Question

I had an extremely high heart rate (upper 190s) and on the max dosage of metoprolol daily. About 3 1/2 years ago, I had my heart ablated 3 times to slow my heart rate down. The third time, it slowed it down too much (into the low 40s) and ended up with a pacemaker implanted in 2/2008. I still take metoprolol 25 mg twice a day and recently my heart rate has been getting up to 105 several times a week. Does anybody have any possible ideas why this could be happening? I just had my pacemaker checked about a month ago and it is working fine.

15 Comments

AFIB flutters

by HarleyPete - 2012-01-11 11:01:28

I too was having this issue after my pacer was implanted and after several visits my cardiologist found out, by reading the pacer output that I was having AFIB flutters. He went in 3 weeks ago and birded my critical isthmus to stop the cycle from happening. Seems to have done the trick!!! I had wolfe parkisons and got my peacer after my secong ablation when to many nerves were cut

105? Why is thAat exciting you?

by donr - 2012-01-13 12:01:15

Cheree: 105 is not very high - mine goes there frequently - all it takes is an exciting/surprising event or some exertion. I do not even realize it.

For some reason, 105 is getting your attention - sounds like an incomplete story. What are theupper/lower limit numbers your PM is set for? Therein is part of the story that is missing. Have you become an obcessive/compulsive about taking your pulse?

Don

Not Offended

by donr - 2012-01-14 07:01:10

Just an incomplete story. And, not a stupid question at all. Just one that needs more data IMHO. And, I told you so. If you do not like my answers, please ignore me. There are lots of very nice ,helpful people in here.

I have been there for 40 years now when it comes to sensing my own heart beat. How about nearly 24/7 for a year? Please re-read my first para. When I look at the histogram of HR on my PM download, I'm bimodal - I have one peak at 75-80 & another peak at 100-105. After 105, the histogram trails off, just like everyone else. To put my PM in proper perspective, I'm paced at 70-140.

What are your lower & upper rates? Is RR turned on? Those two factors help put the 105 in perspective. When you say non-resting, what is your level of physical activity?

Do you know what your HR is normally when at rest?

If you went to your cardio, he'd know the answer to the questions I asked. We do not. Any answers we give would be worse than a guess under those conditions.

response

by chereescott - 2012-01-14 07:01:21

I am about sounding so rude. When I don't feel well, I get a bit grumpy. Alot of what you just said I don't even know what it means. The only thing I was told is that my pacemaker is set at 70. It controls the bottom of my heart 90% of the time and fires around once or twice every 3 months in the top part. I know that from going in for pacer checks. Since the pacer, the lowest it has gotten is 56 and the highest is 85 (that I know of) until this past week. I feel horrible again (like I did before the ablations). I don't have a lot of physical activity due to other health conditions. When I say resting, I mean just woke up and haven't dont anything yet at all. I just took a 6 hour nap (also not normal for me) and checked it when I woke up and it is 115. When my cardiologist first did the ablations he said I had the worst arrythemia he had ever seen. I am just afraid that the high heart rate/arrythemia is returning. Is that even possible?

response to "Don"

by chereescott - 2012-01-14 10:01:06

No I have not become ocd about checking my pules but when I can feel my heartbeat in my head and hands, yes I do check it. And by the way the 105 is resting (I guess I left that). Mine non-resting rates are getting into the 130's. Sorry if I offended you in some way by asking a question that you obviously think was stupid. I thought this forum was for asking questions to a "group" of people who have all been thru the same type things. If not, I will find somewhere else to seek support.

Square One

by donr - 2012-01-14 10:01:41

Cheree: I assumed you pretty much knew about PM's. BAD assumption. You are authorized to feel grumpy when you feel like crap - & especially when you cannot understand the reason why you feel that way. Let's see if we can explain some things for you.

Let's start at Square 1: Your PM is an active/passive device. It can do something or just sit & record data about your heart & how it is functioning.

The device is a miniature digital computer w/ the ability to monitor everything your heart does and save a lot of data about its functioning. Yours apparently has two leads into your heart - Atrium & Ventricle. The PM monitors them separately & can act on them separately.

Electrically, how does your heart work? Your entire problem, as you have outlined it, is electrical. There are several NODES in your heart. The principal node is the ATRIAL SINUS NODE (AS). It controls everything; it is the master clock for every beat. It has a timer in it that starts counting down AFTER it is told that the previous beat is complete. When that timer hits zero, the AS sends a signal to the TWO ATRIA (Left & Right) to contract, squishing blood down into the VENTRICALS. This same signal travels down a nerve bundle in the wall separating the TWO VENTRICALS (left & Right) to a VENTRICULAR NODE. On the way, the signal is delayed so that there is time for the ventricals to fill w/blood from the Atria. When the signal gets to the VENTRICULAR NODE, it generates a signal telling the VENTRICALs to contract, sending high pressure blood out into the body & into the lungs.

If anything goes wrong w/ these signals, your heart does not beat properly. That's where your PM steps into the story. Your PM senses all these electrical signals. IF ONE IS MISSING - the PM generates the missing signal. Doesn't matter if the signal is just late, to the PM it is MISSING - it wasn't there when it was supposed to be there. The PM can make either part of the heart beat, independently of the other.

This is going to shock you - there is no such thing as the TOOTH FAIRY! There is also no such thing as a HEART RATE!!!!! Yes, you count pulses over a minute & calculate a heart rate. But what you are really counting is a whole bunch of idividual pulses that are reasonably accurately timed & INDEPENDENT of one another. Remember that the AS has a little timer that counts down AFTER every beat is complete. IF your AS node has a sick timer, your pulses can vary tremendously in time & you can have either an erratic HR or one that is too fast or too slow. We use the PM to fix that. It has a timer that is FAR MORE accurate than your AS timer.

The heart responds to the body's demand for oxygen. Now I do not know how it gets the data that tells it to pump faster because the body needs the Oxygen, but when the AS gets the signal, it increases the HR - in other words, it SPEEDS up its count down so the heart beats sooner than at rest. If your heart is normal, it beats at rates roughly between about 60 & 180. If you are in outright panic, running from a hungry bear, it can probably get up to 240!

Now some PM numbers. They set your PM at TWO numbers, expressed as 70/140 (f'rintance). 70 is the base rate; it's the HR below which the PM will not let your heart drop. In your case, your heart wants to beat at something in the 40's. The PM won't let it. Your AS timer is so slow that the PM considers its signal missing most of the time & provides the signal for your heart to beat. At this point, I'm wondering if you are confused about which part of your heart gets paced 90%. From everything you have said, I am thinking that the ATRIA get paced 90%, since that is where all beats start.

The second number - the 140 - is the point at which the PM STOPS acting if it does not see a signal. It just MONITORS the heart & records data. Now, up till this point in HR's the PM has been monitoring the signals & providing them if they are missing.

Remember I mentioned a thing called Rate Response (RR). If, by ablation, they totally destroy the heart's ability to increase rate when more Oxygen is needed, the PM has a feature called RR that substitutes for AS varying rate capabiity, The PM senses that the body is moving harder & automaticaly increases your HR. It does that till it senses a lessening of activity, then it slows the heart down. Now it's not perfect, but it works. The RR feature needs a lot of tinkering to get it functioning to match what yout body is used to.

I have to read between the lines here. IF, IF, your heart STILL has its ability to vary HR, that part is now acting up again & you need cardio help. IF OTOH, you have NO biological capability to vary HR, your RR function in your PM is out of whack & you need cardio help. Unless you just awaken from a nightmare your waking HR should NOT be 115!

YES, it is possible that your high rate arrrythmia is returning. Here's why: These nodes I talked about are not just one spot the size of a pencil eraser. It is an AREA that can be fairly large. Did you hear that the EP was going to "MAP" the inside of your heart when he did the sblation? What he was doing was locating the AREA he had to ablate. That tissue, like all other tissue in the body can REGENERATE - especially if they don't ablate ALL of it. MAYBE that is happenig too you. The only way to find out is to see your cardio & ask.

It's great that your cardio says that you have the worst arrythmia he's ever seen. But you are paying him to FIX it! And he should.

I hope this has helped. Any more questions, just ask. If you want send me a private message - be glad to answer. I am not ablated - my problem is lots of premature Ventricular contractions (PVC's) I am paced 99+% in the artial area because they sloooowed my heart down w/ drugs so that it would beat in the 50's w/o my PM.

Ablations

by Janey L - 2012-01-15 04:01:18

Hi. Donr asked me to contact you as I have had 2 ablations very near my sinus node. I had atrial tachycardia. The 2nd ablation last June (near my sinus node) overlapped part of my sinus node & as a result of the ablation my sinus node stopped working properly. My heart rate was low at 32, terrible symptoms, could hardly walk or function at all. As Don explained above, my sinus node was also unable to increase my heart rate much on exertion, which is why I could hardly walk etc.

I ended up with a pacemaker 3 months after the 2nd ablation & now my life is back to normal. My lower rate on the PM is 75 & upper 130. So now I can walk ok, my HR goes up on exertion & I have no more atrial tachycardia. The rate response is ON with my PM.

So the ablations got rid of my arrythmia, my sinus node got wiped out by the 2nd ablation...but now the PM makes my heart function normally again.

I read your post & had this thought. My EP & arrythmia nurse both told me I could still get arrythmias again, even with the PM. My arrythmia caused a fast HR & the PM can't control fast HR's. However, the PM monitors & records everything going on with the heart. So on the PM check-ups, when they download all the recordings from the PM etc, they can see if any arrythmias have been recorded. Did they tell you that you have any recorded on your last check-up?

Do you have any of your previous symptoms? Like the ones you had before your previous ablations? If any of my previous arrythmia symptoms came back, I would suspect my arrythmia was returning & get in touch with my EP for advice.

I am 100% paced in my atrium, as my sinus node does not work. I am only 0.1% paced in my ventricles as my AV node works fine.

Can I help you in any way? Please feel free to private message me if you would like to, or post on here.

Thinking of you & hope you get some answers soon. Is it easy to get in touch with your Cardiologist/EP? I am lucky in that I can contact my arrythmia nurse with any questions or for help, & if necessary he gets in touch with my EP. I live in the UK.

best wishes
Janey

Another Q/More Info

by chereescott - 2012-01-15 10:01:14

My sinus node was the one having "problems". On the 3rd ablation, he said he would burn and think everything was good and then the "arrythmia" would jump somewhere else and he would have to burn it. So on and so on. He even went out to tell my parents that the procedure went good and was called back in because my arrythmia had started again. He had to go back in and burn some more. It was a terrible couple of years and I am afraid it is starting again.

Cheree - I have...

by donr - 2012-01-15 12:01:11

...reached the point where I am guessing - not having sufferered ablations. There are a boatload of folks in your situation. I'l have one of them contact you. Perhaps they can give you some real insight into what may be happening to you.

Don

Thanks/More Info

by chereescott - 2012-01-16 08:01:12

I did get in with my cardiologist today. They said I am back tachycardic and that I am in a junctional rhythm. The pacemaker tech actually said "if it's any consolation to you, this is GREAT learning experience for me. I have never seen this before". It did not make me feel any better. The dr. took me off my metoprolol to see if it would make my lower heart rate work harder to regulate my upper heart rate. I have to see my cardio again next Friday. If it gets higher, I have symptoms, etc....go straight to the ER (which is about and hour and a half away). So basically, they said that the medicine that was used to keep my rhythm lower is now going to be stopped to lower it????? I have more questions than answers at this point and am very discouraged.

Do you have any...

by donr - 2012-01-16 11:01:13

...questions about what they told you at the appt? If so, pls ask - one of us will answer quickly.

Especially, did they explain what "Junctional Rhythm" means?

Cheree - you should be discouraged - but, the cardio at least asked for you to come back w/o you forcing the issue. The next few days could well be a period of anxiety for you while you wonder what is going to happen. Anxiety does not help people w/ your problems, since it can mimic them & only make them worse.

Try posing those "More questions" to us - perhaps we can help you understand better what is happening to you. The sooner the better - for knowledge & understanding helps reduce anxiety & will help you feel better. There is a lot of knowledge here & someone is bound to havean answer for you.

To help you out - I STRONGLY recommend that you take the entire comment you just posted & insert it as a NEW post. That will take it to the top of the list & attract more attention. Also, briefly state everything that has happened to you. That's why you did not get many answers when you first posted.

Junctional rhythm

by Janey L - 2012-01-17 04:01:20

Hi again. Just read your latest news from your Cardio appt.

I don't know if this is any help but I had a junctional rhythm when my sinus node was damaged. My EP said the junctional rhythm was caused by the AV node taking over the function of the damaged sinus node.

When he put the PM in he said he would have to set the lower rate on the PM high enough to stop the junctional rhythm. He started off by setting my lower rate at 60.

But when I had my PM check up 1 month later, the techs found I now had an accelerated junctional rhythm which was kicking in at a HR of 70. It caused the top & bottom heart chambers to work out of sync & I felt terrible. So the techs increased my lower rate to 75 & managed to stop the junctional rhythm that way.

I don't know much about junctional rhythms that occur with high HR's (over 100) but don't be discouraged...I'm sure there are ways of treating it. It is good your Cardio is seeing you again soon. I usually make a list of questions before I see my Dr's, so I remember everything I want to ask. How about trying that? Then hopefully your Cardio can put your mind at ease.

You could ask him to explain the junctional rhythm & how stopping your drug might help? Or what else he can do to stop the rhythm?

Please let us know how you get on.

Best wishes
Janey

Repost

by Janey L - 2012-01-18 05:01:10

Hi.....please do take Don's advice & repost your latest message on here, so others can maybe help you as well.
Take care
Janey

Today's the DAY!

by donr - 2012-01-18 11:01:17

That your thread of posts will disappear into the archives.

Cheree, pls take my recommendation from several omments back & re-post it so you can attract advice. Re-posting will put it at the top of the list again.

Looks to me as if Janey has some pretty decent answers for your situation.

Don

Sorry it took so long.

by chereescott - 2012-01-20 07:01:15

It has been a long week. I am sorry it took me so long to get back to you. I will try to repost this evening. Thanks for all the responses. I really appreciate it.

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