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Pacemaker and Asymptomatic Atrial Fibrillation

Posted by yoanne @yoanne, Feb 17, 2018

@kanaazpereira ,
since a couple of weeks I am a recipient of a dualchamber pacemaker.(conductionsproblems distal of the atrioventr. node). I just had my first control. the cardiologist informed me, that I have a lot of atriumfibrillations. these are asymptomatic. he put a warning on my pacemaker pass :AT/AF Burden exceeded.
this information made me nervous, so I started to do some research. I learned that this is quite common. Since the modern pacemakers are event-recorders as well, these events "become visible". In the international medical literature it is still a discussion subject. , they call the A-Fib : AHRE (atrial high rate events).
They have no explanations and no suggestions how to avoid them. The occurence does not depend on whether the patient had A-Fib's before or not. the cardiological society agrees that these fibrillalations are not identical with the well-known A-Fib, which are symptomatic.
I would like to know, if other persons have been confronted with this fenomenon.As I mentioned, up to 40% of the persons with a pacemaker show these AHRE.
(AT/AF means Atriumtachycardia/ Atriumfibrillations)
yoanne

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Kanaaz Pereira, Connect Moderator | @kanaazpereira | Mar 4, 2018

Hi @yoanne,

I happened to find this great resource about asymptomatic or silent a-fib from the American College of Cardiology, which you might wish too read:
https://www.cardiosmart.org/~/media/Documents/Living%20with%20AF%20Resource%20Guide.ashx
I'm tagging @dannydamon @balubeje @patinhou Mentor @predictable, to invite them to join this conversation, as they've also shared their insights about this type of a-fib.

Has your cardiologist recommended taking any medications such as blood thinners, @yoanne?

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balubeje | @balubeje | Mar 4, 2018

Thank you. I found this very informative.

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Martin Jensen, Volunteer Mentor | @predictable | Mar 4, 2018

Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the electrocardiogram during my annual physical nearly four years ago. The only manifestation of a-fib was on the EKG print-out. I had no symptoms and to this day don't. But the a-fib is there on each of the three EKGs since then, so I pay attention and follow treatment requirements. Unlike you, I've had no surgery on or around my heart and no pacemaker or other medical hardware, but my other issues may provide some insights on my situation.

First, I have been hypertensive (and treated for it medically) for 25 years. That involves three good medications, physical activity, and good nutrition. Second, I have a bit of hypertrophic cardiomyopathy -- a thickening of the wall of one ventricle -- and that reduces the efficiency of my heart. It is probably related to my a-fib and contributing to my heart's inefficiency. Third, because of those two issues, I medicate with a beta blocker (Carvedilol) to slow my heart rate slightly and with Warfarin to prevent formation of blood clots in my heart chambers.

I have had no "atrial high rate events" that I know of. Historically, my heart rate was about 50bpm, which jumped up to the 80-85 range when the a-fib showed up. The Carvedilol knocked that down to 65-70, and that's where it stays now, except during hard exercise, when it responds to normal healthy levels.

I hope I'm right when I presume that my "silent a-fib" is not worrisome and that I can keep it that way by trusting my medical team and following their instructions. And I earnestly hope that you will find similar confidence that your treatment and the absence of perceptible symptoms are keeping you in your best possible health for all your days ahead.
Martin

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3 replies
yoanne | @yoanne | Mar 5, 2018
In reply to @predictable "Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the..." + (show)
@predictable

Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the electrocardiogram during my annual physical nearly four years ago. The only manifestation of a-fib was on the EKG print-out. I had no symptoms and to this day don't. But the a-fib is there on each of the three EKGs since then, so I pay attention and follow treatment requirements. Unlike you, I've had no surgery on or around my heart and no pacemaker or other medical hardware, but my other issues may provide some insights on my situation.

First, I have been hypertensive (and treated for it medically) for 25 years. That involves three good medications, physical activity, and good nutrition. Second, I have a bit of hypertrophic cardiomyopathy -- a thickening of the wall of one ventricle -- and that reduces the efficiency of my heart. It is probably related to my a-fib and contributing to my heart's inefficiency. Third, because of those two issues, I medicate with a beta blocker (Carvedilol) to slow my heart rate slightly and with Warfarin to prevent formation of blood clots in my heart chambers.

I have had no "atrial high rate events" that I know of. Historically, my heart rate was about 50bpm, which jumped up to the 80-85 range when the a-fib showed up. The Carvedilol knocked that down to 65-70, and that's where it stays now, except during hard exercise, when it responds to normal healthy levels.

I hope I'm right when I presume that my "silent a-fib" is not worrisome and that I can keep it that way by trusting my medical team and following their instructions. And I earnestly hope that you will find similar confidence that your treatment and the absence of perceptible symptoms are keeping you in your best possible health for all your days ahead.
Martin

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@predictable , @kanaazpereira
as I already posted in the past 2 years, I had mitralvalve repair (minimal invasive) .they planned a surgical ablation (pulmonal vein isolation) as well. because of my A-Fib's. . I was doing well.Unfortunatedly I had a syncope in the beginning of january this year. I needed a pacemaker. during my stay in the IC after the implantation, a lot of A-Fib's were seen. I I was surprised, as I did not notice any A-Fib's after my heart surgery (4/2016). So I mailed my cardiac surgeon of the cologne heart center and asked for the operation protocol, which he sent me with the information that he did not do the PVI, as the repair of the mitral valve was difficult (anterior leaflet, the posterior is easier).He was afraid to damage my heart by extending the operation and decided to stop. Nobody told me that. I asked him too, if a reverse remodeling in the left atrium might explain the absence of fibrillations, no answer untill now)
during so many months I was happy to live without these fibrillations. fortunatedly my own cardiologist advised me to continue the bloodthinner (Eliquis) in spite of the "absent" Fib's. now I am living with a pacemaker with a warning: AT/AF burden exceeded..you can imagine that I wanted to find out what this means.and posted my question above.. In the meantime I learned that this is quite common, they are silent. 2-3 years ago it became a discussion point among the cardiologists (international). the crucial question is: does every patient with a pacemaker and silent A-Fib's need a bloodthinner? up to now there is no consensus. june 2016 they started a clinical trial in europe, 200 - 250 cardiological departments send their results to the university of münster/germany. .aim of the study is to find out if the constellation (pacemaker and silent A-Fib's) enhances the risk of stroke and the benefit of bloodthinners.
of course I continued my Eliquis . I wonder why nobody wants to know the reason for these silent fibrillations. there must be an explanation. I don't worry about the eventual negative effects of so many beats per minute. but my husband does.

REPLY
yoanne | @yoanne | Mar 5, 2018
In reply to @predictable "Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the..." + (show)
@predictable

Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the electrocardiogram during my annual physical nearly four years ago. The only manifestation of a-fib was on the EKG print-out. I had no symptoms and to this day don't. But the a-fib is there on each of the three EKGs since then, so I pay attention and follow treatment requirements. Unlike you, I've had no surgery on or around my heart and no pacemaker or other medical hardware, but my other issues may provide some insights on my situation.

First, I have been hypertensive (and treated for it medically) for 25 years. That involves three good medications, physical activity, and good nutrition. Second, I have a bit of hypertrophic cardiomyopathy -- a thickening of the wall of one ventricle -- and that reduces the efficiency of my heart. It is probably related to my a-fib and contributing to my heart's inefficiency. Third, because of those two issues, I medicate with a beta blocker (Carvedilol) to slow my heart rate slightly and with Warfarin to prevent formation of blood clots in my heart chambers.

I have had no "atrial high rate events" that I know of. Historically, my heart rate was about 50bpm, which jumped up to the 80-85 range when the a-fib showed up. The Carvedilol knocked that down to 65-70, and that's where it stays now, except during hard exercise, when it responds to normal healthy levels.

I hope I'm right when I presume that my "silent a-fib" is not worrisome and that I can keep it that way by trusting my medical team and following their instructions. And I earnestly hope that you will find similar confidence that your treatment and the absence of perceptible symptoms are keeping you in your best possible health for all your days ahead.
Martin

Jump to this post

@predictable ,
I forgot to mention an advice my cardiologist gave me. Of course I showed him the answer of the cardiosurgeon from the hospital . he,like me, was quite astonished to read that there was no surgical ablation done. . he thinks that it does not make sense to have a katheter ablation in the near future, as the fib's will come back.
he also said that these silent A-Fib's won't shorten my life expectance. . I hope his opinion will come true.

REPLY
Martin Jensen, Volunteer Mentor | @predictable | Mar 5, 2018
In reply to @predictable "Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the..." + (show)
@predictable

Hi @yoanne. I found out I have atrial fibrillation when my personal care physician conducted the electrocardiogram during my annual physical nearly four years ago. The only manifestation of a-fib was on the EKG print-out. I had no symptoms and to this day don't. But the a-fib is there on each of the three EKGs since then, so I pay attention and follow treatment requirements. Unlike you, I've had no surgery on or around my heart and no pacemaker or other medical hardware, but my other issues may provide some insights on my situation.

First, I have been hypertensive (and treated for it medically) for 25 years. That involves three good medications, physical activity, and good nutrition. Second, I have a bit of hypertrophic cardiomyopathy -- a thickening of the wall of one ventricle -- and that reduces the efficiency of my heart. It is probably related to my a-fib and contributing to my heart's inefficiency. Third, because of those two issues, I medicate with a beta blocker (Carvedilol) to slow my heart rate slightly and with Warfarin to prevent formation of blood clots in my heart chambers.

I have had no "atrial high rate events" that I know of. Historically, my heart rate was about 50bpm, which jumped up to the 80-85 range when the a-fib showed up. The Carvedilol knocked that down to 65-70, and that's where it stays now, except during hard exercise, when it responds to normal healthy levels.

I hope I'm right when I presume that my "silent a-fib" is not worrisome and that I can keep it that way by trusting my medical team and following their instructions. And I earnestly hope that you will find similar confidence that your treatment and the absence of perceptible symptoms are keeping you in your best possible health for all your days ahead.
Martin

Jump to this post

Thanks, @yoanne. Your cardiologist and mine are on the same wave length: Bottom line, silent a-fibs are good to know and good to highlight on our medical records, but not ordinarily threatening (if our status is stabilized with physical activity, good nutrition, intellectual and emotional enjoyment, and balanced medical therapy).

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