Junctional Rhythm after a Pacemaker Implantation

I haven't been on here in several weeks. I have been so busy and just haven't had time. I will give a little background information: I had a very rapid heartrate (in the 190s) and was on the maximum dosage of metoprolol and it wasn't working. I had my heart ablated 3 times and the third time, it slowed my heart down too much so I had a pacemaker implanted. This wass all in 2007/2008. Since then, things have been going great until a few weeks ago. My cardio left me on the metoprolol because he said it was just a good medicine for your heart. About a week and a half ago today I went in to see the pacemaker technologist/dr because I was noticing some high heart rates again and in general don't feel good. They said that I was in a junctional rhythm (which I still don't fully understand). They said my lower rate was too low and the upper rate was too high. They took me off the metoprolol and hoped that that would make my lower rate work harder to pull the top rate down. I went back yesterday and they said it didn't work. They have now put me back on the Metoprolol in a double dosage than before. I go back in another two weeks. The cardio said that they would try several different medicines and see if they worked but it not, they may have to ablate again and then I could very possibly end up 100% dependent on the pacemaker. Could anybody give me some insight into all this. Also I would like to know if the extreme exhaustion and terrible migraines that I am having could be related to this?

Thanks so much!!!

5 Comments

Welcome Back!

by donr - 2012-01-28 10:01:07

Cheree: glad you are back. We exchanged a couple msgs when you last posted. I know I sent you a long comment on 14 Jan - over two weeks ago, discussing the rudiments of the heart's electrical system.

IIRC, a lady in England also commented about your condition. She likewise suffered a junctional rhythm Her name is Janey L. If you send her a private msg w/ your questions about the junctional rhythm, I'll bet she can answer them. There are several people here who are 100% dependent & I'm sure they will chime in w/ some help. Janey told me what they did to control her junctional rhythm, but I cannot recall it. We all have individual situations, so we know our own best.

Sounds like you are not feeling well at all (probably an understatement at best). I cannot address migraines, I don't have them, but when you are having problems w/ your heart, extreme fatigue is always a possible consequence. Face it, your body is working harder than usual to function at its normal level, so fatigue & anxiety can easily set in.

Don

Hope some folks here can help you out.

Thanks!!

by chereescott - 2012-01-29 10:01:51

I just sent her a private message. I am going to post a new message with a question about doctors in Georgia (if anybody knows of a good internal medicine doctor). Again, thanks for answering back so quickly!!!

Junctional rhythm

by golden_snitch - 2012-01-29 11:01:27

Hi!

I have never tolerated Metoprolol well, but there are a bunch of other betablockers to try. My "favourite" is Nebivolol, and I've heard from others that Bisoprolol works well for them. However, if you want to slow a junctional rhythm down, you might need something that has a stronger effect on the AV-node as for example Verapamil. Juctional would mean that the rhythm originates at the junction of the atriums and ventricles, so most likely very close to the AV-node or even within a part of the AV-node which is exactly at that junction.

Usually a junctional rhythm overtakes the pacer rhythm. The electrical activitation of the heart therefore does not start somewhere at the top of the right atrium, but much lower at the junction to the ventricles. This can lead to atriums and ventricles being activated at the same time, instead of atriums first, then ventricles. Basically two things can help: Either to set the pacer's minimum rate a little higher, for instance 70 bpm instead of 60; or to slow the junctional rhythm down with medication. If they ablate again, the AV-node could be damaged since, as I said, a junctional rhythm usually originates very close to the AV-node or even in a little part of the AV-node.

I have had a junctional rhythm, but now have problems with a rhythm that is not even junctional, but they think it originates somewhere below the AV-node, so at the top of one of the ventricles. It leads to complete AV dissociation making my ventricles beat faster than my atriums. I'm taking meds to slow that rhythm down, and have also had my pacer's minimum rate set at 70bpm. Cannot have anymore ablations, already had six, and suffered a very serious complication from my sinus node ablations.

If I were you, I'd try all meds before having another ablation.

Good luck!
Inga

Thanks for the info.

by chereescott - 2012-01-29 12:01:26

I have been on metoprolol about 8 years without any side effects. I absolutely want to try every medicine possible before I have another ablation (and my doc agrees). The main problem at this moment is that I am so exhausted that I don't want to get out of bed and I am a single mom to a 13 year old. I have to work and it is a high stress job. I am also having horrific migraines that are getting worse instead of better every day.

Thanks again for the info!!!

Thanks for the info.

by chereescott - 2012-01-29 12:01:58

I have been on metoprolol about 8 years without any side effects. I absolutely want to try every medicine possible before I have another ablation (and my doc agrees). The main problem at this moment is that I am so exhausted that I don't want to get out of bed and I am a single mom to a 13 year old. I have to work and it is a high stress job. I am also having horrific migraines that are getting worse instead of better every day.

Thanks again for the info!!!

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