. As you said, your tachycardia will still show up on your monitor reports, but if they only show up every 3 months or so, the opportunity to take some action might be missed. Have they said anything about fixing or replacing that noisy lead?

@jc76 I am "fortunate" to have dramatic SVT episodes (180-20+ bpm) rather than Afib, but the bottom line is that whenever svt strikes at that rate, it is AWFUL too! My svt exploded from easily managed to out of control in Nov 2025.
I also have been fortunate that my cardiologist understands completely and got right on top of it; and the ER staff are very compassionate each time I show up because standard at-home interventions no longer worked. But the outside world can't see or feel what we are feeling and thus don't necessarily understand the reality or urgency, not to mention the effect on our quality of life!

My story looks lie it's going to have a happy ending. Four ER visits in 3 months provided excellent EKG evidence. My cardiologist got me to a good electrophysiologist. He took one look at the ER records and got me scheduled for an ablation in exactly 13 days!

I am 4 days post op and and beyond relieved. Dr is extremely optimistic that he knocked out the offending cells. I don't think I realized just how anxious and stressed out I've been. I know Afib is so much harder to deal with, and I truly wish for all of you the same level of success that @gloaming is experiencing.

@osgilian That's great news! I've had my share of SVTs throughout the years, along with the A-fib and flutter ( multi-talented heart, I guess.....) still get the SVTs so I can attest to how badly they can make you feel. Comparing the "misery" factor between SVT, A-fib and flutter in my opinions, it'd all be a tossup. My symptoms have always been very similar for each of these arrhythmias, none of them are any fun. I still get the same shortness of breeath, lightheadedness and if it goes on for some time, some chest pain that feels to me like a "stitch" in the heart muscle from racing over time ( similar to the stitches in our sides we'd get when we ran for a long time as kids).

My cardiologist, who gets my pacemaker monitor reports, tells me they see both SVT and A-fib on the reports. Interestingly enough, the heart rate during SVTs is higher than it is for A-fib, with the SVT being around 170 BPM and the A-fib around 130.

From what I've been told over the years, having a greatly elevated heart rate over time can cause "tachycardia-related cardiomyopathy" - damage to the cardiac muscle, and that's also an important factor in considering ablation and other treatments to correct the tachycardia. There are a couple of SVTs that involve aberrant electrical pathways, ( ie, AVNRT- AV node re-entry; ) may be genetic in nature ( Wolffson-Parker-White-WPW) where the aberrant pathway is well known and can be ablated which often results in a "cure" for these types of SVT. Far as I know these SVTs are not associated with abnormal clot formation so patients with these arrhythmias don't need to consider taking a blood thinner as they might with A-fib.

As I understand it, A-fib is associated with many factors which must be considered in treatment of this arrhythmia. Ablation can be and often is successful but there are other medical issues that may well make the A-fib recur. Its association with abnormal clotting and stroke risk make it more complicated to treat than another SVT in an otherwise healthy heart. I don't think of A-fib as "worse" or any reason to minimize the symptoms and issues associated with other SVTs, just more complicated to deal with, perhaps. And of course A-fib dominates the literature in the field of cardiac electrophysiology!

Anyway, I'd never ever be one to minimize the symptoms or problems you had with your SVT, I know how lousy it makes you feel, affects your lifestyle, and it can affect your heart adversely if it goes on long enough and your tachy burden is high. So high fives to you and many best wishes that your future will now be SVT-free!

I had afib for a number of years and was always able to feel it. However, I have a brother who never felt his afib, but went in for knee surgery and the doctor told him he had afib. It got bad enough that he was feeling pretty lousy and eventually got it resolved after his third ablation. One and done doesn't always do it.
I've been taking Eliquis for a number of years and have never had any adverse reactions; however, some people have a hard time tolerating it. I've had an ablation and a mitral valve repair surgery which has me no longer in a-fib, but I'll probably be on Eliquis for the rest of my life.
All the best!