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?

[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.

[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]

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.

[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!