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Heart Disease (Expert Forum)
sinus node recovery
Answered by
Cleveland - OH
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sinus node recovery
by KAD, Feb 07, 2005 12:00AM
Hi, I am a 27 yo female who has had 2 sa node ablations for iappropriate sinus tachycardia. A week after the second ablation I dropped into a juctional bradycardia and subsequently needed an AAIR pacer placed for brady and chronotropic incompetence. About 3 weeks ago my inappropriate sinus tach returned. Resting HR 120-130. Have mild dizziness and moderate fatigue again. but symptoms are not as bad as initial IST. My questions are:
1. MDs are encouraging me to go for yet a 3rd ablation. I am very reluctant considering the first two did not work. I have tried timolol, metoprolol, flecainide, propanaolol, and cardizem with little to no success. One of the EP's in my EP doctors group said don't go for ablation again, but my EP encourages it. EP is also worried about hitting phrenic nerve. I don't think I should go, but what is your opinion?
2. My EP said that with a decade of rates in 120-130's I can develop cardiomyopathy. Is that true? Is their a certain number for the HR that will cause cardiomyopathy?
3. I am OK with just not treating this condition at all and learning to live with it. Is that a feasable option?
4. Pacer issue. If I am planning on just toughing the IST out, should I have the doctors remove the pacer ASAP, while it is still possible to remove it? It was just put in beginning of November.
5. A lot of times I have checked my BP and it has been on the high side. Especially the second number 130-170's over 90's-100's. Is that common with IST?
6. Should Dr's do a tilt table test to sort out POTs vs. IST? Thanks!
1. MDs are encouraging me to go for yet a 3rd ablation. I am very reluctant considering the first two did not work. I have tried timolol, metoprolol, flecainide, propanaolol, and cardizem with little to no success. One of the EP's in my EP doctors group said don't go for ablation again, but my EP encourages it. EP is also worried about hitting phrenic nerve. I don't think I should go, but what is your opinion?
2. My EP said that with a decade of rates in 120-130's I can develop cardiomyopathy. Is that true? Is their a certain number for the HR that will cause cardiomyopathy?
3. I am OK with just not treating this condition at all and learning to live with it. Is that a feasable option?
4. Pacer issue. If I am planning on just toughing the IST out, should I have the doctors remove the pacer ASAP, while it is still possible to remove it? It was just put in beginning of November.
5. A lot of times I have checked my BP and it has been on the high side. Especially the second number 130-170's over 90's-100's. Is that common with IST?
6. Should Dr's do a tilt table test to sort out POTs vs. IST? Thanks!
Doctor's Answer
by Cleveland Clinic, Feb 07, 2005 12:00AM
, Feb 07, 2005 12:00AM
KAD,
You've been through a lot.
1. MDs are encouraging me to go for yet a 3rd ablation. I am very reluctant considering the first two did not work. I have tried timolol, metoprolol, flecainide, propanaolol, and cardizem with little to no success. One of the EP's in my EP doctors group said don't go for ablation again, but my EP encourages it. EP is also worried about hitting phrenic nerve. I don't think I should go, but what is your opinion?
Its a difficult question and one I couldnt attempt to answer without reviewing the previous data and sitting with you to discuss in detail how this has effected you in the past and currently. I think it would be a reasonable option to seek a second opinion from a tertiary referral center. A new set of eyes might help make the decision easier.
2. My EP said that with a decade of rates in 120-130's I can develop cardiomyopathy. Is that true? Is their a certain number for the HR that will cause cardiomyopathy?
Yes, you can develop a cardiomyoapthy related to the extended periods of teachycardia. There isnt a strict cut off for heart rate, instead it is probably related to the extended periods fo time when the hear rate is elevated inappropriately.
3. I am OK with just not treating this condition at all and learning to live with it. Is that a feasable option?
Point number 2 is an important one. I would need to have a comfortable reassurance that you were not racing too often. Holter monitoring might help with this. Again, I think a second opinion would be beneficial for you.
4. Pacer issue. If I am planning on just toughing the IST out, should I have the doctors remove the pacer ASAP, while it is still possible to remove it? It was just put in beginning of November.
Probably not, but I cant answer specifically. If you needed it when it was put in, odds are you are going to need it again in the near future.
5. A lot of times I have checked my BP and it has been on the high side. Especially the second number 130-170's over 90's-100's. Is that common with IST?
No, not particularly. But it is worth evaluation and possible treatment.
6. Should Dr's do a tilt table test to sort out POTs vs. IST?
They may not separate out. Alot of people with positive tilts can have other diseases as well. For this reason I wouldnt recommned just getting a tilt test, but do recommend a second evaluation.
good luck
You've been through a lot.
1. MDs are encouraging me to go for yet a 3rd ablation. I am very reluctant considering the first two did not work. I have tried timolol, metoprolol, flecainide, propanaolol, and cardizem with little to no success. One of the EP's in my EP doctors group said don't go for ablation again, but my EP encourages it. EP is also worried about hitting phrenic nerve. I don't think I should go, but what is your opinion?
Its a difficult question and one I couldnt attempt to answer without reviewing the previous data and sitting with you to discuss in detail how this has effected you in the past and currently. I think it would be a reasonable option to seek a second opinion from a tertiary referral center. A new set of eyes might help make the decision easier.
2. My EP said that with a decade of rates in 120-130's I can develop cardiomyopathy. Is that true? Is their a certain number for the HR that will cause cardiomyopathy?
Yes, you can develop a cardiomyoapthy related to the extended periods of teachycardia. There isnt a strict cut off for heart rate, instead it is probably related to the extended periods fo time when the hear rate is elevated inappropriately.
3. I am OK with just not treating this condition at all and learning to live with it. Is that a feasable option?
Point number 2 is an important one. I would need to have a comfortable reassurance that you were not racing too often. Holter monitoring might help with this. Again, I think a second opinion would be beneficial for you.
4. Pacer issue. If I am planning on just toughing the IST out, should I have the doctors remove the pacer ASAP, while it is still possible to remove it? It was just put in beginning of November.
Probably not, but I cant answer specifically. If you needed it when it was put in, odds are you are going to need it again in the near future.
5. A lot of times I have checked my BP and it has been on the high side. Especially the second number 130-170's over 90's-100's. Is that common with IST?
No, not particularly. But it is worth evaluation and possible treatment.
6. Should Dr's do a tilt table test to sort out POTs vs. IST?
They may not separate out. Alot of people with positive tilts can have other diseases as well. For this reason I wouldnt recommned just getting a tilt test, but do recommend a second evaluation.
good luck
Sounds like you have some pretty tough decsions to make. When did you notice you had IST? And how long would this last? Was there a trigger specifically?
regards