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sinus node dysfunction after ablation
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sinus node dysfunction after ablation

I had an ablation of atrial fibrillation in 1992, I was in my early 40s and the fibrillation was present from birth.  Actually, the area was ablated twice because the group of cells was larger than normal.  

Now, I'm nearing 66 years and experiencing unusually slow, irregular pulse rates, fatigue, exercise intolerance, etc.  I'll be having an echocardiogram and treadmill test later this week.  My current cardiologist suggests Sinus Node Dysfunction as the cause of these current difficulties.

So, I'm learning about Sinus Node Dysfunction and pacemakers.  Are there different types of pacemakers?  What are the advantages/disadvantages of each?

And I have quite a few thoughts on how to fix the darn thing myself!  Could a little coffee help?  Can sinus node function be improved by cardio exercise?  (cardiologist says no) Could loosing weight help? - OK, couldn't hurt. . .  Does sleep apnea contribute to the problem?  How about over the counter supplements?  For instance, I found that regular anti oxidants helped during the years of atrial fibrillation.

Thanks for any suggestions or advice you may have.  Linda
Tags: sinus, sinus node dysfuntion, Ablation, cardiologist, sleep, Exercise
Avatar_dr_m_tn
Dear linda631,

Thank you for your question. I'm sorry to hear about your rhythm problems and symptoms. Hopefully your visit to the cardiologist will answer most of your questions. It sounds like you are on the right track with an echocardiogram and stress test: both will provide important information. The echocardiogram is helpful in understanding your pump and valve function, while the stress test will allow your cardiologist to see what happens with your heart rate during exercise. Depending upon the type of exercise test, your cardiologist may also gain indirect information on blood flow to the heart and whether disease in the coronaries (blood vessels supplying your heart) is likely. Your question about whether cardio helps improve your heart rate will in part be answered by the response of your heart in the stress test. However in general terms, cardio by itself will not be a long-term solution in patients with significant sinus node dysfunction as it doesnt address the underlying problems with the electrical circuits in the heart which can progress over time.

In addition to these cardiac tests, your evaluation (either with your cardiologist of family doctor) should exclude other reasons for fatigue. Common things that can be easily excluded with blood work include anemia, low iron, and changes in thyroid and kidney function. Factors that can influence heart rate and rhythm should also be checked, including the balance of potassium, magnesium, and calcium in your body. Thyroid function is again important here. A history of chest pain warrants further assessment. An inability to lie flat in bed at night, and swelling in the ankles or tummy should also be reported to your doctor. Let him/her know if you have experienced fainting episodes or near-fainting episodes: this can be important information for deciding on whether you require a pacemaker. Finally, a review of your medications is vital because a slow heart rate can improve following adjustment of contributing medications.

You mention obstructive sleep apnea - if this is suspected on the basis of snoring and periods of non-breathing ('apnea') a sleep study would also be indicated. There is a link between sleep apnea and changes in heart rhythm, including sinus node dysfunction. Whether this link is important in your case will be best answered by your cardiologist after all of your test results are back.

If you copy and paste the Cleveland Clinic link below into your browser at the top of your computer screen, it will take you to an overview of different kinds of pacemakers:

http://my.clevelandclinic.org/heart/services/tests/procedures/pacemaker.aspx


Of course we might be putting the cart before the horse here because it's not clear that you require a pacemaker. The decision to implant a pacemaker is not a simple one and so again I would recommend direct discussion with your cardiologist.

Interestingly, an increase in 'oxidative stress' has been associated with atrial fibrillation and there is increasing interest in how to counteract these markers of inflammation. It appears that commonly used medications such as cholesterol lowering drugs (from a family called 'statins') and blood pressure medications (such as 'ACE inhibitors') reduce atrial fibrillation in some settings by virtue of their antioxidant effects. Compared to atrial fibrillation, the evidence for oxidative stress being involved in sinus node dysfunction is less clear and I'm not aware of any specific medications (over the counter or otherwise) that would be of benefit.

From the tone of your email you sound motivated and interested in understanding your treatment options. Keep up the good work.

Take care and good luck.
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