Issues 5 weeks post 3rd ablation

38 yr old F Dx 8 yrs ago with SVT. Had been pretty asymptomatic, except for the occasional PAC's&PVC's,until last Sept when I ended up in the ER in AFib with rapid vent. response. IV meds failed to convert and I had to be cardiverted. I then had EP study, flutterline ablation and failed attempt to ablate the AVNRT. I was started on Flecainide 2x day along with my 360 Diltiazem and aspirin. In Nov had another ablation which was thought to be successful until 6 weeks later event monitor caught sustained Atrial Flutter with HR 300+. I also suffer from Atrial Tach and junctional escape.

I was referred to EP ath the Brigham and Woman's Hosp for 3rd ablation using the Cardo Mapping system to pinpoint and ablate the AVNRT. He was unable to locate the Atrial tach and unable to do anything for the junctional rhythm.

It is now 5 weeks later and I am still feeling very fatigued, lightheaded and have experienced 2 episodes of tunnel vision and near syncope. Event monitor continues to show junctional rhythm, sinus tach with HR as high as 180 at rest (which cardio has said is a bit unusual) My question is what can be done to help with these problems? I am very symptomatic when my heart goes into junctinal rhythm and the continued sinus tach drains me of what little energy I have. I have been off all cardiac meds since Feb 25th and cannot take Betablockers due to severe asthma.

What kind of treatment should I be seeking? I just need to get my life back. Any advice you have would be great!

Thank you in advance for any light you may be able to shed on my problem

[Forum-M.D.-MJM]

Hello,

My question is what can be done to help with these problems?

Junctional rhythm is a tough problem it fix.  With normal heart beat (sinus rhythm), the atrium contracts to fill the ventricle and the ventricles then pump blood to the rest of the body.  This is a very efficient machine.  It is common to have symptoms with junctional rhythm because the heart beat originates between the atrium and venrticle.  This decreases the efficiency of your heart beats and causes symptoms.  The only potential fix for symptomatic junctional rhythm is an atrial pacemaker.  In general, we don't put pacemakers in for this reason.

I am very symptomatic when my heart goes into junctinal rhythm and the continued sinus tach drains me of what little energy I have. I have been off all cardiac meds since Feb 25th and cannot take Betablockers due to severe asthma. What kind of treatment should I be seeking?

It is hard to say from the information above.  My first question is when are the symptoms worse?  A holter monitor or event monitor with a good log will help us correlate symptoms with the rhythm involved.  If junctional rhythm is causing most of the symptoms, that is a tough problem to fix.  An atrial pacemaker would help, but you are aweful young for a pacemaker.  It is important to know if the atrial tachycardia is sinus tachycardia (inappropriate) or a true atrial tachycardia.  If it is true atrial the ability to ablate it is complete dependent on being able to induce and map it in the lab.  The team at Brigham is very good.  I would go back to them and give them some time to try and fix it before looking for another opinion.

I hope this answers your questions. Good luck and thanks for posting.

[TCN]

Your problem sounds similar to mine.  We are the same age.  I also went to Brigham and Women's hospital.  What is the rate of your junctional rhythm. If it gets really low, it would explain your light-headedness.  Mine was not reliable and at times I would end up with long sinus pauses.  
I did get a pacemaker.  That would solve that problem for you.
It will not solved the fast atrial arrythmias.  I have those as well, and had attempted ablations.
Last year I ended up with an av-node ablation which took me off the flecainide and no more amiodarone.  I  feel so much better.  The av-node made it so even though I still have the fast rates I don't feel them as much.
I had a total of 5 ablations, so I completely understand what you are going through.  Next week I go in for surgery to replace my pacemaker which has run out of its battery life.
Good luck to you!!

[heartofgld]

Thanks for your post...I had Dr Bill Stevenson, did you see him or Dr Epstein? I had an appt this afternoon with my cardiologist. He reviewed the tracings that I have sent with the event monitor. Lets just say, it was a potpouri of rhythms. From sinus tach, sinus arrhythmia, junctional escape and 2nd degree AV Block(Wenckebach's) He wants to wait another 6 weeks to see if things simmer down. He said that giving me meds for the tach arrhythmia would make the junctional escape worse, so it's basically a double edged sword for me now. I am expected to wait it out a little longer, I did mention that I am running out of steam and that my quality of life is in the toilet! I work full time as an RN and I have a husband and 2 kids that have patiently waited for me to resume some aspect of a life.

What was your original diagnosis before you received a pacer?

[PikaPika88]

"I still have the fast rates I don't feel them as much."

Isn't it the heart still can wear off sooner than normal people?  The upper chambers are over worked now.  It sounds like silent heart problem for me!  Even more scary because it is unknown how much tachy that you get!

I also have an av node ablation.  Now my upper chambers are still conducting to the lower chambers via an accessory pathway.  (Even worse?)   Now a cardio told me my left side can't catch up the beats as right side (paced).

[TCN]

I also had Dr. Stevenson.  I ended up with my pacemaker about 5 weeks after an ablation for inappropriate sinus tach.  Once my rate slowed way down and I got my pacemaker the a-fib, flutter and everything came out.  
I am assuming you have had holter monitors etc. to make sure your rate is not stopping.  I ended up with just an escape rhythm in the teens with periodic pauses lasting up to 10 seconds.  I would pass out.
My diagnosis was sinus node dysfunction.  I had several ablations after my pacemaker was placed as well.
Good luck!

[bama jane]

I have several arrhythmia problems, 2 being  junctional rhythm and acceleraed junctional rhythm.  Could you tell me what your symptoms are when you are having junctional rhythm?

[heartofgld]

TCN: Yes, I have had holters and I have had an event monitor on and off since Oct. My heart rate has dipped as low as 38 and I have had 2 syncopal episodes. My cardiologist said that if he thought a pacer would help he'd do it in a New York minute. He is just waiting to see if things will improve with time. I guess I will just have to be patient and do what I have been doing....WAIT:(
By the way...I would be interested to know how your experience was at the Brigham. I felt like I had walked onto the set of a medical bloopers and blunders show. My pre-op testing was lost and had to be done all over the morning of, my procedure was slated to start at 11:30a.m. but Dr Stevenson was tied up and I was told that it would be at least 2-2:30 before I would go in(I certainly was understanding about how that can happen). I was left in the cath lab waiting area for almost 3 hrs., by the time I made into the pre-op area the nurse couldn't get the IV started because I was now dehydrated! During the course of her fiddling around with the IV she reached across me and inadvertantly slapped me in the face(OUCH!) Then the alarms started going off on the monitor. The last straw was when the nurse from the EP lab came in to say they were waiting for one last lab result before I could go in...When I asked which one? she said oh, your pregnancy test. I informed her that since I had a hysterectomy last June, that if I was pregnant that she had better call the guiness book of world records and that if they thought they needed to stress me out to induce my arrhythmia...it was working! Once I saw Dr S, I felt safe then:)

Bama Jane: My symptoms during junctional rhythm are light headedness, almost a tunnel vision sensation, it feels like a cannon wave that comes over me, I have had 2 syncopal episodes (fortunately not while I have been driving)

[soupdipper]

I was wondering if any of you that are dealing with the PVC's, PAC's etc feel real stuffy-headed right before you have an "event"?  It seems as though each time my PVC's decide to go crazy, my head seems really stuffy and there's a lot of pressure in my sinuses.  After it goes through its (resetting - as the doctors call it) then it's like taking a breath of fresh air...does anyone else feel this same way?

[PikaPika88]

I've that head fullness but it comes after my funny beats.  After the beats and head fullness gone then I've the chest tightness.  Dr said my symptoms could be due to anemia, anxiety or blood sugar.  They said it wasn't due to the heart.

May be yours one is different.