Hello doctor, I am 63 years old male. I am a known case of atrial fibrillation 20 years. I had a brain hemorrhage 23 years back. I have a paroxysmal type of afib. Recently its frequency has markedly increased. I am taking Sotalol 80 mg and 80 mg. But now Sotalol increase is required which causes bradycardia when the rhythm is sinus. My cardiologist wants to implant a pacemaker to pace the heart in bradycardia. Please let me know about the role of PM in arrhythmia. My cardiologist says during abnormal rythm PM is inactive.
Hi. The rate in AF is controlled with beta blockers, calcium channel blocker or Digoxin. You are taking Sotalol which is a beta blocker as well as the anti-arrhythmic drug. The permanent pacemaker is implanted when there is tachy-brady syndrome. It means sometimes there is tachycardia episode and sometimes bradycardia episode. If we control tachycardia, during bradycardia episode there will be even more severe bradycardia and if we control bradycardia, tachycardia episode will be severe. So, in this situation, a pacemaker is implanted to avoid bradycardia, and for the tachycardia, medicine is continued. The pacemaker is programmed to pace the heart when the rate drops to a certain threshold such as 60 bpm. Paroxysmal AF is one in which rhythm is restored to sinus within seven days, persistent is seven days to 12 months, long-standing persistent is more than 12 months. Cryoablation technique is used to revert rhythm back to normal sinus. It is done in paroxysmal AF, but some trials exist even for persistent and long-standing persistent AF as successful ablation can be done. Please consult your cardiac electrophysiologist about the possibility of this procedure in your case.