SA node tachy with a pacemaker

I'm 37 years old. I have had my pacemaker since i was 31. Recently i've been struggling with SA node tach as well as junctional rhythms. I have a heart rate that varies constantly, and is irregular, this has caused me to have a very significant decrease in activity tolerance, and a long list of "feeling crappy" side effects. I'm struggling to perform my work duties as a physical therapist and to care for my 4 young kids. So far treatment has been a failed trial of beta blockers bc my baseline bp is already too low, and now a trial of a med to raise my bp in hopes to settle my rhythms down and decrease my orthostatic symptoms. I'm very frustrated at my poor activity tolerance and how this is affecting my functional ability. Walking for 3 minutes has me needing to sit and rest. Has anyone experienced anything like this... and did anything work for you treatment wise... thanks for any input......

4 Comments

frustrating!

by Tracey_E - 2014-07-21 09:07:04

I had something similar, tachy but not junctional. I was able to get it under control with beta blockers. I, too, have fairly low bp on my own so it's been a challenge to find one I can tolerate, one that doesn't lower my bp more. It took about a year to find a medication (atenolol) and dosage that worked for me. If I skip a dose, I can barely walk up the stairs and every little thing makes me out of breath. On it, I can finish a Crossfit class or go for a run or spend a day kayaking or hiking. It's crazy the difference that tiny little pill makes.

You should to talk to Inga (golden_snitch). She's been telling me about the possibility of having an ablation so I wouldn't need the meds. I would love to be off the meds!! I'm going to ask my dr next time I see him. I could be wrong, but I don't think the meds do much for junctional, only the tachy. If I'm correct, ablation might be a better choice because it can stop both.

Study

by golden_snitch - 2014-07-22 03:07:03

This is a small study a friend of mine did on Ivabradine in the treatment of Inappropriate Sinus Tachycardia (IST):

http://www.ncbi.nlm.nih.gov/pubmed/22981555

He also did a presentation about this study:

http://www.cardioegypt.com/ce2013/files/ECRA2013_Presentations/022001.pdf

Another article on this study also cites Dr. Scheinman, one of THE experts in IST. I once contacted him, and he told me that he very rarely does sinus node ablations today, because the outcome is not good, and because once the sinus node is slowed down, other arrhythmias kick in. He says about the same in this article:
http://www.thedoctorschannel.com/view/ivabradine-often-corrects-inappropriate-sinus-tachycardia/

Inga

Sinus tachycardia

by golden_snitch - 2014-07-22 03:07:18

Hi!

For sinus tachycardia you should try "Ivabradine" instead of betablockers. Ivabradine is the only direct sinus node inhibitor, so it does nothing else than slowing the sinus node down.

My whole story started with what was first labled "inappropriate sinus tachycardia" and then re-labled with "permanent sinus node reentry-tachycardia". I was in tachycardia 24/7, even at night. My sinus node was doing 120-140bpm at rest, up to 180-190 bpm when I moved the slightest bit or was excited etc. My heart rate was unstable, too, never staying the same for a few seconds. Like in your case, betablockers failed, but not only because of low BP, but also because they simply did not slow the rate down. Ivabradine wasn't available back then, in 1999. So, I had several sinus node catheter ablations. After three procedures they finally slowed my rate down. Six weeks later my first pacemaker was put in. But this was not the end of the story. More atrial arrhythmias followed, so more drugs, more ablations.

My sinus node ablations led to a superior vena cava syndrome. The SVC syndrome required open heart surgery and led to me being no longer able to have transvenous pacemaker leads, so it's epicardial (much more invasive procedure) now. And all this has also led to the need for a blood thinning medication to keep the reconstructed vein open.

I would not suggest a sinus node ablation to anyone, unless that person is in permanent tachycardia and has tried different drugs to treat it. Junctional tachycardia - I had that, too - is originating in the AV-node, so that a catheter ablation on this would most likely lead to a heart block. Betablockers are not the only drug that works for junctional rhythms, though. You can give Verapamil a try or Flecainide or Propafenone.

So, at this point I'd not suggest any catheter ablation to you. Your arrhythmias originate in the natural pacemakers of the heart, the sinus node and the AV-node, and that complicates an ablation. Give Ivabradine a try for the sinus tachy, and see how that goes.

Best wishes

Inga

Similar issues

by JaneJ - 2014-07-25 10:07:04

I have also struggled with an accelerated junctional rhythm. I have a single chamber atrial pacemaker and have the junctional rhythm that competes with the pacemaker which ends up causing a retrograde ventricular atrial conduction. This can cause me to have a lot of pounding in my neck, as well as horrible headaches and jaw pressure/pain. Not a lot of fun. I ended up developing a junctional ectopic tachycardia last year, which they ablated and not I just have the accelerated junctional which occurs about 10% of the time, the rest of the time I am paced. They put me on metoprolol and flecainide, which seems to help a lot. My last check up was good, but now I would like to get pregnant and obviously cannot get pregnant on flecainide. Beta blockers are okay, not ideal, to get pregnant on. They said it causes a decrease in the size of the baby. I did a trial over this past week, to not take my medicines and it did not go well. Really bad junctional symptoms returned. I have an appointment at the end of August to fuirther discuss pregnanacy/meds with my doctor. He has said that he could upgrade my pacing system to biventricular and then go back and induce a heart block, which would free me from a lifetime of taking medications, but I'm not sure it's worth the risk of having the biventricular pacemaker. Looks like to get pregnant that would be my only option, as I don't plan to go through 10 months of being miserable without my medications. I hope you are able to figure out a medicine or treatment that helps you. Are you willing to try flecainide? That seemed to help me quite a bit.

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