Anyone else out there had a Junctional Rhythm?

Junctional rhythm

by AgentX86 - 2020-01-16 15:42:49

Almost everyone has a junctional rhythm, just that most have a junctional rhythm well below their sinus rhythm that it's never seen. The junctional rhythm is really a safety feature of the heart. If the sinus node stops, the junctional rhythm takes over. People with complete heart block survive because of this junctional rhythm.

Sometimes the junctional rhythm is too fast (or the sinus rhythm is too slow) and the junctional rhythm is seen in the normal sinus rhythm. This isn't good (but not immediately dangerous) because the atria don't beat normally,  rather via a reverse conduction pathway from the AV node backwards to the atria. The AV synchronization is all wrong. If there is a complete heart block,  of course, there is no AV synchronization, again not an immediate life threatening condition,  if at all.

I did.

by Gotrhythm - 2020-01-16 15:48:27

That's how the need for a pacemaker became apparent in the first place.

Me too

by crustyg - 2020-01-16 18:54:04

I survived on a junctional rhythm for over two years - a lot longer if you include the times when I was running and my SA node couldn't keep up.

For me, the biggest problems (apart from not being able to raise my HR enough) were the impact on my atria - both now massively dilated from contracting against closed valves, and the reduced ventricular filling due to lack of A-then-V contraction.  Having AV sync restored improved my cardiac output a lot.

In answer to your question, it's very common in those with SND or Sick Sinus Syndrome or SA node failure.

Why the question?  What is the real question that you're sidling towards?

To Gotrhythm

by mdudek - 2020-01-17 13:15:14

Oh wow - nice to finally find someone who may have the same issues I do! 

I had AVNRT for a while.  It was never a real problem until it was in November 2018.  I got my first ablation to try and fix the AVNRT a year ago January but felt worse afterward.  EP said it was the JR that was compounding issues in a big way and that the only real way to fix it may be to go after it and possibly destroy it and the AV node which would mean I would need a PM.

I had my second ablation in March 2019 and woke up with a PM.  I am 100% paced on the bottom.  I have not "met" too many people who are in the same boat. 

I have still having trouble getting back to my previous activities which includes playing sports.  I can work out but anything cardio related - from walking the dog in the neighborhood to doing overhead exercises and walking up stairs - taxes me like nothing else.  I was hoping by this point it would be getting better but it's not. 

How are things for you?  What is life like for you post-PM?

To CrustyG

by mdudek - 2020-01-17 13:18:25

I am just trying to find more people - well, just find anyone, really - who have had similar issues as me because I can't seem to find many people that relate to what I have been going through based on what I have had going on.

I have met people who have never heard of issues with JR.  It doesn't seem that too many people out there are 100% paced. I wonder if I am just not finding the right forums, not asking the right questions, or maybe I am a unicorn ; )

JR

by islandgirl - 2020-01-17 13:40:29

I had it before I got my pm for SSS.  My EP just mentioned it the other day at my EP appointment.  He was fiddling with my heart, so I assume he dropped the pm rate and I went into JR.  

I suspect we're not talking the same language here

by crustyg - 2020-01-18 04:18:08

A junctional rhythm is no big deal - it's not a killer and although the cannon waves up the throat and neck don't look pretty one gets used to them.

AVNRT, however, is a very different ketttle of fish.  Much like WPW, episodes of dangerous tachycardia, not easy to treat, and in this case resulting in AV-node ablation.  A junctional rhythm just means that the initating electrical activity arises in the AV node and not from the SA node.  No-one would ever describe AVNRT or WPW as a junctional rhythm.

However, there are plenty of folk here with a normal SA node and CHB.  The usual challenge is getting a PM set up properly to match your individual requirements.  In essence, your (dual lead) PM should be sensing activations from your SA node and, after a suitable delay, passing them down to your RV (or His-bundle, perhaps).  Assuming that a) you have a dual-chamber PM, and b) it's been set up properly to meet your requirements.

Not clear

by AgentX86 - 2020-01-18 12:53:17

Do you have a normal two-lead pacemaker (RA + LA), in that the sinus node is still in control or are the ventricles completely independt of the atria?  I have the latter case.  I had an AV node ablation to isolate the atria to get rid of the symptoms of Aflutter (still there, just can't feel it).  I'm now paced in both ventricles and the atria do (less than) nothing.  I've had little trouble (some bigeminy PVCs but they've all been eliminated) with my PM.  A few settings changed but really just tweaks.

Running on pm

by Dandelion - 2020-01-18 22:39:52

Ok how come a year ago I could run at  an 8-9 minute pace for five miles and now after 10 months I get breathless run/walking the dogs one

Running on pm

by AgentX86 - 2020-01-18 23:23:23

Your bio is pretty thin so it's hard to guess what the problem could be. It's likely that you need some serious tuning of your pacemaker. Work with your EP and device tech to get some help. You may need to have them tune your PM while you exercise (on a treadmill). In any case work with your cardio staff and don't take "no" for an answer.