Pacemaker

Hello. I had a Pacemaker fitted on March 30 and an ablation to deal with the node on May 6. This followed three years of procedures and medications following a stroke caused by an atrial flutter. That flutter and my atrial fibrillation were succcessfully dealt with by two ablatiions but a second flutter appeared and became persistent.  I think my cardiologist was confident all,would be well immediately but I have had palpitations and the accompanying loss of energy and nausea a few times since.  He lowered my heart rate to 60 p.p.m. Instead of 70, but in the week since then I've had two other episodes. Last night it felt like my pulse was going slow then fast. This morning I am fine again. 
After three years of this I am feeling quite despondent (also coping with severe osteo-arthritis). I see my cardiologist again in a month but is what I am experiencing a normal settling down time? How many times am I likely to need an adjustment? Will I ever have a stable pulse rate? Any reassurance would be greatly appreciated.


3 Comments

Have you had an AV Node ablation ?

by Gemita - 2021-06-07 02:48:01

Annie, your post is somewhat confusing.  Your history even more so.  I see you live in Australia, Novar Gardens, but your province/state is Saskatchewan?  I believe your have posted before but there is no history, unless you have deleted your earlier posts?

You say you had an ablation "to deal with the node on May 6" (presume AV Node ablation?).  If successful this should have stopped your "2nd Flutter" from getting through your AV Node to affect your ventricles, so if you have developed further symptomatic palpitations, the arrhythmia is probably coming from your ventricles not from the upper chambers.  These could possibly be PVCs (premature ventricular contractions), or even runs (hopefully non sustained) of VT (ventricular tachycardia).

They usually keep a higher ventricular rate setting following an AV Node ablation I believe for a period to prevent a dangerous ventricular arrhythmia from occurring.  I am surprised they have already lowered your rate to 60 bpm from 70 bpm, the latter rate wasn't high in any event.  Do you have home monitoring?  You could send a transmission to your clinic for them to check which ventricular arrhythmia is occurring to cause your symptoms.  After a successful AV Node ablation you should be relatively free from symptoms (arrhythmias) coming from your upper chambers and affecting your ventricles but you could start experiencing ventricular arrhythmias instead (usually ectopics) which can respond well to a higher lower minimum heart rate setting but your doctors will know this.  I would take the problem back to them if your symptoms concern you.

You do know of course that an AV Node ablation will not stop any breakthrough atrial flutter/AF from occurring which could still continue in the upper chamber(s) unless it can successfully be stopped by another ablation.  I note Atrial Flutter has reoccurred.  With a successful AV Node ablation, you should no longer feel it fluttering in your atria.  Unfortunately  following an ablation for AF, less so usually for Flutter which can be easier to ablate, there is no guarantee of success.  AF in particular can be really difficult to eradicate or control.

I am hopeful though that your symptoms will ease with time but you may need immediate help to control your present symptoms.  When you are next having symptoms, try to feel your pulse.  Is it fast, steady, or fast, unsteady (regular or irregular).  Get to know what is normal for you.  Good luck Annie.  It is still extremely early days and this could all be so perfectly normal while you heal from your ?AV Node ablation and implant procedure.  

Surgery and recovery

by AnnieM - 2021-06-07 04:54:08

Thank you, Gemita. Firstly, my apologies for the confusing information. I do live in Australia but found that impossible to select that when I set up my account, and I am new to the Forum. I'm sorry I don't yet possess all the terminology that many of you seem very familiar with, but I am learning!

I did have an AV node ablation, and I do have home monitoring so the information is transmitting to my cardiologist's technicians daily.  The cardiologist lowered the bpm to 60 after I had experienced palpitations in the three weeks since the AV node ablation when it was set on 70 bpm.  Re-setting to 60 bpm was only done a week ago and it may well be that the beats I have experienced twice since then are ectopic beats. When I felt my pulse while experiencing these last night it seemed to be moving between slow and fast.

I'm aware that having a pacemaker isn't an automatic  fix for some arrhythmias, but have been told not to take metropolil, which was helping me before.  (The decision to go to a pacemaker came after a week in hospital with my bpm swinging between 70 and 150 for six days).

As you say, it is early days and your comments have given me possibilities to consider and will help me formulate questions for my next visit.

I do appreciate you taking time to reply and the generosity of responses that are offfered in the pacemaker club. 

 

 

AV node ablation

by AgentX86 - 2021-06-07 21:38:36

I've also had an AV/His ablation.  I'm still, and forever will be, in flutter but I don't feel a bit of it.  Since I'm still in flutter, I'll need to take Eliquis for the rest of my life (even though I have had my LAA clipped).

Shortly after I had the ablation and PM implant I was experiencing bigeminy PVCs (one PVC every other beat).  It felt awful.  My PM couldn't record them because it'll only record strings of PVCs (single PVCs are so common and unimportant that there is no way, or need, to record them).  I had to catch it in the act and send a transmission right then.  It took a couple of times because they'd go away as I got up to go to the box. 

As Gemita said, after an A/V ablation, its now standard care to raise the heart rate for a little while, until the heart gets used to being paced.  There is a risk of SCA with a "normal" heart rate, at first.  Usually they'll crank it back after a month.  Mine was originally set to 80bpm and set back to 70bpm after a month.  A month later they were going to set it back to 60bpm but I started having the PVCs when they dropped it to 70, so raised it back to 80, and there it sits.

I don't understand why you aren't supposed to take metoprolol.  I've been on it since the day of the flood, in varying dosages from 25mg/day to 200mg/day.  I'm still on 2x25mg to try to minimize the flutter and, as a bonus, PVCs.

 

 

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A pacemaker completely solved my problem. In fact, it was implanted just 7 weeks ago and I ran a race today, placed first in my age group.