St Jude abbot PM2272

I am a active 53 year-old male and had a pacemaker installed in August 2020 with an AV node ablation. My condition is hypertrophic cardiomyopathy that I did not discover until my 40s. The first medication I was on after discovering it through arrhythmias was Verapamil. I felt the best I ever did with my condition while on that medication. As Time passed heart problems began to increase including atrial fibrillation. After four extensive oblations and numerous cardioversions (too many to count). It seems the only option left was to get a pacemaker with an AV node ablation. My initial PM programming was controlling the top and bottom chambers which turned out to be disastrous because the atrium was going in and out of afib and flutter constantly. Now it is just controlling the bottom chamber and I feel much better but was hoping for much more. I am a contractor and have always been physical and very active. Just wondering if there's anybody out there that has my same condition and would be willing to exchange ideas or help the Improvement of stamina with medication and programming.


1 Comments

A/V Ablation

by AgentX86 - 2021-01-12 16:13:53

I don't know why you had so many DCCVs.  Once you've had a couple failed, there's no point in trying again.  I had one in 2007 that held, with the help of a pretty good dose of Metoprolol, for seven years.  Then it was all downhill.  One chemical cardioversion lasted a week or two then a DCCV that worked for a couple of weeks until I had a CABG, with Maze and Articlip.  The Maze failed, throwing the persistent Afib into permanent Aflutter.  Another DCCV didn't last long enough to get be back to my hospital room.

Sure, BTDT.  I got there via a little different route in that I don't have cardiomyopathy, but the drugs (sotolol, primarily) I was on to surpress the flutter damaged my SI node so I was getting Bradycardia, big time, then pauses (then long pauses).  I needed a PM, so it wasn't a long jump to an AV ablation to kill the (effects of) the flutter, as well.  I'm still in flutter but I can't feel it.

I never had an atrial lead. It would have been silly because the whole idea of the ablation was to permanently disconnect the atria from the ventricles.  The only purpose of the atrial lead would have been to reconnect them.  I have two leads in the ventricals (CRT-P) and then the pacemaker in VVIR mode.

I'm not a contractor but I'm not a couch potato either.  I walk 10mi before breakfast in the morning, without much trouble.  The atrial "kick" is rather like a supercarger and simply pushes blood into the ventricles more efficiently.  I've read that this "kick" is about 20% of cardiac output.  If your heart were completely healthy (you do have cardiomyopathy) the loss of performance would be somewhat more than this because our atria still do something but the ventricals do their thing at different times.  The two aren't coordinated so the ventricles may need blood while the atria are on the opposte cycle. That loss is less than the reserves that the heart has, unless you're an athlete.  That's a long way of saying that I think (but I don't even pay doctor on the TeeVee) you'll be fine.

You will need programming optimization because 1) you're active and 2) you have no natural rate response to exercise.  You'll have to have the PM's rate response function tuned to you and your lifestyle. We're all different and what works for me probably isn't what works best for you.  You're going to have to be a little patient but assertive with your PM technician.  Only you know what works for you.

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