High resting pulse even after Ablation for afib & crt d implant

If safe with heart failure, would a higher minimum heart rate help?

by Gemita - 2021-05-30 10:05:02

Hello Sandoval, hope you are enjoying the sunshine at last.  I cannot comment on the symptoms of heart failure but reading that your heart rate normalises by walking around makes me wonder whether as you try to drift into sleep your heart rate falls too low and then you get runs of tachycardia to compensate.  This used to happen to me with falling heart rates.  I wonder if the answer is to raise the lower minimum rate if it is safe for you to do so, to see if that might help correct any rhythm disturbances?

I know you have had an ablation and pacemaker upgrade to CRT, but could things still be settling down ?  Could you have developed short runs of break through tachycardia.  Maybe an event monitor would help give your doctors and you some answers. I would also recommend monitoring your oxygen levels too and treat sleep apnea if you have it.  In the meantime I would use extra pillows, or raise the head of your bed 

High resting pulse

by sandoval - 2021-05-30 13:15:27

Hi Gemita, I noticed before that I had a high pulse after waking up but now it seems to happen quite alot (as I write it's 110) so something else going on. A holter monitor is an idea. Charing X told me over the phone I didn't have sleep apnea after several tick box questions so that was that. I know when my my pulse is up because I feel a little breathless. Didn't notice this before the CRT so maybe related but it's nearly 6 months so would have thought things should be back to normal by now. I'm not out of breath climbing stairs like I was before CRT so you would think all was fine but the pulse rate is disconcerting

I would definitely speak to your doctors Sandoval and ask for some monitoring

by Gemita - 2021-05-31 02:32:59

I meant to add, I note you are on beta blockers and Ivabradine.  Perhaps you could ask whether any of your meds might be contributing to your new symptoms or whether a change in medication or dosage might help.  Sometimes meds may trigger the very symptoms we are trying to treat (Ivabradine, side effect of a fast heart rate)?   

As you have had some respite with CRT (not so out of breath climbing stairs as before CRT) this suggests that CRT is definitely helping which is really reassuring.  It sounds to me like this might be arrhythmia related Sandoval.  I get breathless often when I experience an irregular arrhythmia (AF) or a regular arrhythmia (Atrial Flutter), particularly at higher heart rates and with unstable blood pressure which often occurs during the arrhythmia.  Of course the pacemaker cannot control my blood pressure unfortunately.  I got this yesterday working (bending) in the garden.  Partly my fault because I allowed myself to become dehydrated.   But of course I do not have heart failure and can therefore probably tolerate these symptoms better than you are able to.

Have you recently had another echocardiogram to check the functioning of your heart and your ejection fraction?  Together with event monitoring, might be the way to go and give you some useful feedback.

High resting pulse

by sandoval - 2021-05-31 08:35:53

I take on board what you say Gemita and will get tests done but what is baffling me is that I have a resting pulse of say 110 but after a 10 minute walk its in the 60's ? Isn't it supposed to be the other way around ?

I took Ivabradine last night as well as a beta blocker with no effect on pulse. This morning had a 10 min walk and pulse came down by 40 bpm ?

Sounds an easy solution but I can't really walk all day.

Will get Holter & Echo arranged asap.

This is a challenge

by Gemita - 2021-05-31 10:26:13

Yes Sandoval, I would agree with you.  It is baffling which is why you need to explain all this to your doctors.  The more detail you can give, the better will be their understanding of what might be happening to your heart during pacing, or to help them to look for other health conditions which might be causing this (apart of course from any change in your heart condition/ejection fraction)?  Other reasons for a higher resting heart rate need to be ruled out ? like perhaps any adverse reaction to your medication, thyroid/electrolyte imbalances, anaemia, infection.

I would ask ideally for an exercise (treadmill) echocardiogram as well as an event monitor.  Maybe they need also to do a 24 hour blood pressure check, since a sudden fall in blood pressure would affect your heart rate.  A treadmill test should help identify the cause for the sudden heart rate drop during exercise and give a lot more information about your settings and whether they need adjusting.  The event monitor should pick up any arrhythmias/sudden changes in heart rate.  I would also question whether this could be a pacemaker/ICD problem or alternatively a completely appropriate reaction in the presence of an arrhythmia, that is the speeding up of your heart rate to outpace an arrhythmia or a sudden slowing to try to bring the heart rate down to a safer level?  

How effective is your home monitor you are using for your heart rate?  In the presence of an arrhythmia like AF, it can be difficult to get an accurate reading sometimes, although I appreciate you are clearly able to tell by your symptoms alone of breathlessness when you are in a fast rhythm.

I wonder what has been set up in your CRT-D and what settings have been activated.  I know there is a setting known as "Rate Drop Response".  I wonder if the drop in heart rate on exercise could be affected by this or one of your other settings?  It would be really good to know what your settings are and to get them optimised for you and a treadmill would give them this opportunity.  

While waiting for answers from your team, you could post another message on the forum maybe entitled "Why does my heart rate increase at rest and fall on exertion?  Please can someone with heart failure help throw any light on this problem?  I have a CRT-D".  There may be other heart failure members who have experienced something similar?  Worth a try.

The only other suggestion Sandoval is whether you have developed some autonomic heart rate dysfunction but let us assume the explanation for your symptoms is simpler and easier to fix. 

This is a challenge

by sandoval - 2021-05-31 17:36:42

Posted again as you mentioned. I remember asking for a CPET after the ablation last year but it never happened. I'm awaiting an echo but doubt it's a stress echo. You've given me some questions to ask; hopefully I'll be able to answer some if not all.