Complete Heart Block after Cardiac Ablation

I'm 28 yoa and had a cardiac ablasion 10 days ago today. During the procedure I went into complete heartblock for approximately 30 seconds and the physician pulled off in 0.4 seconds from the initiation of the rhythm and then I returned to RSR. Approximately 2-3 hours post procedure my rhythm returned to a CHB maintaining a rate of 50-65. I was discharged on post op day three the my rhythm alternating between CHB, 2:1 conduction and RSR. I got a serial of EKG's this week and I am to follow up with my EP on Monday. All three showed that i'm still in CHB with my rate maintaining 50 to the highest of 65-70 with activity. I become fatigued and short of breathe very easily and ecspecially at night develop chest heaviness and frequent palpitations. The physician is hoping this is due to the edema and is fairly confident that he didn't damage my AV Node but at day 10 I'm getting a little apprehensive and looking into my options if this doesn't resolve and I believe a pacemaker is the only way I can go. As a nurse I am familiar with the type that doesn't allow the HR to drop below a certain rate but with browsing the internet found out about the rate-responsive pacemakers (which eased my anxiety immensely). I guess I'm just looking to see if anyone else has been through a similar situation and how ones activity level has been after a rate-responsive pacemaker was placed.
Thanks!

5 Comments

Been there, had that happen!

by SaraTB - 2012-09-14 08:09:00

Hi TRL28 and welcome to the Pacemaker Club. Yes, I had exactly that happen to me, aged 42: I had an ablation for tachycardia, which damaged my AV node, and 24 hours later I had a pacemaker implanted.
I am now on my second PM, replaced after 6 years: it's now 10 years since the original implant.
In fact if you do get a PM, with complete heartblock, you should not in fact need rate response to be switched on: your own brain will control the upper chambers, and the pacemaker simply passes the message on to the lower chambers, to keep everything in the correct rythmn. The AV node communicates between the upper and lower chambers, and the PM will fill this role, and should respond as your brain indicates your activity level.
It took about 6 months to get me PM tuned to suit my needs: it's not one size fits all, so be prepared for a few visits, discussing what's working and what's not. In all other respects I am leading an entirely normal life.

Feel free to keep asking questions as you learn more about your condition - I do hope that things recover and you don't need the PM, but if not, please do not feel that it's all bad news. The members here are very supportive and knowledgeable so don't be shy about asking questions.

Sara

rate response

by Tracey_E - 2012-09-14 10:09:15

Generally with a bad av node, the natural pacemaker (sinus node) works normally and goes up when it should but the signal doesn't make it to the ventricles. The pm steps in with ventricular pacing when the signal doesn't get through, the atrial lead mostly just watches.

Rate response is atrial pacing, for when the sinus node doesn't function properly. If the pm senses motion (i.e. exercise) and your rate doesn't go up on its own, rate response will kick in and raise your rate for you. It's there as a back up but not used much with av block. Sometimes it can compete with the natural sinus rhythm so it's better to turn it off if it's not helping.

As far as I know, they all come with rate response now. You probably won't need it, but if you do, it's there.

If your only problem now is heart block, you should be able to do whatever you want with the pacemaker. I was born with 3rd degree block and got my first pm at 27, I'm 45 now. I hike or ski most vacations, have had two kids, do boot camp 5 mornings a week... anything I want!

Fingers crossed the block is temporary and this is all moot! If not, it's not a big deal. Modern pacemakers are amazing technology and able to do an incredible job of mimicking what our hearts should be doing on their own. If you have more questions, please don't be shy.

If you need a pacer

by ElectricFrank - 2012-09-15 01:09:21

An electrical block is one of the easiest problems to handle. As TraceyE mentioned the pacer simply provides the missing link between your atrium and ventricles. With this is place your heart responds normally to exercise.

The only gotcha is the reason for the ablation. If they ablated your atrium its possible that the natural sinus pacemaker was disabled in which case you would need the Rate Response. Properly adjusted it works well in substituting for the natural pacer.

Best wishes,
frank

Thank you!

by TRL28 - 2012-09-16 08:09:17

Thanks everyone! I was able to go to a NFL game today and did pretty well. My rate still remained below 60 but I only become short of breath a few times and really didn't have too many palpitations. I go back to the doctor tomorrow to check my rhythm and discuss my options. Since I did so well today I may see about waiting it out a little longer to see if I convert on my own. My friends aunt works at the hospital I had this done and I had her ask around about my physician and they said he's the best in what he does so I feel confident he'll direct me in the right direction. Thanks again for the responses and education, I'll keep you updated on what's to come. You've all eased my mind immensely!

Waiting Game

by TRL28 - 2012-09-25 09:09:05

I'm on day 21 and I am still in a CHB. I am to follow up with my EP Oct. 22 with hopes that I still have some swelling and may have a chance of coming out of it however I'm not so optomistic with this much time passing. I'm still handling the block okay with my rate 48-65 max but a little anxious about waiting so long before going ahead with the pacemaker. I'm just going to take one day at a time and if it gets to a point I can't handle it my doc said just to call. My atrial rate runs just about double my ventricle rate, so does this mean my resting rate will be around 100-115 consistently when the pacer is placed. After a pacer is placed will I be able to return to work, I'm an RN however work on the computer system 4 out of 5 days a week. He is going to place the pacer in my axillary area, under breest tissue hopefully so it will be cosmetically better than on the chest, has anyone had this placement before. Sorry I'm rambling, just getting a little anxious.
Thanks everyone,
Tiffany

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