Pacemaker or Not??

[BillyboyAA]

Hi, I have written a few times in the past about my having a slower than normal heart rate.  I am 34, 5'9", 160 lbs. and in pretty good shape.  I have a resting rate of about 45.  I have been to two different cardiologists and two EP doctors.  The two cardios think I have a low rate due to conditioning.  I am by no means an olympic athlete.  The two EP doctors, one being Dr. Sergio Pinski of the Cleveland Clinic Florida, think even an EP study is not warranted for me.  I recently had a stress test due to what they have called me having, "wandering atrial pacemaker" and "ectopic atrial rhythm".  They noticed on my EKG's that most of my P waves are inverted.  On the stress test my heart rate increased to about 150 BPM, but my sinus node didn't kick in until about 110-120.  He seemed not the least bit concerned about this.  I am still scared that I need a pacemaker.  Is this abnormal, that my sinus node doesn't work as it should in a normal situation?  Dr. Pinski says if I keep going to Cardiologist, I will find a bad doctor who will just put one in me for no reason.  Is what I have considered "normal?
Do you think I might eventually need a pacemaker?  Can Zoloft cause this to happen?  Can my heart just stop beating on it's own because of the sinus node not functioning?  Sorry for all the questions, I just am seeking reasuurance.  Have you ever seen this before, the sinus node not working during excercise, but the heart rate increases like it's supposed to?  PLEASE HELP ME, I AM SO SCARED OF THIS KILLING ME>  Thanx a million

Billy....
PS>  Does this sound like SND??

[arthur]

Have you contacted Dr. Marchlinski at the Univ of Penn Hospital?
I got the impression from his incredibly huge publication list that he has a very large staff with tons of experience in a variety of arrhythmias.  Personally, he struck me as being quite intelligent and perceptive...perhaps he can help you.

-Arthur

[arthur]

After the first bout with PAF, I spent about a year reading medical literature, talking with cardios (and EPs), and yes, even perusing the Web.  By year's end, I had gone through about 6 episodes.  The latest cardio suggested I go to an experienced EP, and sent me to Dr. Francis Marchlinski at the Univ of PA (Philadelphia).  He is head of a cardiology center well-experienced in these matters, and was able to diagnose my exact condition immediately (I did provide him with copies of all my tests).  As is often stated in this forum, the best place to go to for these types of problems is a big center with lots of experience.

Procedure choices were few and were provided by Dr. Marchlinksi.  In my case, it was a choice between drugs for life, or an EP evaluation (to confirm the diagnosis and to set up a protocol for an ablation), so I took the evaluation...which led to the rf ablation a week later.  I think if you are considering an ablation, it should be preceeded by an "mapping" study wherein the EP figures out what can actually be done, at which point you should be able to decide whether to go forward or not.

I wish you the best.

-Arthur

[Cathy7]

Thanks for the input, Arthur.  

The options I listed for my PAF were given to me by the second EP doc that I saw.  My cardiologist gave me the names of two EP docs and I saw them both.  The first one just gave me like five Rx's that just made me sick.  The second one gave me these options.  

When you went for your RF ablation, how did you decide which procedure to have?

Thx,

Cathy

[pat57]

Hankstar.What is increased vagal tone, is that vaso constriction or something similar? I did try to "ask Jeeves", but no luck, and a search bore the term but not the definetion.

Thanks

And Billyboy,
Since you get dizzy you might want to ask about a Tilt table test re vaso deppressor problem.Also Orthostatic Hypotension. And since I see that you are worried- don't be, neither of the two things above, are dangerous but can cause dizziness.

Good luck

[arthur]

I had paroxyzmal AF and it was cured by rf ablation of the offending foci located in a pulmonary vein ostium (connection to the rear of the left atria in my case).  No meds, no pacemaker, and no more AFib.  I understand that success using rf ablation varies from case to case, however, the stats suggest a very good chance of cure for folks having PAF, and less chance for those with a persistent AF.  One reason for this is an electrical remodeling which tends to occur with repeated AF.  If I were you, I would ask your cardio for a referral to the best EP (electrophysiologist) he/she knows, in order to be evaluated for this type of treatment.

My first experience with a cardio was after my first AF episode, and his suggestion was to consider the course of action you described in your note.  Needless to say I went into immediate anxiety mode.  Please get a second (or third) opinion from a specialist in these matters (an EP).

-Arthur

[Cathy7]

I am a "young" 55 year old, active, energetic lady with no other health problems.  I have paroxysmal atrial fib that is occurring more often (about every other day) and for longer (about 8 to 18 hours) before it converts to normal on its own - or I have to take a Klonopin (plus my regular 800 mg magnesium glycinate and Benadryl) to get to sleep.  I have passed out a coupla times.

My question is:
Among the options (ablation of right atrium, ablation of both atria) he said a pacemaker could be inserted. He said they would disconnect the communication between the atria and ventricles and insert a pacemaker so that even if the atria still go into AF, the ventricles would beat OK.  

He said I would have to be on Coumadin and heart meds forever after the other two procedures, but only be on Coumadin after the pacemaker insertion.

Does that sound right?

I'm looking for the option that will make the AF GO AWAY, and I don't need to take meds ANY MORE.

Is there such a thing?

Thanx,

Cathy

[BillyboyAA]

Thanx again Hank, you are always here to help me out when I need it.  I have been complaining for years about being lightheaded and dizzy, but have never passed out.  Everyone seems to think it is anxiety and stress.  Oh well, I hope they're right...

Billy

[BillyboyAA]

Just came back from the doctor and had another EKG done and it said at the top Junctional Bradycardia with a rate of 43.  On my last holter, my average rate was 45, so this is nothing new for me.  Every test I have a copy of, from the two different cardiologists say, sinus bradycardia.  Why all of a sudden am I not in a sinus rhythm.  Please help me......

Billy

[Cleveland Clinic]

Billy,

relax. stop. go no further for the time being.

You do not need a pacemaker. Dr. Pinski is right, if you look hard enough you can pretty much find a doc that will do crazy or uneccessary procedures.

Zoloft is not causing this.

Your heart will not stop beating.

In a nutshell, your heart is responding like it should, so relax, exercise and enjoy.