Almost afraid it won't happen

I am on cardizem because Toprol was causing too many issues. Since going on cardizem, I have had an Svt episode on nearly a daily basis with the most violent being 240bpm for over 20 minutes and causing great fatigue. I am scheduled for a second cardiac ablation in October and the electro physiologist has stated that I will more than likely leave the hospital with a PM. I wore a holter monitor back in May which showed my HR running between 35 and 59. I am 60 years old and not athletic. I sent my EP an email yesterday asking if he thinks the bradycardia could be indirectly triggering the SVTs. I am wondering if a PM is a necessity at this point rather than just a possibility. I sleep for about 2 hours at a time. Wake up but generally go right back to sleep only to wake up again in a couple of hours. I have no dreams if that means anything. And I get out of bed in a very fatigued state. It will be interesting to hear his response and I will let you know what he says.

5 Comments

Optimism

by golden_snitch - 2013-08-11 03:08:12

Hi!

Honestly, I do not like any doctors who always foresee the worst. Don't get me wrong, they do have to speak the truth and inform you about possible risks and complications. But if your doctor goes into the procedure thinking that the pacemaker will most likely happen and having told you so, it's bound to happen. One could say, bless his honesty; but one could also ask, what does this say about his confidence? I prefer those doctors who say, you know, it's going to be tricky, not easy, but I'll do my very best so that you, for instance, won't need a pacemaker. I have always had doctors who acted this way and who assured me that they felt confident about the procedure. Even when I had my third SA node modification my EP didn't say I'd most likely end up with a pacemaker; he told me afterwards, when the pacer was in, that he knew from the beginning that my chance of getting out without a pacer was less than 5%. Had I known that before, my attitude when going into the procedure, would have been one of already having given up. The patient needs to be as optimistic as possible, and the doctor, too.

What you suffer from sounds very much like an AVNRT = AV-nodal reentrant tachycardia. The high rates are typical for that, and also that the episodes happen more and more frequently. AVNRT ablations are usually the easiest ablations. Nevertheless, in my Mom they needed two attempts to stop it, but she still didn't end up with a pacemaker (I had AVNRT, too, and needed one ablation for that). Maybe your EP really only chose the wrong source of energy, cryo (cold) instead of radiofrequency (heat). Maybe he also chose the wrong mapping system or none at all? Today's mapping systems are very precise, so even if pathways are at a tricky spot, one can usually map them very well and then ablate safely.

Now, regarding the holter: Was 35-59bpm the average at daytime or did that happen only at night? Are you on any medications that slow your heart rate down? If you're not on any meds, and if that was your heart rate over the day, you seem to have a bradycardia issue, too. What happens when you exercise? If your heart rate doesn't rise adaquately when you exercise, but stays that low, you might really need a pacemaker, no matter what happens during the ablation.

Best wishes
Inga

Sleep Apnea, also?

by donr - 2013-08-11 05:08:46

I was going to suggest that before KMOM did, but got distracted. It would not hurt to be screened by a sleep Dr. using the questionnaire they have to decide if it is worth it to run the overnight study.

The 2 hr sleep periods is a symptom of it. Also lack of REPORTED dreams, meaning you never get into the REM sleep necessary for dreaming. Reported dreams is not necessarily a necessary symptom by itself, since many people dream & forget about it before waking. Nice part of Apnea is that the test is not invasive like an ablation.

Would not hurt to check it out before going into the ablation.

Don

Thanks for the thoughtsj

by rfassett - 2013-08-11 09:08:48

I will do some research and inquiries about sleep apnea. You may very well be on to something.

golden_snitch, I do appreciate what you are saying, but I believe every patient is different in how they interact with their Dr. I have the utmost confidence in my doctors to do the right thing and the best possible job. My EP is the "go to guy" in a very wide area surrounding where I live. And the lab where the ablations are done have the state of the art equipment and tools. My first ablation took 5 1/2 hours and my EP did, in fact, use cryo because of the location of the errant pathway. His statement about the pacer is that if he has to use heat (which he thinks he will have to do to fix the problem) he is not certain he can get the job done without damaging the good pathway. I expect nothing but the highest level of professionalism from my medical personnel and I demand to be told the truth. If there is a better than not chance that I will leave the ablation with a pacemaker, I want to know that so that I can do my due diligence and be prepared mentally with whatever the outcome. As a professional, myself, I treat my clients in the same manner and do not presuppose to any outcome. That is part of a professional's training. But, again, I do appreciate your thoughts.

Sleep Apnea?

by kmom - 2013-08-11 11:08:12

Have you been checked for Sleep Apnea?? Sleep apnea can cause those issues--although that being said, I have sleep apnea too which i've been on CPAP for 4 years and still having issues like the ones you described. and yes, even though i'm on CPAP, I'm getting broken sleep like you described. The lack of sleep can also cause more fast heart rates as well. are we a double here haha?? except i'm only 53 and on Propafenone --good luck and keep us posted.

Hang in there

by bearss27 - 2013-08-13 12:08:02

When I had my first ablation they thought they were going to have to put a pacemaker in then and decided against it and now 8months later I had to have a pacemaker put in and feel so much better. I was on metoprolol and that got to the point it didn't help and the cardizem they gave me never helped with the arrhythmia's. Before I had my pacemaker I had a terrible time sleeping I was always tired but couldn't sleep very long and also was very restless during the night. Since I have had my pacemaker I sleep alot better so it could be your heart but you should also look into the sleep apnea like the others recommended because you want to make sure you get the right diagnoses. Every persons body is different and reacts different to situations but it never hurts to get all the information you can and fingers crossed they figure it out. Just remember everything happens for a reason and even if the outcome is not what we would have expected it could be the better rout for us. Keep us posted.
Mary Katherine

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