sinus node modification

I am a 43 yr scottish female with IST who had a sinus node modification 4 weeks ago for highly symptomatic and medically refractory IST. At the time the procedure was considered very successful. With the final infusion of isoproterenol my heart rate would not go above 130 (i believe it was 170 pre-procedure). After, for 4 days i felt better than I'd felt for years, more alive, not fatigued, not breathless, had energy. Can more or less put it down to within an hour when it reverted back and felt awful again. i have a loop monitor implanted and my downloads now are similar to those pre-op with all my symptoms having returned.Fastest recorded is 158 and all i did was stand up.I'm having frequent periods where my resting rate lying in bed is between 90 an 100 for hours. Minimal activity it shoots up giving me pre-syncope, nausea, chest pain and tightness, dizzy, forcing me to lie down fast to avoid passing out. Not currently on any rate reducing medication. The only success we had was on a combination of Ivabradine 5mg 2X daily along with Verapamil 80mg 3x daily but devolped pauses up to 5secs with associated syncope. Wha do you think the next step should be. Many Thanks

[leonel]

Hi, I have been thru some hellish tachy episodes myself. Additionally, I developed high blood pressure. For this I was put on a med called atenolol, which did not work at all, then switched to nadolol, with which I stayed for 10 years until Bristol discontinued it. Now I'm taking bisoprolol and my episodes are not so awful but they still come out of the blue, especially at night. Have you considered going on a betablocker like nadolol? Actually they can be associated with ivabradine, that would boost the bradicardic effect in my book. I have not tried verapamil or diltiazem, are they any good? Get better soon, all the best! Leonel