2nd degree Block and PM

Hi Everyone, I wont go into great detail about why I'm scheduled for PM on May 20th but I'll try to give the quick facts and hopefully someone can provide some advise. I'm 32, female, I have 2nd degree type I AV Block as a result of the EP causing damage to my AV node during the last Ablation. And though 2nd degree type I should be benign and symptom free, that I certainly am not. So they have told me that the only way to treat my symptoms and increase my heart rate is to place a PM. They've already had to take me off my calcium channel blocker as it was slowing my conduction further, but I'm still on flecanaide to treat my Atrial tachycardia. I just feel so torn though because it seems like I shouldn't need the PM but yet they are recommending it MAY help. I'm scared I'll have it done and it wont help alleviate the symptoms. I get major Jugular pulsating back flow when my pulse drops below 60, I'm dizzy, lightheaded, SOB, I get this horrible chocking sensation, and I'm exhausted 90% of the time....is there anyone on here that has had a PM put in to treat Second Degree type 1???? did it help? Is my Dr crazy for recommending this, and should I just try harder to ignore the symptoms?

4 Comments

Pacemaker indication

by golden_snitch - 2014-05-06 02:05:33

Hi!

How long ago was your last ablation, and how many did you already have?

Just wondering, because if I were you, I'd rather try again to get that atrial tachy under control by doing another ablation. Who knows, with a 2nd degree heart block type 1 only and while you are on an antiarrhythmic drug, once you are completely off of the drugs, the block might disappear. Or, if the ablation was just recently, the AV-node might recover. I mean, it's really only 2nd degree type 1 that occured after an ablation, so it's not definite that this block stays forever. You have that connective tissue disorder plus a diagnosis that is not necessarily a pacemaker indication, so I'd try to put the pacemaker off for as long as possible.

What about getting a second opinion? Don't know where you have had your ablations, but if it wasn't one of the large centers that specialize in ablations, I'd certainly seek another opinion somewhere where they do at least more than 1000 catheter ablations per year. They just have much more experience there, and very often also the better/more advanced mapping equipment. They can ablate arrhythmias that other EPs have problems with.

I have had so many different atrial arrhythmias, and some of them were really difficult to ablate. But I was always seen at centers that perform more than 2000 ablations per year, and they were able to ablate my arrhythmias successfully.

Best wishes
Inga

EP says no more ablations

by CCBlock - 2014-05-06 04:05:39

Hi Inga,
Thanks for the input, I'm mostly on the same page as you. My last ablation was in January 2014, that was my second one in 9 months. This January one was quite a aggressive with 22 burns around the AV node only. The doc said that he got rid of the AVNRT but now I'm left with Atrial Tachycardias. He said he would not do another ablation as my last two did not flair up the Atach during the study, so he does think he'll be able to find the Atach sites if we try again. I also asked him if I could come of the sodium channel blocker as maybe that is causing the block, he said no because my tachycardias will get worse. Then I asked him if my AV block could get better with time, maybe my heart would heal more. He again said no, he said the AV Block is due to the damage of my fast pathway and that it will always remain there and I will likely always be symptomatic with it. I live in Canada and we don't get to pick our Doctors really, and according to everyone I see when I go into the ER they say he's the best in our city.

Not that easy

by golden_snitch - 2014-05-07 03:05:06

Nicey,

how do you know that this IS going to work?

CCBlock has atrial tachy-arrhythmias and also a connective tissue disorder. The latter can make the healing process difficult after the surgery, and the fast arrhythmias can confuse the pacemaker. A second degree heart block type 1 does not cause very low heart rates or long pauses. After all, it simply leads to one skipped beat. Might happen again and again and again, but since just one beat is skipped, it does not lead to a permanent bradycardia or long pauses. There is a good reason why this is no definite indication for a pacemaker implant according to all guidelines published.

When I had intermittent heart blocks, I had my pacemaker in a special mode where it did not pace me out of every single heart block (to reduce ventricular pacing). In order to start pacing the ventricle, certain criteria had to be fulfilled: 7 consecutive prolonged PQ-intervals for 1st degree hear block, 3/12 blocked p-waves for 2nd degree heart block, two consecutive blocked p-waves for 3rd degree heart block. So, I was still experiencing first and second degree heart blocks, and only when I had lots of them happening within a short period of time, my pacemaker started to pace the ventricles. Felt a bit odd in the beginning - I did feel every single block and also the prolonged PQ-intervals, and I had symptoms but only shortly - but I did get used to it.

I'd still try to get a second opinion. The pacemaker indication is not clear, and there is a connective tissue disorder that could cause problems with the healing process. So, better be 300% sure that this really is the way to go, and that not just one doctor thinks it is.

Inga

Hello CC

by NiceNiecey - 2014-05-07 12:05:17

Welcome to the Club.

I have a daughter your age, FYI, so I'm going to be motherly and blunt: Honey, you cannot ignore your symptoms forever. You need to be treated. I tried telling myself that my symptoms were probably from my thyroid, from hormonal imbalances, from not getting enough sleep, etc. Try as I might, there was no talking myself out of nearly blacking out on the floor of the green grocer!

While I have Second Degree HB Type 2, it doesn't really matter that you have Type I. If you're experiencing very low HRs, and your doctor has you scheduled, you need a PM. End of discussion. Your life will improve and you won't need to worry about your heart not working properly. I'm sorry the ablation didn't work. But don't worry: the PM WILL WORK.

It's not a matter of trying a little harder to be "normal." You're doing what you can. Now you need to take the next step. Please keep us posted. We really want to know how it all comes together.

Mother Niecey :-0}

You know you're wired when...

You have an excuse for being a couch potato.

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