contro; afib with pace maker or oblation?

I have Aflutter and an AV blockage. I had cardioversion first. I wasn't offered ablation afterward, just went straight to having a pacemaker implanted. The procedure was pretty easy. You're not under general anesthesia, but I didn't feel any pain. I hope you hear from others with helpful advice from others here!

You don't have an arrythmia so much as bradycardia...slow beat rate. So, ablating is not going to do anything, and almost certain to make things even worse. Instead, the gold standard for people with persistently low HR is to install a pacemaker. You don't even need an ICD since you have no rhythm defects....just the pace. A simple pacemaker is what you need. Please put these questions to an expert like a cardiologist or electrophysiologist.

@lak1967
My comment is also for Shamus.
I’m one month out from heart ablation after cardio version didn’t last long. I also have aflutter and afib at lower rates. I’m interested more in the decision to do the pacemaker. My cardiologist has never mentioned a pacemaker as an alternative.

According to "Dr. Google," ablation is also done to correct electrical issues, but a pacemaker corrects both Afib/Aflutter and AV block. It also says that, in some severe cases, they're both used. It says ablation actually can cure issues by "stopping chaotic electrical signals from spreading." A pacemaker doesn't cure underlying arrhythmias but is best for severe heart block (which I have). I just learned a bunch!

@lak1967 Dr. Google is wrong if it claims that a pacemaker corrects AF and AFL. It 'might', surely, but just as often it doesn't. It depends on the patient's particular re-entrant circuitry. A pacemaker only works if it isn't being fought constantly by the AV node, so the AV node must be 'nuked' first....meaning ablated...to destroy its output. This leaves the SA node to do the usual signalling, while the pacemaker 'paces' the ventricles. If that signal is confounded by re-entrants, rotors, and foci that permit extra signals causing AF or AFL, they remain in place...intact. So it is only medication or an ablation of the rogue signalling tissues that will stop AF/AFL, and even then, as we know, it doesn't always work. Same for the pacemaker...sometimes its placement and working stops AF or AFL, but it sometimes does not.

@gloaming
Thank you for the info!

Shamus, I was in similar situation. Low heart rate a-fib, tachycardia, and every other arrhythmia. Have had 4 ablations since 2015, cardioverted 17 times, developed complete heart block with rate of 25 and heart stopping up to 14 seconds at a time. Got a call after Holter monitor reading at 6 am to come in for an urgent pacemaker insertion. Got to EP lab at 130pm and was on the table at 2pm. Saved my life. There were issues with programming several times. Heart rate would jump to 140 with several E-room visits and finally corrected pacemaker programming issues. Still have arrhythmia issues and on my second 4 wire pacemaker. Without out it I would not be here. Cardiologist tried to correct it pharmacology with a myriad of drugs from Tykosyn to isobromide, metoprol the works. Was feeling better then had hip replacement that got infected stem. 3 yrs and 6 surgeries later I'm still in pain and heart issues returned. I'm 74 and my quality of life kind of stinks but I muddle through it and do what I can. Was a professional athlete and its taking quite an adjustment but its better than the alternative. I walk several miles a day taking rests when needed and enjoy sunrises daily. Do what's needed to survive, try different Drs, and contribute to your surroundings! Remember your better off than most and worse than some! "Always look on the bright side of Life". Monty Python!

@shamus
I see others have posted some very informative information for you. I am on my 3rd ICD/Pacemaker. As mentioned a pacemaker is not there to correct underlying problems. It can fixed what is wrong with heart. It is there to provide an electrical pulse when HR gets low, you have things like a LBBB, other electrical issues.

There is a fine definition given to those with pacemakers. Pacemaker depended or not. They are very different classification of what a pacemaker does for you. I am not pacemaker dependent. My medication I take lowers my BPM pulse to low 40s. The pacemaker is set to pulse me at 70 bpm so I don't get the dizziness and problems that can occur with a very low pulse rate.

I also have an ICD (I have dual device). It is there to correct tachycardias and VTAC that is common with those of us with heart failure and low EF.

How much does having a pacemaker affect your life? Everyone different but I had to stop playing tennis (was pretty aggressive) as was bothering wires. I moved to doing Sprint Triathlons. I do water aerobics 5 days a week, swim 2 days a week, and bike one day a week. My pacemaker is not set to exercise mode but I never have any shortness or breath. I exercise at moderate rats as I am 79 with heart failure (had HF for 25 years though).

I just had LV ablation done on June 4th to correct PVCs and tachycardia.

I had a separate post here related to flutter ablation (did two weeks ago).
So at the moment I am between getting pacemaker or still wait for improvements which could be/or not in coming weeks. My heart rates are pretty low (just around 40 more or less during the sleep and 50-60 after wake up). There are not much changes even after 30-40 minutes walks on treadmill.
I did have one encouraging ECG during my latest doctor's visit (sinus rhythm with HR about 70) otherwise no good sighs after that.
So was wondering if anyone had similar situation and what was the waiting time to move forward with pacemaker.

@gregkogan
A pacemaker is usually an outpatient procedure and most go home the same day. Millions are done. They even have programs that can monitor you movement and increase your pulsing when exercising.

Having a pacemaker and your heart rate go down means it will react and keep it steady and at the rate your cardiologist want you to be at.

I have a very low HR because of medications and would be in low 40s. So my ICD/Pacemaker paces me at 70 bpm. Why that rate. We found lower bpm I was having a lot of PVCs and we found that 70 bpm was a good rate for lowering PVCs.

I read someone posted his/her ICD paced his heart. And ICD is there to provide shock if needed with tachycardia. It is not a pacing of heart device. ICD can be programmed to try to pace you out of tachycardia. But an ICD is not a pacemaker that paces your heart continuously or comes on at a certain rhythm.

After 21 years with an ICD/Pacemaker and on my 3rd device had a lot of experience (not sure that is good) with surgeries, and how each device works. I am having my 4th device surgery in about 1 year as battery is getting low.