Newbie looking for some insight please

Morning folks, my name is Andrew and I'm a long time lurker and newbie here. This site has been fantastic with gaining information, now I'm looking for some insight.
Folks, I wonder if I can ask a couple of questions to the group?
I have a fairly complicated cardiac history which started (four years ago) with an episode of SVT caused by Wolf Parkinson White Syndrome which I knew I had and never caused an issue, this pathway was ablated and following this I’ve had three ablations for Atrial Fibrillation and two for Atrial Tachycardia. I tend not to tolerate high BPM and end up with LVF which on at least two occasions has resulted in other organ failure issues (Liver/Kidney – now fully resolved). As I was becoming more and more difficult to cardiovert and there are very few medications that could hold me in Sinus (Amioderone was the most successful – now not an option due to a Thyroiditis) my Cardiologist and I decided that a Pacemaker would be the way forward (I’m 47), I have a biventricular device implanted, pacing at present on the RA and LV lead for Bradycardia only following an episode of Syncope. Whilst out cycling yesterday evening I developed an irregular rhythm which is intermittent this morning. I’m normally paced at rest at 55bpm, no upper pacing at present. This morning I have a ‘stable’ according to my Omron recorder regular rate of 83bpm, however this degenerates into an irregular rhythm upon any activity. Can anyone suggest a cause for this? Also the ultimate fallback plan is to have an AV node ablation and be permanently paced, is there anyone here who has had a nodal ablation and can shed some light onto what it feels like and what impact it has on life in general – I’m a fairly fit guy who cycles a lot when not in an irregular rhythm and would not like to give that up, however health comes first! My cardiologist has stated I will be able to exercise as normal following a nodal ablation, anyone confirm or deny? What concerns me is the very violent feeling I have during my palpitations always being present following a nodal ablation as there is no going back from this. As it is this morning I’m considering resigning from my current job as a remote nurse due to fears of becoming unwell quickly again if I result to a consistent irregular rhythm whilst I’m away from home, after almost five years of this its getting a little depressing for me and my family.
Looking forward to contributing to the group.
Your thoughts are appreciated. Thanks

2 Comments

Irregular rhythm

by golden_snitch - 2014-07-17 01:07:38

Hi!

An irregular rhythm is typical for Afib, and since you have a history of that, maybe it's back?

The pacemaker cannot do anything about your fast heart rates (Afib, atrial tachy), it can only treat bradycardia and pauses. So, I don't understand why the fact that you were becoming more difficult to cardiovert and keep in sinus rhythm, led to the implant of a pacemaker. Together with an AV-node ablation ("ablate & pace approach") this would have made sense, but without the AV-node ablation - hm, not really. Or was that pacer implanted only after you suffered an episode of syncope? Or were you one of those Afib patients that go into bradycardia when in Afib? If so, then I misunderstood you at first.

I have had an AV-node ablation, but not for atrial fibrillation. I have a long history of different atrial tachycardias, and also had an accelerated junctional rhythm/tachycardia with AV-dissociation, that was very difficult to manage with drugs. So, I finally had the AV-node ablated, which stopped that fast junctional rhythm. I'm currently paced 100% in the ventricles, and 94% in the atria (had several sinus node ablations, too). I'm doing much better now. However, please keep in mind that my atria are not fibrillating; with the help of the pacemaker, my atria and ventricles are currently beating insync, just like in a normal heart. Your case is a bit different, as you would have episodes with the atria fibrillating, and the ventricles being paced. I cannot say how that feels, but I know that there are some members here, who have Afib and had an AV-node ablation, and who are doing much better now.

One problem you might have to deal with is that, in a situation where your atria are fibrillating, and you are being paced in the ventricles, you will need the pacemaker to adjust your heart rate to your level of activity (rate response function). Usually, the sinus node does this job, but during an episode of Afib it is unable to perform it, as it's simply "overdriven" by the Afib. Different pacemaker manufacturers work with different rate response sensors. I see that you have a Medtronic pacemaker. Medtronic works with a motion sensor, a so called accelerometer, only. While this sensor is good for activities/exercises that involve upper body movement, it does not react well to activities without upper body movement. And here's the issue: many patients with accelerometers therefore have problems with cycling. I was on accelerometer only for a while, too, and it was not reacting well to cycling, either, I just couldn't bring my heart rate up. That led to weak legs and shortness of breath.
So, if you go for the AV-node ablation, and you later experience problems when cycling, have this in your mind, and if it's really bad, you might need to discuss with your cardio, if a pacemaker with a different sensor might be better for you.

Hope this helps.

Best wishes

Inga

Proton Pump inhibutors

by TheFox - 2014-07-18 08:07:39

Hi Newby
I am 67
I too have had a lot of svt's over the years iregular beats, affib,
failed ablations including a 3D type, was fitted with a pacemaker dual leads in the ventricle and atrial. Then a av node ablathion in oct 2013 i was still left with missing beats ect.
i don't get get fast rates anymore but did get a lot of ectopics up to 4000 a day.
However I think I have found what was causing my problem and may have had for many years. I think the cause was a long time user of proton pump inhibitors namely Nexium 20 or 40 mg for gerd! (they now say not to use this drug for more then 6 weeks at a time)
I read online elswhere that this drug causes any amount of arithmias in heart patients.
I stopped taking this drug 5 or 6 weeks ago now, after the first 5 to 8 days i started feeling much better without the missing beats, it was like a weight being lifted from me. Mind you i improved a lot after the pacemaker insertion but having regular missing heart beats did'nt seem right to me. i hardly get a missing beat now. I can safely say that I feel simply fantastic!
Good luck
The Fox

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