I got a PM 2 years ago for AV block and all has been well.  Beginning of Oct I sent my transmission and was called the same day to be seen the next. They told me that I have AVR    they saw 120 episodes in the previous 3 weeks.  nothing that lasted too long.  My dr has no idea why this is happening and my PM had only needed to work 8% of the time which is much decreased.  I am going tomorrow for a EP study with ablation.   The procedure  is  a little scary to me...  Any words of wisdom or what I can expect.  Also has this ever happened to anybody else having 2 different Electrical issues


Doesn't really make sense

by crustyg - 2019-11-06 16:24:47

Tell me you've been properly investigated for Lyme disease?

Lyme Disease

by donr - 2019-11-06 20:06:07

Crusty - Dunno why you asked about Lyme, but Rhode Island is right next door to the home of Lyme Disease in New England. I have a friend who lives therre - his daughter came down w/ Lyme well over 20 yrs ago & she still is pretty badly knocked down by it.



by kmg021 - 2019-11-07 05:30:28

yes I was tested for lyme prior to the PM insertion 

Because Lyme myocarditis can cause these heart block, arrhythmias

by crustyg - 2019-11-07 05:54:39

As you say, Donr, RI is in the heart of the CDC map of Lyme incidence in the USA (pun intended).  And it's an under-recognised cause of heart rhythm disorders.

*If* I understand the original post, and I'm not sure that I *have* decoded the AVR abbreviation correctly, the symptoms have gone from AV block to atrial-derived tachycardia.  Which doesn't make sense to me, so I'm almost certainly missing something.

Usually AVR means aortic valve replacement in a heart-related context, but that's not something that makes sense in this context either.

So if what is being reported *is* an atrial tachy, then either the heart block has got better, or there's a (new?) accessory conduction pathway, or what's being seen is Pacemaker Mediated Tachycardia (PMT!!!!) which the PM makers have tried to avoid for a couple of decades now - it's not a new discovery.

None of this seems very likely, so it doesn't make sense to me (which is *my* problem), but something wacky like Lyme *could* possibly explain it all.  Occam's Razor.


by kmg021 - 2019-11-07 06:13:28

it is AVRT which is atrial ventricular reenter tachycardia 


by donr - 2019-11-07 13:23:20

AVR = Atria-Ventricular Retrograde conduction in my understanding of the term.  I didn't google it till this AM & found that definition of it.  Recently I have been having short bouts of V-Tach, which concerned my Cardio.  He stuck me in the hosp for threee days to do some diagnostics, which he could not explain quickly.  It was not till three weeks later in a F/U appt that he had the time.  His discussion went over my head, hit the wall & slid down it.  He was concerned about a time delay of some sort that allowed the heart to conduct backwards & cause the events.  He adjusted that time somehow & appears to have fixed it.  Jury is still out on his success.  I am going to my local informal expert (my Cardio's retired head nurse) on these things & pursue the discussion.  She suspected that I was really having low Potassium levels that are causing the arrhythmias.  They are coming periodically, not continuously  at random.   I suffer periodic diarrhea due to a colectomy that took out half my large intestine.   She prescribed a high Potassium smoothie daily, in addition to my daily pair of potassium pills.  So Far, it seems to be working.  Galloping trots are under control & I don't feel like trash now.   Jury is out on that, too.  When I was in the hosp, I did have very low Potassium levels.

As to Lyme - you said you were tested BEFORE the PM.  What about NOW?  Could you have contracted it since the PM implant?  The AVR just showed up - suddenly, apparently.  I don't know how long it takes Lyme to affect the heart, but that is a possibility & a heck of a lot sompler & CHEAPER to test for.

I have a Daughter in Law who has Lyme out in Minnesota, of all places.  It is a cpmplex disease to deal with & has some subtle effects that are bad news.  Maybe you have one of them.  My D-i-L did not even know she had hosted a tick - ever, but she has Lyme.  She probably picked it upin Fargo, ND.  Not exactly east coast, US.  But, that is where Lyme has spread.

Crusty invoked Occam's Razor.  As I recall, that says that the simplest answer to a problem is probably the correct answer.  Testing for Lyme AGAIN is a lot simpler & less invasive than all the cardiac testing you are facing - & after all, you are living in RI.  You have just passed the  height of the Lyme season.  2019 was a very bad season for ticks everywhere in the US - I read an article about it  in New York and the very heavy concentration of ticks this past year.  It was estimated to be in the BILLIONS per acre.  Sounds a bit hefty, But that was what the samples indicated whem examined w/ ststistical means.

Hope this all turns out well for you.



by crustyg - 2019-11-07 15:54:24

My difficulty in understanding this is a) you had a PM implanted for heart block - out of the blue - and b) 2 years later you're telling us that it's only needed 8% of the time!  Seems a little odd.

Now, you're reporting atrial-derived tachy (lots of them) which I think they are *assuming* is retro-grade conduction.  I'm not entirely sure that anyone can make that diagnosis without an internal EP study, but perhaps without J-waves it's a valid presumptive diagnosis.

There's a long list of diseases that cause acquired HB, but most of them are relentlessly progressive, which doesn't seem to fit your history.

I think I'm the one learning here...


by donr - 2019-11-10 17:45:58

What is happening?  How did the procedure go?  Any news to report?



by kmg021 - 2019-11-16 21:04:59

had the EP study and they checked the pacemaker for history prior which did show AVRT.. They were unable to do an ablation because the Dr could not simulate it even after trying a medication during the procedure.   I did question Lyme and they do not feel this wound cause this     Want me to try a beta blocker and see if that helps

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