AV Node Ablation

A few thoughts

by Gemita - 2023-05-06 04:07:00

Meg, I note from your comments on another post, that you do feel better, less breathless, following your AV Node ablation.  Following any ablation, the heart needs to heal and this may take several months.  During the healing period we may experience additional rhythm disturbances both in the upper chambers and in the lower chambers.  Perhaps this is what is happening.

Since your AV Node has been ablated, rhythm disturbances from the upper chambers are no longer able to pass through the AV Node to affect your ventricles, but any new rhythm disturbance starting in your ventricles (lower chambers) will still be felt during the healing period which hopefully will soon settle.  After an AV Node ablation they usually set our lower rate limit higher for a period (like 80-90 bpm), so this is why you are running a bit higher and sometimes hitting 100 bpm which is still a normal heart rate (60-100 bpm).  Anything over 100 bpm would be tachycardia.  

Going down to 50 bpm sounds as though this might be due to an ectopic beat (premature ventricular ectopic).  I am sure your pacemaker is accurately recording the heart rate and keeping your lower rate higher than this, particularly following an AV Node ablation, but you might want to ask your cardiologist/EP what your lower rate limit is set at just to be sure?  However being an ectopic beat sufferer, I know any ectopic beats can certainly feel as though they are slowing our heart rates right down.  What are your symptoms, if any?  If you have symptoms, then I would let your doctors know.

How are you recording your heart rate?  Sometimes home monitors do not work accurately in the presence of an arrhythmia like an ectopic beat, so it could be this too.  When I have irregular heart rhythms, my blood pressure monitor for example often errors when I try to check my blood pressure/heart rate, so I usually feel my neck pulse to confirm a slow or fast heart beat or a regular/irregular rhythm.

I hope this helps you to feel better and to explain why your doctors may not be particularly worried about your fluctuating heart rates while your heart is still healing from your AV Node ablation

AV Node Ablation

by MegZ - 2023-05-06 10:48:02

Thank you, Gemita.  Your comments and explanations are far more helpful than anything I've heard from my doctors.  I do appreciate them.  It's a whole new world!

Meg

AV Node Ablation

by AgentX86 - 2023-05-06 12:38:37

I followed a path much like yours (three cardiac ablations followed by an AV node ablation).  Gemita describes my experience pretty well.  I'd just add that your pacemaker is correct (working the way your EP set it). The chances of it doing its own thing are probably one in ten million.  They just work.

I don't know how your EP set yours up but my EP said that he sets them at 80bpm for the first month, then 70 for a month, then after another month to the final setting (usually 60bpm).  There is some evidence that there is an increased possibiliy of an SCA after an AV node ablation. Setting the rate high, then backing off, as the heart gets used to beign paced in the unusual manner, greatly reduces the risk. 

As such, mine was set to 80bpm and all was fine.  As soon as they moved it down to 70bpm, I started having begeminal (every other beat) PVCs, so he had it set back to 80bpm and it's been there for the last five years.  I had trouble sleeping with the higher rate so eventually used the clock function of the pacemaker to set it back to 50 at "night" (it doesn't understand DST or time zones😣).

Again, as Gemita said, PVCs are felt as a "skipped" beat and this will (won't, depending on  how you look at it) be picked up by anything that uses blood flow in the arm to measure rate (BP cuff or pulse-ox meter) as a lost beat so will read low.  It might just throw it off completely because it doesn't know how to deal with the arrhythmia. in any case, the numbers are useless.

For more information, count your pulse manually in the carotid artery (neck). If this is the case, you will feel a double pulse followed by a "skipped" beat.  The beat isn't skipped, it's part of that double pulse.  The problem is that the short pulse doesn't allow the heart to completely fill so you might feel light-headed or your stomach may feel queezy.  In any case, they suck.  Bigeminal, are really bad because the output of the heart rate and blood output essentially drops to little more than half normal and the beats are quite uncomfortable.

I still have PVCs and have been worse lately.  When I stop exercising I'll have them, about every third to tenth beat for a half-hour or so.  Sometimes I'll get them in the evening while watching TV.  They're quite annoying but rarely dangerous. Everyone gets PVCs just most have them so infrequently that, if they even notice them, will think "hmm, what was that?". Then wait and nothing happens again. They then think it was part of their imagination and go on with their business.

Certainly tell your EP about the problem but expect him to brush it off.  It's not that he's not listening, just unless you're really symtomatic, they're not important and there really isn't a lot that can reasonably be done.  Maybe a beta blocker but that's about it. They shoud settle down but some minor changes can be tried.

As hinted above, your heart can be quite upset by being paced abnormally and takes a while to get used to it.  This isn't an issue just after an AV node ablation.  It's common after any pacemaker implant.

AV Node Ablation

by MegZ - 2023-05-06 18:24:27

Thank you, Agent X86.

I have learned so much from all the replies to my post.  I was used to taking my BPM readings regularly with My Kardia and of course, now I can't use it.   I was using my blood pressure monitor for the readings but, thanks to you, will trust my fingers on my neck now.   

It has been a great relief to find this site.  I do believe I have been worrying unnecessarily.

Thank you all.

MegZ