Pacemaker and AV Node Ablation, Coumadin vs. ASA

[BABlocker]

BACKGROUND: Age 49, diagnosed with PAF/lone in Feb. 2005. Heart rates in the 250s and then down to 30s, mostly at night but had one presyncopal episode during the day when active and my heart rate plummeted to 30 when in AF. Procedures include: Ablations for fib and flutter (2), cardioversion (failed), 4 antiarrythmics (failed) and a near fatal blood response to Hurricane Spray during a TEE (developed Methemaglobinemia and was coded). Final procedure: AV Node ablation and Pacemaker insertion (Medtronic INSYNC III BiV--no cardiomyopathy, but it was offered to me by my surgeon and I said YES! to prevent possibility of ventricular paced induced cardiomyopathy).
PACEMAKER SETTINGS: Low of 75 and high of 140. Pacing 80% in atria, 100% in ventricles.
MEDS: Tarka 2/240mg TID, ASA 325mg Niaspan, Synthroid, Cytomel, Zyrtec, Singulair. I was on Coumadin but stopped it one month ago, per my EP.

My high atrial rate episodes/mode switches have dropped from 1800 in 3 months to 13 in 11 weeks, with the longest being 22 sec, thus the switch from Coumadin to ASA one month ago.

I am being treated for HTN, prediabetes, and high lipid panels. With diet, exercise and meds, all are in normal range, except for an HDL of 34 (I take Niaspan for this). Is it safe for me to be on ASA vs. Coumadin? I have concerns that with the AV Node ablation, I won't know if/when my afib worsens and I am dealing with longer episodes.

Question 2: for the past 23 days, suffering from Bronchitis and violent coughing...as I am pacemaker dependent, I wonder: can the leads be pulled out or fractured?

Comments?

[Cleveland Clinic]

BABlocker,

Even though you have a pacemaker you can still have atrial fibrillation. The Nodal ablation just stops the talk between the top and bottom of the heart to prevent the heart from racing. If you were completelty atrial fibrillation free for an extended period I would consider changing you to aspirin. This could be checked on the pacemaker interrogations. If you continued to have episodes though, I would probably keep you on coumadin, especially with your history of hypertension.

The coughing will have no effects on the leads.

good luck

[fablegirl]

hello ladies and all:

My trip to my parents was a nightmare...I developed tachycardia as soon as i got to their house...had pac's every day and night while there, and now that i am back home i am still not any better.  I am going back to the doc ASAP.  a few weird observations and questions that i have and just would love some input about:


1.  Have any of you ladies developed a sensitivity to bra's?
    Please take no offense i mean this in the most basic way.
    I seem to get more palps and tachy when i am wearing one.
     Does this sound crazy?  I am always more comfortable
     without the bra and only where one when i leave my house
    and am miserable the whole time.

2.  Is it possible that if a person has been under a lot of stress for months that this could create an overabundance of
adrenaline in the body making them have tachy and palps:  See,
my daddy had a heart attack in sept. 2005..These was only a few
days after hurrincane katrina hit and new orleans was flooded.
My parents live in louisiana and it was  a trauma for me...then
my husband was hospitalized with kidney stones....then my little
boy 3 years old got double pneumonia twice....by the time my
first attack hit i had been under 4 months of heavy and unabating stress... Then after my "atack of whatever it was"this put me in a whole other mode of stress thinking that i had a heart problem....I have not been well since that first night.  Anyone have any thoughts , comments?

[fablegirl]

my GP gave me a prescription for TOPROl XL 25mg taken once a day.  I have not taken any yet because i have read some comments that a lot of people had no luck with these things and that they can have scary side effects....I would be interested in hearing from anyone who cares to comment about their experience with this drug or other beta blockers...I have noticed that my prescription seems to be a very low dose....
MOMTO3GIRLS what beta blocker do you take, and has it helped?
And also how are you feeling, how was your trip to your DAD's.

take care and thanks for the input

[fearfactor]

Hi, I take 12.5 mg of Toprol XL per day (a very tiny dose because any more makes my BP go down too low) and it really does help with tachycardia.  My HR normally doesn't go too high, thank God, but with this med it doesn't even get up in the 120s, which is high enough to terrify me!  I haven't had any bad side effects, just some tiredness at first.  Give it a try, it may just help you!

[BABlocker]

I would appreciate that during my post that the comments pertain to my needs and to not use my post to get answers to your questions, that have nothing to do with my issues.

You can separately post your concerns, please.

[BABlocker]

Well, I can see there is no way to just post a question to the group unless it is posted when asking the Dr.

I apologize for my immediate response...it's just that I have waited almost 11 months to finally get into the forum and would like to have my time respected.

Thanks for your understanding.

[BABlocker]

I went back to read some of your posts and can read the fear and anxiety...in fact it is almost palpable, jumping off the page.

Absolutely, stress can increase adrenaline and with someone who has adrenergically based arrythmias, that stress can be a trigger.

I find the PACs, tachycardia and flutter occur during a very stressful work day.

I'm glad that you are going to see a Dr. very soon. Hopefully he will run the battery of cardiac tests we have probably all had the opportunity to be familiar with (stess test, echo, ekg) and if all points to a healthy heart, then the next step is to work with a cardiologist you trust and find medication that can reduce your symptoms, as well as making lifestyle changes.

Hang in there...I can relate to the feeling of being at the bottom trying to find the light in the situation...with six hospitalizations last year, almost dying, and finally a pacemaker, I've had to conquer my fears and anxieties...still in the process in fact.

Again, sorry for my harsh words about your post and for your stressful situation.

[bama jane]

For both people that posted I am sure this is very stressful.  I can sympathize with you both since I have several arrhytmias and have had a failed ablation attempt. In answer to fable girl I find that bending over or things too tight around the waist can cause me problems with skippd beats.  I get extra beats during exercise and  and sometimes it just takes off (too fast for the amount of exercise) and sometimes it just takes off for no reason. I can be laughing and having fun or sleeping. This is a real quality of life issue for people. I have learned a lot from reading what other people do on this forum and talking to other people with rhythm problems. Why was your av node ablated?  One of my rhythm problems is accelerated junctional rhythm at times.  I have quite a few and I don't understand them all.  Sinus tach, atrial tach, wandering pace maker, pvc's pac's, trigeminy, bigeminy,junctional rhythm, acclerated junctional rhythm, couplets, and sinus arrhythmia. What I do not understand is why so many in what is supposedly a  structurally normal heart. Good luck to both of you!

[fablegirl]

so sorry to hear that your question had not been answered.  I do not ever mean to infringe on anyone else's time, and respect that you are frustrated.  I have not posted my questions to the
doctor so please don't worry about my question being answered before yours.  I just post my comments to the other fellow sufferers like me.  I had a full cardiac workup several months ago and was told all was fine.  They all said ANXIETY...i guess its hard to believe all is fine when your heart seems to pound and race ect.  Maybe i shouldn't do it, but it gives me comfort being able to send notes to other people with these issues. I hope the doctor's answer your question quickly and hope you feel
better soon.     fablegirl

[BABlocker]

My AV Node was ablated because my atrial fibrillation could not be controlled, despite multiple ablations, antiarrythmics and hospitalizations that seemed to occur no more than 10 weeks apart for 8 months.

I was told that a third ablation would unlikely be much more successful and my recovery periods post ablations were hell, and my arrythmias were worsening.

After a TEE when I had a near fatal blood reaction to the local anesthetic, and after my heart started exhibiting heart rates of 30s to 250 despite antiarrythmics, I made the choice that I wanted my life back.

A controversial decision for most people, but my quality of life was gone, I had lost my job and the stress was almost unbearable.

Today, 10 months later, I have my life back, the pacemaker and meds are doing a great job in curtailing my arrythmia most of the time and I am able to live the life of an active 49 year old again.

I've made some lifestyle changes...I now work as a Licensed Clinical Social Worker in an inpatient unit as a part time person rather than full time, allowing me to go home and take care of other needs. I exercise daily with some of that extra time and the stress level reduction has been a contributor, I believe, in my recovery and clinical picture today...

Thanks for the well wishes...the same to you as well.

[dmil241]

I've got a question for you all about the PAC's and PVC's. My cardiologit told me I get mainly PAC's. In fact one day I went in because my heart was fluttering away and they did an EKG and it showed a PAC averaging about every 7th beat. That was after it had settled down to almost nothing. So he told me that I was probably having them every other beat when they were at there worst. Well the last six weeks have been a VERY quiet time for them and I have been THRILLED. However the appear to be rearing there ugly head again BUT I am feeling them differently it seems. Whereas in the past when I feel my pulse, it feels like three rushed beats lately it seems like a pause then a beat. It is like beat...beat...beat.......beat...beat...beat. Before it was like beat...beat...beat,beat,beat...beat...beat. Is that understandable? MY question is: Is that still a plain old PAC or possibly PVC or is something else going on? It is like me heart is waiting to beat again...like it is taking longer instead of being an extra beat? Is that still benign? It is scaring me a bit but I don't want to go into an all out panic if it is still just the same old thing.

[bama jane]

I am so glad to hear that you got your life back.  Sounds like you have been through a lot. My husband and I have talked a lot about at what point I would go through another ablation attempt. It is good to hear that you finally found some help and are feeling better.  I hope you continue to get better each day!

[momto3girls]

Hi,

Boy I'm always amazed to hear of a new person suffering with these little buggers because it sounds so similar to what I experience.  I have both pac's and pvc's.  For me, pac's always feel like a flutter and my heart trying to catch up.  When I feel a pvc, it's like a regualar beat and then THUMP, a big THUMP, and pause and back to normal.  I have had the sensation of numerous flutters in a row and it makes me catch my breath.  Not fun, is it.  My cardiologist says it's very normal to feel the compensatory pause, like your heart is catching up to that extra or missed beat.  Very weird feelings but my doctor has told me time and again (after echo's, ekg's, stress-echo's, holters, event monitors and nuclear stress test) all are benign.  My heart is structurally normal, always good to know, so they are benign.  I will say this, they sure as heck don't FEEL benign when they happen!  I am finally to the point where I get them, and say, hey that was a pretty good one (:  It's so hard to ignore them, I know, and mine tend to act up around my period or when I'm stressed or while trying to sleep!  Good luck to you, you are in good company here (:

[momto3girls]

Hi Bablocker,

I truly hope you feel better soon.  Just wanted to chime in...I too have really crappy hdl, mine is in the low 30's and I am considered pre-diabetic.  Mine is controlled with diet and exercise as well. What dose of Niaspan are you on?  What were your hdl #'s before going on it?  My cardiologist is suggesting Niacin to try and raise mine. Best wishes to you (:

Hi there Fablegirl,

I'm so sorry your trip was awful, heart-wise!  I really notice that stress aggravates mine.  I too traveled over 6 hours, alone with my kids, and had chest pain while driving.  I know it was because with each hour that passed, I was further from my husband.  Anxiety is such a nasty beast and can further aggravate and highlight symptoms.  About bra's...I have costochondritis so wearing one isn't too comfortable.  I don't notice any more or less palpitations with one or without.  I am very sorry to hear of your dad's heart attack, not to mention the other stresses you've been dealing with.  Again I really (for me) think that stress makes it so much worse.  I don't notice any weird food triggers at all, just stress.  The best thing I could do was get my butt in a gym!  I felt like I was at least doing something to combat all these weird palpitations, almost like proving I wasn't going to drop dead (:  I truly understand everything you're feeling about these palps though.  Good luck at the doctor, be up front and honest about your fears with him/her.  Best wishes and let us know how your dr. visit goes (:

[PikaPika88]

I wonder, could any chance an accessory pathway will grow after the AV node ablation?  Just curious.

[bama jane]

Do you get palps, racing, during exercise or chest discomfort while on the treadmill?  BetaBlocker, did the insertion of the pace maker stop you from feeling the afib?

[Momto3]

When I feel a pvc, it is like my heart pauses (or skips) a beat.  I remember being so surprised when the doctor told me that I was actually throwing EXTRA beats.  Weird.  Despits having over 20000 per day, they were still considered benign.  Hope that helps : )

[Joan991]

A related discussion, av node ablation was started.