New pacemaker

SOB

by Gemita - 2019-10-17 05:39:00

Hello Marsidoats,

I am not surprised you feel the way you do with so much happening in such a short space of time. You have been through so much.

If I read your post correctly your main concern is the SOB, which seemed to improve for a few days before starting again.  Despite your interventions and medication it is possible that you may still be in AF or having episodes which is fairly common while the heart is healing.  Did you have an AV Node ablation or a regular PVI (pulmonary vein isolation) ablation ?

They can do a stress Echo with an intravenous medicine which can increase your heart rate without the need to exercise, so try not to worry.

I have frequent paroxysmal (intermittent) Atrial Fibrillation and it causes breathlessness too, especially at high heart rates and it also prevents me from doing normal activities during episodes.  It is an electrical heart disorder as you will probably know, not a structural one, but it still causes many unwanted symptoms for me including also chest pain, syncope and at times, overwhelming weakness.  Blood flow from the heart to the rest of our body can be poor during episodes of AF because the heart rhythm during AF is so irregular and the heart may be unable to pump blood around efficiently, so it may feel as though we have heart failure.  My blood pressure is very volatile during AF and although my pacemaker can help prevent heart rate crashes, it cannot prevent my blood pressure from falling.

I do hope things improve for you.  The most important treatment for AF as i am sure you have been told, is anticoagulation, if required, and a heart rate control medication, like a beta blocker or calcium channel blocker to bring your heart rate down if it goes too high during AF.

I was scared at first, so much to take in, but it does get better with time and knowledge.  I wish you well

Afib

by AgentX86 - 2019-10-17 10:18:18

Sure, you're panicked but try to wrap your head around the fact that Afib, in itself, is not dangerous.  It will not kill you, however its side effects can be very serious and indeed can so the priority is to take care of these issues. The primary concern is stroke, followed by heart failure.  A stoke can occur because the heart isn't pumping efficiently and blood pools in the heart.  This can cause a blood clot, which then may travel through the arteries to the brain.  To (greatly) reduce the probability of this, all Afib patients should be given anticoagulants (commonly called "blood thinnners").  Some of the more common are warfarin, Eliquis, Pradaxa, and Xarelto.

The next priority is heart failure.  This is a longer term issue but also serious.  The key here is to regulate your heart rate. The goal is to get it under 100bpm.  Anything over that, long term, will cause "cardiomyopathy" or enlargement of the heart. As Gemita mentioned, beta blockers and calcium channel blockers do this job well.  You should also be on one of these. 

With these two issues taken care of, your unlikely to have any life-threatening issues caused by the Afib.  However, the Afib is caused by something physical.  Usually, the cause will never be known but your doctors want to make sure that it isn't something serious, hence the stress test. Don't worry about alking a treadmill for this test.  Your doctors know what the situation is and won't ask you to do something that you can't do.

After the immediate threats, on to making your life right again.  You had an ablation recently.  As Gemita indicated, there is often a reoccurance of Afib during the "blanking period" (three months) after an ablation.  This shouldn't be too concerning but it doesn't make life suck any less (been there). The rest depends on what else they find, if anything (that's the best case).  If you get to this point, it's a matter of treating the symptoms.  There are rhythm control medications that can be used to get you through the blanking period.  They may want to do another ablation soon but I suspect they'll want to wait. It's too soon to do an AV ablation, IMO, but it's not clear why you have a pacemaker. 

Thank you to All .

by Marsidoats - 2019-10-17 15:22:18

Next is Stress Echo and Dr. Said probably another Ablation for AFIB called AV. 🙏

AV ablation

by AgentX86 - 2019-10-17 18:24:39

It's really unclear why you have a pacemaker now (you've left a lot of information out, here) but an AV ablation is the last step, only to be considered after everything else has failed and you can't tolerate the Afib.  Particularly since you *just* had your first ablation, I don't think you're anywhere close to being there.  You probably need to see the best EP in the area, now.  You might even consider travel to see the best that you can see.  An AV ablation is for keepsies. There is no going back and you not only be dependent on your pacemaker but you will lose AV synchrony so your atrium will do nothing (actually less than nothing).  An AV ablation doesn't fix Afib, rather just papers it over so you don't notice it. You will be on anticoagulants and probably beta blockers for life, just as if you continued to have Afib (you will still have AF).

I had to go there but only after everything else failed, including three ablations for atypical flutter (caused by a full Cox Maze procedure intended to fix Afib).  Please get a second opinion from the best before you take this huge step.