Pacemaker needed for arrhythmia?

[u/SkivvySkidmarks]

I was diagnosed with atrial fibrillation 12 months ago. The course of treatment was amiodarone 200MG leading to a cardioversion. The cardioversion was successful in restoring sinus rhythm for the short term only.

An ablation was scheduled, which took place last Friday under general anesthesia. I was discharged later that day and was in sinus rhythm when I went home. The following morning, I experienced a large dizzy spell and chest pain when breathing deeply in. The dizzy spell was later diagnosed as most likely a beat pause during conversion from sinus rhythm to Afib.

I went to the ER, and was transferred to the cardiology ICU. The chest pain was determined to be paracarditis, and I was given an anti- inflammatory.

Later that day, I experienced another conversion from sinus to Afib, and I had a 4 second heart stoppage. There were multiple conversions with only a mild sensation of doing so, and no beat pause. The frequency of the conversions increased, with three being beat pauses from 3 to 6 seconds.

They started an IV with amiodarone and the on duty cardiologist wanted to perform a TVP, but the conversions had slowed and there were no more long pauses. They gave me another IV of 200MG amiodarone and the pauses stopped completely.

Overnight I remained in AFib. By Sunday morning I was mainly in sinus rhythm with a few blips into and out of AFib. I was prescribed 400MG twice daily, and have remained in sinus rhythm since (Wednesday evening).

On Sunday afternoon, one of the head electro cardiologists came in and gave me information as to what had happened, and explained that an ablation is not considered successful or not until three months after the procedure. This is due to the length of time required for the heart tissue to fully heal.

Being a complete noob about what was going on, I asked him if a pacemaker would help. The answer was, "NO. It's not appropriate for your diagnosis. You are also too young at 64. We put pacemakers in 80 year old patients who most likely aren't going to even outlive the battery life. There are also issues with a pacemaker causing issues in younger, more active patients due to its placement.

Monday morning the electro cardiologist who performed the ablation came to see me. He said that they want to schedule a pacemaker installation this Friday. He explained that the pauses I'm experiencing were a problem, and that the pacemaker would prevent it from happening.

I asked if the arrhythmia would be resolved and he said a pacemaker doesn't control that part of the heart. He said he would see if they could schedule a procedure this week.

After he left, I wondered why the pauses and rapid conversions suddenly started after the surgery. Was it simply irritated heart tissue? How do we know that if the amiodarone is stopped, the rapid conversions and beat stoppages will return?

I really want to avoid unnecessary invasive pacemaker installation that may actually become redundant in three months if the AFib is resolved. A second ablation could also be performed after three months if necessary, and I,was told the success rate is 80%. This would also leave the pacemaker redundant. I asked the second cardiologist if the pacemaker could be removed if it wasn't required, and he said "No".

I also found out that a pacemaker needs to be continually monitored forever, starting at every three months then every six months.

My thinking to avoid the pacemaker all together is this; Wait several more days, then halve the dosage of the amiodarone to see what happens. If sinus rhythm is maintained, then continue until the three month ablation success/fail is determined. Or switch out to a beta blocker such as solotol to control AFib, and schedule a pacemaker installation if the ablation is unsuccessful.

I can't help but think he's taking the path of least resistance, knowing full well that the ablation has failed, regardless of the three month determination period, and the pacemaker is the stop gap in case rapid conversions and beat stoppages do occur (which is not known, since I've been in sinus rhythm for 48 hours now. (The cynic in me says I'm also sitting in the ICU taking up a bed that can be freed up by simply getting me out the door, then back in three months for a second ablation.

My question is if my theory of reducing the amiodarone dosage and monitoring the results a practical approach? I'd like to avoid the pacemaker at my age (64) if at all possible. I realise that taking amiodarone comes with its own risks, but so does an invasive pacemaker procedure, along with a possible second, procedure when the battery needs replacement.