Ablation or pacemaker?

I wouldn't dream of second-guessing your cardiologist or PCP, and don't know what he/she has related to you, nor what any symptoms you currently experience are. Just taking your facts as you report them, and if I can assume you don't have any shortness of breath, no syncope, no fainting and falls, and your heart responds well when you stand or move about, you heart rate doesn't sound worrying to me. Many of us have sleeping HRs in the low 50's and even into the high 40's. It doesn't necessarily mean it's dangerous. Your body will let you know if it's too low.

It might be better to record your BP several times each day. If it never drops below 100 systolic and 65 diastolic, I would day you're probably doing well...even enviably well. But as soon as you start to get signs that your heart is actually weakening, and that you are experiencing dizziness, closed off vision, falls, shortness of breath....that would be the time to squawk to your PCP or cardiologist.

You are asking about a pacemakers, so perhaps you have already received advice and a caution that your BP and/or HR are getting too low....and I would never disagree. Not that I'm trained medically, so certainly not going to disagree. I would expect an increased rate to improve your O2 perfusion, help with organ function, eyesight, help you to keep warm, to move better, maybe digest better....all sorts of improvements. So, if a pacemaker it must be, yes, I would hope and be optimistic that I will feel better in general. The surgeon will discuss settings with you and you would both agree on something sensible and sustainable. Even so, there's a good chance you'll need a rate adjustment at least once in the weeks following.

Thanks very much. I think I will learn something from your comments and plan to go over them carefully to assess things further.

Far as I know ablations are done for tachycardia, NOT bradycardia. And pacemakers don't correct blood pressure issues, high or low. Pacemakers may improve symptoms caused by bradycardia by raising the heart rate to levels more commensurate with the patient's activity, but pacemakers cannot be expected to relieve symptoms from causes unrelated to the heart rate activity. For a patient taking medication to control tachycardia, who also has symptomatic bradycardia due to side effects of this medication, a pacemaker may allow the patient to take high enough amounts of that medication to control the tachycardia without the heart rate going too low.

Pacemaker or no pacemaker is a discussion to have with your cardiologist, who's familiar with you and your medical history.

I’m a 72 year old woman, and I have a leadless dual pacemaker, set to 60 bpm. I have afib w/RVR, and when I was medically converted, my heart paused for 8 seconds. I had to get the pacemaker, so that wouldn’t happen again. Little did I know that the reason I was always so tired and cold was because my heart rate was low. Long story short, I have hit the limit of the drugs they have to use for me. They wanted me to do amiodarone, but it can be toxic to the lungs and I have COPD, MAI, bronchiectasis and pulmonary hypertension, along with heart failure. Right now I am on digoxin while I wait for an ablation in September. It doesn’t stop the a fib, but it keeps the heart rate lower. I think that if your electrophysiologist thinks you need a pacemaker, I would go for the leadless dual Pacemaker. It is the latest technology. I would also do the ablation if I were you. The afib just keeps getting worse if you leave and weakens your heart. And yes, I do feel better. I am warm now and I don’t have to worry about my heart going too slow. The dual chamber Pacemaker has improved my pulmonary hypertension and heart failure. I hope everything goes well for you and everything turns out just like you wanted it to. Take care.

Thanks for the helpful info. You have a lot of issues as many of us do. The fatigue and being cold due to low heart rate sound familiar. The 100 mg of amiodarone seems to be holding my AFIB in check for now, although I have had a Left Bundle Branch Block for a long time, and I think it causes some of my fatigue and brain fog. I will be meeting with my EP soon and will discuss all of this.

Hi there... not sure if this is relevant but just incase it is... i have between 37,000 and 45,000 Ectopic heart thuds per day. Someone might have 1 a year ... i amon meds to i can sleep and not feel it as much. Two ablations did not help ... heading for third reluctantly but i was born with an extra electrical current running from top to bottom. Mine are going off together at the top two chambers ... i was told a pace maker won't fix it... but if anything happens in surgery like it almost did last time they will put in emergency one. I have freezing cold feet and hands even ona scorching day... the heart specialist said something about another TITLE but i can't be bothered with more because there is nothing i can do but treat the symptoms no matter what title i have. wishing you all the very best and take care

Thank you. Seems like many of us are born with some abnormality. My LBBB seems to be from birth. A former primary doc told me I only had "two wires" to the heart, not three. He was trying to make things simple for me.