Tachy-Brady syndrome

[jbs5315]

I am a 63 year old male, in good health and condition, who runs 4 miles every other day to relieve stress and stay fit, and have been doing so for 30 years.  I have just been diagnosed as having Tachy-Brady syndrome.  Symptoms include feeling my heart beat (HB) and occasional lightheadedness almost to point of passing out (but no incidents of such yet).  These episodes occur most frequently after a meal and can last 30 minutes to several hours.  I wore a 'King of Hearts' (KOH) monitor for a week and the results showed rapid HBs followed by pauses of 3-4 seconds with no heartbeats, almost always in that sequence.  Pretty consistent results over the 5 recording sessions on the KOH.  My cardiologist has recommended a pacemaker (PM) to control the slow HB and then medication to control the rapid HB.  My Mom had a PM implanted at age 70 for similar reasons and my Dad died of a stroke at age 65. Both were heavy smokers and I have never smoked.
Questions (all related) I have are:
1. Is there any other treatment?  I've read some about Cardiac Ablation.  Is that an option?  Any other treatment options?
2. Are their any nutritional supplements that might restore regularity to my HB? Any naturopathic treatment options?
3. Does this syndrome increase my risk of stroke?
4. Does this condition ever get better on its own or will it keep getting worse?
5. Do the rapid HBs cause the slow HBs or are they totally independent?  
6. If I take medication for the rapid HB without having the PM will it cause even slower HBs on the other end?  

My cardiologist feels I should have the PM implanted ASAP. I've scheduled a second opinion appointment but have to wait 2 weeks.  Should I wait for the second opinion or proceed quickly.

Thanks.

[Michael J. McWilliams, M.D.]

1. Is there any other treatment?  I've read some about Cardiac Ablation.  Is that an option?  Any other treatment options?

It depends on what the monitor shows. If you are having bouts of atrial fibrillation and pauses when you convert to normal rhythm, an ablation of the atrial fibrillation is reasonable.  The risks of pacemaker implant are less than the risks of the atrial fib ablation.  If the rhythm that you have is an atrial tachycarida, that would be more difficult to ablate.  Atrial fib ablations are anatomical, you can ablate them if you are not in atrial fib. Atrial tachycardia ablations would require that you are in atrial tach to localize it.  

2. Are their any nutritional supplements that might restore regularity to my HB? Any naturopathic treatment options?

No.

3. Does this syndrome increase my risk of stroke?

If it is atrial fibrillation, yes, you have an increased risk of stroke.  If it is atrial tachycardia or another SVT, they do not increase your risk of stroke.  The risk of stroke with atrial fibrillation increases depending on the number of risk factors you for stroke (heart failure, hypertension, age greater than 75, diabetes, previous stroke).  Ask your doctor if you have atrial fibrillation.

4. Does this condition ever get better on its own or will it keep getting worse?

It does not usually get better on its own.

5. Do the rapid HBs cause the slow HBs or are they totally independent?  

It depends on the rhythm.  As we get older, the sinus node (origin of normal heart beats) is slower to respond.  The faster heart beat suppresses sinus node activity. If you have sinus node dysfunction, the rapid rate can suppress the sinus node and cause these long pauses.  If you can get rid of the rapid rates with ablation, the sinus node dysfunction would not be as significant.    The pauses could be from other causes like your AV node (conduction point between up and lower chambers).  It would be easier to tell you the mechanism if I saw the strips.

6. If I take medication for the rapid HB without having the PM will it cause even slower HBs on the other end?  

I would not do that.  You risk causing longer pauses and if your pauses are any longer, you are likely to pass out.

If you wait, you will accept the risk that you may fall or pass out.  Your doctor is probably right, but it might be worth a second opinion.  If you talk to your primary care doctor, he might be able to get your a consult with an electrophysiologist faster.  If a primary care doctor called me and said I need you to see this person tomorrow, I would see the person the next day.  Doctors don't usually ask these things so when they do, you assume it is very important and see that patient ASAP.

I hope this answers your questions.  Good luck with your decision.  I wish you all the best.

[AJY]

A related discussion, Superventricular tachycardia and sinus tachycardia with braycardia episords was started.