AFib

Afib

by AgentX86 - 2023-04-10 23:13:30

It might not be Afib, rather some other arrhythmia.  Whenever you feel something off, measure your pulse manually.  Afib is usually tachycardic and "irregularly irregular".  That means it is above 100bpm and there is no pattern whatsoever.  The beat is chaotic. 

Aflutter is usually tachycardic, too, but it's regular (a regular beat but usually faster), or it can be irregularly regular, meaning a randomish beat but with an underlying regular pattern, like NSR with beats dropped.

It could also be SVT (supra ventricular tachycardia) which is, more or less, a catch-all for any tachycardia that comes from the atria.  This will just be a fast heartbeat.

The other alternative would be PVCs (pre-ventricular contractions). I don't know if you have any experience with car mechanics but this is the equivalent of "dieseling". The engine pre-ignites or the ventricles contract before they're told to do so.

Any of these can cause the symptoms you describe but some may not be able to be recognized by your pacemaker. Afib should be but the others, probably not. If you have your bedside box handy when you have these symptoms, push the button to send a report as it's happening.  They'll be able to tell more.

Meanwhile, check your pulse manually and keep a log with your feelings and any interesting things you notice by taking your pulse.  If you can give a time, perhaps they can find the issue in your pacemaker logs.

You are still in the healing period

by Gemita - 2023-04-11 04:15:50

Indyglo, you say, I feel fine today....but........why before the pacemaker I never had a feeling like this...when I was in the hospital about three months ago, the nurses that were monitoring my heart said they did not see any AFib?   So now, WHY would I feel this and also be told, if this continues then they can do something about it!   BUT WHY only after the pacemaker would this happen????   

I experienced a worsening of all my arrhythmias, including AFib, following my implant in 2018.  I also noticed a new arrhythmia (Atrial Flutter).  In fact I wasn’t happy at all and seriously questioned whether the pacemaker was actually making the situation worse during those early few months.  It settled at around 3 months, particularly after a review and the stopping of some of my meds which had become pro arrhythmic (Flecainide and Digoxin).

Indyglo you shouldn’t assume that this is the start of a “continuous thing”.  It is known that after any trauma many of us experience unwanted symptoms and a pacemaker implant is no different and is most definitely a physical/emotional trauma.  Remember too that pacemaker leads have been physically attached to our hearts, that we are being paced for the first time and this is bound to have an affect on our bodies while we heal and get used to pacing.  It took my heart around 3 months to heal and to settle down.

I note you feel fine today but that your team has told you “if this continues they can do something about it”.  Since you clearly had evidence of a high heart rate, and presumably the arrhythmia responsible - AFib? - they can help prevent this from happening again by giving you a rate control medication like a beta blocker, to take daily to settle your electrical disturbances during the healing period.  It might be trial and error until they find a medication or treatment to suit you.  Hopefully this won’t be needed long term.   Electrical disturbances should ease as healing progresses - at least this is what I was told by my doctors and which was certainly my experience.

Yes the irregularity of heart rhythm combined with any high heart rates from AFib can really affect blood flow so this is why you were struggling on Easter Sunday.  I had an episode of AFib yesterday due to lack of sleep and I was most definitely feeling poorly for the duration of the episode. 

I wish you well Indigo and a speedy resolve of your symptoms.  Whatever you do, please do not start worrying about your situation, since this may just worsen your AFib or other electrical disturbances present.  I note you are due to have a TAVR procedure.  Valve problems can certainly trigger an arrhythmia like AFib, so although the procedure may not immediately help with any AFib, especially during the healing phase, long term you should benefit from better blood flow through the Aortic valve.

Pacemaker

by Indyglo - 2023-04-11 05:55:12

Thank you for the insights.  When I got home Sunday I did check my blood pressure and it showed my heart rate at 90+ which was a suprise as it has remained near 60-70 since the pacemaker.  My blood pressure showed normal?  

Article

by Penguin - 2023-04-11 06:44:45

Hi Indyglo, 

I agree with the above two posters re: alerts triggered by the implant procedure rather than by the pacemaker itself.  Settings can also play a part and no doubt your clinic will investigate and discover the cause.  In the meantime, I understand your despair that this may be A.Fib. but agree that it is probably premature to define the rhythm disturbance as AF unless your doctors have confirmed it. 

This article explains that medicine itself is somewhat conflicted as to 'What comes first? - New Onset AFib or TAVR' and finds significant links between the two.  https://www.jacc.org/doi/10.1016/j.jcin.2022.01.018#:~:text=New%2Donset%20atrial%20fibrillation%20(AF,TAVR%20%3D%20transcatheter%20aortic%20valve%20replacement.

It also explains that AF may be discovered more often due to better monitoring once Aortic valve issues are diagnosed.  A pacemaker is one way to improve monitoring and will throw up alerts if it detects anything unusual depending on how it has been programmed.  The PM sits and monitors what your heart is up to 24/7 and this does lead to more results being generated, particularly if the device is set up for high alerts. 

What you need to remember with PMs is that they can only respond to alerts that have been programmed and that it is then up to a 'human' to investigate further.  Some of what is flagged up will check out as confirmed rhythm disturbances but others will not. Try to keep calm whilst this monitoring takes place and keep a diary of dates/times when these events happen. 

Lots of people with AF and other rhythm disturbances on this forum have had significant issues trying to prove that their arrhythmia exist. They can be devilishly difficult to capture on ECG and pacing data isn't always clear.

In your case the discovery of A.Fib - if that's what was found - or suspicion of A.Fib has been monitored and reported back to you immediately and although this doesn't seem like great news on the one hand, given the links between aortic valve issues and A.Fib and the significant risk of stroke, I'd be very pleased that my doctors are so attentive and alert to potential issues.

Try to see the device as your ally and friend in this respect. It's looking out for danger and that's a good thing! 

I hope you will do very well

by Gemita - 2023-04-11 09:35:43

Indyglo, thank you for your comment.  I am glad by the time you got home on Sunday your blood pressure monitor showed a heart rate of 90+ bpm which would not be regarded as tachycardic (tachycardia = anything over 100 bpm, with 60-100 bpm being a normal heart rate).  90+ bpm on its own would probably not have triggered an alert.  

AF though can in fact occur at a slow, normal or fast rate, so if you had symptoms such as you described, particularly the fatigue at the time of your alert, it could well have indicated a rhythm disturbance like AF but you will need to ask your clinic the reason for the alert?  

A heart rate of 90+ bpm though may seem very fast if we have problems with our heart valves or if we have heart failure for example (which you do not appear to have).  On its own 90+ bpm is not a fast heart rate.  I am also reassured that your blood pressure was normal at the time of testing.  

The statement from your team that the TAVR will not help with AFib is an ominous one and I would want to know whether in fact AF has already been confirmed?  Having "pre existing" Afib could complicate a TAVR procedure, so I would want a full frank discussion before your TAVR in May, so that you will know what all your options are and can make an informed decision on the safest way forward (if this hasn't already been done).

I wish you all the very best and hope that you will do very well indeed.  There are a few members who have successfully had a TAVR procedure, or will be having one soon, so you are in good company

High pollen and allergies

by Persephone - 2023-04-11 20:21:56

Hi Indyglo - just want to add that the tree pollen count was very high on Sunday where I am (mid Atlantic US) - you were outside on the patio and experienced trouble breathing as well as general weakness and feeling unwell - perhaps a connection? You may want to check it out.

Pacemaker

by Indyglo - 2023-04-11 21:43:35

I did forget to mention what the device clinic told me...they said the blood in my lower heart was having a hard time keeping up with the upper heart?  Not sure how they know that for sure but the next time this happens and I am at home I will be sure to send a message via my monitor.  Again, thanks for all the good information.