Pacemaker and irregularity?

  1. I have a few questions for cardiac nurses. Is it normal for a patient to still have an irregular rhythm with a pacemaker? Are pacemakers ever placed for a fib? Also, if a patient has a-fib, is the normal treatment warfarin to prevent a clot, but is there a long term solution to help control the heart rate?
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  2. 5 Comments

  3. by   pmabraham
    From my understanding, a pacemaker just paces the heart when certain lows or highs are hit; a combination pacemaker/ICD can be used if there's a chance for vfib. I've never seen a patient in Afib rvr given a pacemaker until their rates are controlled typically via medication management: amio, cardizen, ranolazine or otherwise converted to NSR. As you know, Warfarin doesn't deal with the rate or the rythm, and other options are eliquis, lovenox, etc.
  4. by   offlabel
    It's possible for a patient to have an irregular rhythm with a pacemaker, but unusual. One scenario I can think of is if there is afib with an A-V conduction blockade to one degree or another and there is a junctional brady that needs a pacer. That patient could have a ventricular pacer with an occasional atrial signal that conducts.

    A pacemaker is not ordinarily therapy for the afib itself. If there is, I've never seen it. The problem with atrial pacing in afib is that the pacer would sense the atrial activity and inhibit itself, ie, not pace. You could, I suppose, demand pace the atria at a certain rate for bradycardia, but, again, that isn't for treatment of the afib itself.

    Electrophysiologic ablation of afib is the definitive treatment for afib where the cardiologist "maps" the left atrium to determine where the foci of the fibrillation are and using radio frequency ablation, basically kill the cells that are causing the problem. It doesn't always give a permanent cure, but it is pretty effective.

    Anti thrombosis therapy includes warfarin, but also Xa inhibitors and direct thrombin inhibitors.
  5. by   brdavis17
    Ok, so if a fib is rate-controlled with amiodarone or other meds, will the heart beat still be irregular on occasion? Or should it be normal sinus? Would it be normal to hear occasional PVCs?

    Also, if a patient has a pacemaker, is it normal for them to still have an occasionally irregular heartbeat, like PVCs or something? I ask because yesterday I was listening to a patient who had a pacemaker, also was on meds for a fib. I heard groups of 3 beats (and also heard those while I was taking her BP) and then that went away, and then I heard occasional dropped beats or an extra beat like maybe a PVC. I was wondering if this is cause for concern.
  6. by   offlabel
    Quote from brdavis17
    Ok, so if a fib is rate-controlled with amiodarone or other meds, will the heart beat still be irregular on occasion? Or should it be normal sinus? Would it be normal to hear occasional PVCs?

    Also, if a patient has a pacemaker, is it normal for them to still have an occasionally irregular heartbeat, like PVCs or something? I ask because yesterday I was listening to a patient who had a pacemaker, also was on meds for a fib. I heard groups of 3 beats (and also heard those while I was taking her BP) and then that went away, and then I heard occasional dropped beats or an extra beat like maybe a PVC. I was wondering if this is cause for concern.
    Rate control meds don't permanently cure afib. They just decrease the amount of electricity that makes it to the ventricles from the atria. Extra "beats" aren't necessarily a concern with pacemakers. They're mostly not. Irregular rhythms aren't uncommon either.
  7. by   PeekabooICU77
    I've definitely seen pacemakers implanted to treat a fib RVR indirectly. The idea is to beta-block the heck out of them for rate control and have the pacer set up at 60bpm (for example). I've seen many patients in a fib that are demand paced if the ventricular rate is lower than what the pacer is set to.

    You can also see other atrial and ventricular ectopy with pacemakers. I usually see more ectopy if the pacer is set at a low rate. If the pacer is set to 80 or higher (just another example) we might be out-pacing the ectopy so it doesn't have a chance to be ectopic (lol).

    Are you you in the inpatient setting? This sounds like a type of patient that would be on continuous monitoring. That would make it a lot easier than trying to guess if heartbeats were PVCs.
    Last edit by PeekabooICU77 on Jan 18 : Reason: Added info

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