Junctional Rhythm

Hi all,

First of all I want so send out a special thanks to donr and Janey L, they have helped me so much trying to explain this new junctional arrythemia that I have. After alot of thinking and research I'm going to talk to my dr about doing the av node ablation and getting a duel chamber PM instead of the single atrium one I have now. The dr put me on meds which so far is not helping, if fact I seem to be having more episodes now. I can tell when I have the episodes cause my heart starts beating hard with palpatations then it makes me dizzy which from what I understand is when my av node is trying to overide my PM. My pacing percent has went from 70% down to 58% in just 3 weeks. My dr appt isn't until nov 19th so it should be interesting to see what my numbers are then!
It makes me real nervous thinking about going back in for another surgery, I have had 3 so far this year, but I'm thinking this av ablation is the only thing that is going to help. I am making this post to see if anyone else has had this done, if it helped, what recovery time was, and how you are doing now.

Thaks Everyone!!

8 Comments

Last resort!

by golden_snitch - 2012-10-28 02:10:02

Hi!

I have had it done, but it was my 8th (!!!) ablation. I'm getting a bit the impression here that this kind of ablation is suggested or demanded too soon. AV-node ablation should always be the very last resort. You should have tried several anti-arrhythmic drugs (I tried Nebivolol, Flecainide, Propafenone, Amiodarone, Dronedarone, Sotalol, Nebivolol + Flecainide /Propafenone), change of pacer settings, and not only one or two ablations. After all, AV-node ablation leaves you with a ventricular pacing percentage of 100%, and as it has been explained in an earlier post, this leads to a significantly higher risk of developing heart failure and atrial fibrillation. That is no fun, if you're going to be paced for a long time like 30-50 years, and this risk should not be underestimated.

I have seen two of the best heart rhythm specialists in Germany, and I am pretty sure that neither of them would do an AV-node ablation because of junctional rhythm as the second or third ablation in someone's rhythm history. They both always pointed out that this should be, as I said before, the very last resort. In my case one of them finally said, we have no other choice, because not only did I have junctional rhythm, but the EP study also showed several other supraventricular arrhythmias, and there was just no way to get them all under control. So, in my 8th ablation, after having lived with junctional rhythm for about 11 years (with drugs, with faster pacemaker minimum rate), he did the AV-node ablation. It helped. But I would have not agreed to have it done, before having tried every single alternative that there is. And I also agreed in the end because I'm not paced in my right ventricle, but have an epicardial lead on my left ventricle, and the EPs say that this will most likely not lead to heart failure; it's the right ventricular, apical pacing that does this.

Just saying, be careful and try several drugs. In my opinion, a good heart rhythm specialist will not agree to do this procedure in someone with a rather "short" history of arrhythmias and anti-arrhythmic drug treatment who's comparatively young and requires pacing for at least another 30-40 years.

Best
Inga

confused!

by daisy0388 - 2012-10-28 03:10:24

Inga,

I have in the past tried several drugs incluiding most of the ones that you suggested for my IST, I do not tolerate them, makes me feel horrible and almost drunk. The one I am taking now is the only one I can tolerate but they can't raise my dosage cause it will start doing the same thing. My dr did say that he wasn't keen on the idea of going back in there and going after the spot in the av node cause it could give me heart block. Is there another type of ablation that he could do? I just know something will have to be done as its getting very hard for me at work after having episodes all day i'm exhausted by the end of the day not to mention feeling dizzy. The dr also said I probably had this rhythm the whole time I had IST but it never showed up cause my rate was too high. I'm always open to suggestions!

Drugs

by golden_snitch - 2012-10-29 03:10:16

Hi!

How long did you try the drugs? Quite a few of those I mentioned can have horrible side-effects in the beginning, but if you hang in there for one or two weeks, it gets better. And just because they probably did not work for IST that does not mean that they won't work for your junctional rhythm either. I have had permanent sinus tachycardia, and I would not compare that arrhythmia to junctional rhythm. Betablockers did not work and I did not tolerate them when I had permanent sinus tachycardia, but for junctional rhythm - completely different story. You start all over again when you are diagnosed with a new arrhythmia.

So, there is according to my knowledge no different ablation, but if I were you I'd give the drugs a try again.

Best
Inga

question.........

by Pookie - 2012-10-30 02:10:11

what kind of pacemaker do you have?

i'm asking because i too went for almost 6 (yes six) years with having junctional rhythm and i was soooo close to going in for an ablation until my EP and PM Tech figured how they could fix it - it was a simple adjustment to one of my settings.

With that being said, it might not work for everyone, I don't know enough about it, but I have a dual lead Medtronic Enpulse and the setting they focused in on was called Optimization which is part & parcel of the Rate Response feature. In 99.99% of the population of pacers, when the Optimization feature is ON everything is fine, but when they turned my Optimization setting OFF I literally felt that I got my life back.

Just something to discuss with your doctors before going ahead with surgery. Again, everyone is different, but I just thought I'd throw that out just in case what is going on with you is the same that happened to me.

Pookie

Overdrive?

by golden_snitch - 2012-10-30 02:10:37

Does this pacer have something like an "overdrive" for atrial arrhythmias? If you "only" have episodes of junctional rhythm, and do not have it most of the time, this overdrive function might help. With this switched on, everytime an episode starts the pacer should speed up, overdrive the junctional rhythm, and then slow back down. Could be worth a try. And like I said before, I'd give some drugs a second chance. You might not even need a high dosage.
Inga

Pookie

by daisy0388 - 2012-10-30 08:10:20


I have a Boston Scientific single lead in my atrium. I got the pm after 3 ablations for IST cause my heart rate went into the 30's. Does this make any difference or do you think they he can still change my settings. He also said that because my heart rate jumps to 100-110 when I have my episodes that its accerlerated junctional rhythm. This morning when I rolled over to shut my alarm off I had an episode, I wasn't even out of bed yet. I hope they can figure out soon what to do!
Thanks
Holly

Inga

by daisy0388 - 2012-10-30 10:10:46

I am having juntional rhythm off and on most of the time. I called my drs nurse today to see if I could get my appt moved up closer and today I had felt really bad, when she found out what was going on she seemed very concerned and even wanted me to fax some ekg readings that they did on me at work. Most of the time I had no p wave cause I was in junctional, its not letting my pacemaker work like its suppose to. She's going to show my dr tomorrow cause he was not into today and also moved my appt from the 19th to the 9th. The meds are having no effect at all, if anything it seems to get worse by the day so hopefully I will get some answers soon. I wish they could change settings but she acted like that would not be an option.

Which drugs?

by golden_snitch - 2012-10-31 03:10:58

What meds did you try particularly for the junctional rhythm? Propafenone and Flecainide can be very effective, and I also found Amiodarone doing a good job. They all did not work for years, but they bought me some time.
Do you go into AV-dissociation? That was another problem I had: Because of the junctional rhythm and a retrograde conduction to the atriums, I often had my atriums and ventricles beat in different rhythms or had them beat at the same time.
Good luck with your appointment!

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