Aa
Staying in irregular rhythms
When i visited a different cardiologist couple weeks ago, he said that while i had a junctional rhythm, it didn't sound like something that was a danger...His wording was "The heart rhythm textbook is 6 inches thick and your rhythm is in chapter 1"...He also said "if you are given medication for this rhythm doesn't mean it will go away, but if you don't take any medication, it does not mean you'll die"...My echo, which was 2nd one i've had, was completely normal..This doctor is not an EP, but he mentioned if an ablation is done, it could work, but if it doesn't could need pacemaker for life, so don't like those odds..
1. If you have a completely normal echo, can one sustain long episodes of juncitonal and/or A-Tach, or at some point must all rhythms be dealt with, with treatment?...
1. If you have a completely normal echo, can one sustain long episodes of juncitonal and/or A-Tach, or at some point must all rhythms be dealt with, with treatment?...
Now I'm throughly confused...the cardiologist sent this report (its very long so I'll edit) to my PCP after our visit::
"I had the pleasure of seeing your patient, (name withheld) today in office for follow up...As you know, he has been evaluated by our group for some time...He has a long standing history of palpiatations some were associated w/isolated atrial and ventricular ectopy but also related to a mildly increased heart rate secondary to junctional tachycardia...His father died of sudden cardiac death (at 48) which has increased his anxiety over his palpitations..He has had a recent echocardiogram which demonstartes normal LV function...Most recent rhythm strips demonstrate junctional tachycardia...He has no history of dizziness or syncope w/his palpitations..He reports no chest pain..
I talked with him about the physiology of this and why he is so symptomatic...I provided reassurance that his rhythm issues were not dangerous...I talked with him about his low risk for sudden caradic death and i suspect that his father died of an acute myocardial infaraction w/ventricular fibrilation rather than a primary arrythmia..I told him about the option of an EP study and possible ablation recgonizing the potential risk for pacemaker given the proximity of the source of this arrythmia to his AV node..I also talked w/him about limiting his caffeine intake...Thank you for allowing me to partcipate in his care"....
"I had the pleasure of seeing your patient, (name withheld) today in office for follow up...As you know, he has been evaluated by our group for some time...He has a long standing history of palpiatations some were associated w/isolated atrial and ventricular ectopy but also related to a mildly increased heart rate secondary to junctional tachycardia...His father died of sudden cardiac death (at 48) which has increased his anxiety over his palpitations..He has had a recent echocardiogram which demonstartes normal LV function...Most recent rhythm strips demonstrate junctional tachycardia...He has no history of dizziness or syncope w/his palpitations..He reports no chest pain..
I talked with him about the physiology of this and why he is so symptomatic...I provided reassurance that his rhythm issues were not dangerous...I talked with him about his low risk for sudden caradic death and i suspect that his father died of an acute myocardial infaraction w/ventricular fibrilation rather than a primary arrythmia..I told him about the option of an EP study and possible ablation recgonizing the potential risk for pacemaker given the proximity of the source of this arrythmia to his AV node..I also talked w/him about limiting his caffeine intake...Thank you for allowing me to partcipate in his care"....
It is possible that you misunderstood your doctor, or perhaps that he did not know what he was looking at. Let me explain...
First, you comment on junctional rhythm. This is a rhythm where the AV node (the junction of the atria and ventricles) is the initiating site of the electrical signal which goes to the ventricles, instead of it starting in the atria. There is no medication to treat this, and no ablation procedures. Junctional rhythms occur because there is no stimulation from above (the atria, which typically has the fastest timer in the heart) so the next fastest site (the AV node) kicks in to stimulate the ventricles. Sometimes this is caused by disease or medications which slow the signal start in the atria so the AV node has to kick in. If medications are being taken to slow the heart, they should be stopped to see if no further junctional rhythm is noted and allow the normal electrical signal to occur. If the heart rate is slow enough to cause symptoms (lightheadedness, passing out, chest discomfort or other symptoms), then pacemaker may be indicated to prevent your rate from getting too low (junctional rhythm is usually in the 40s-low 50s).
Atrial tachycardia (atach) is a completely different rhythm, where the atria are going too fast, thus causing your heart to race (junctional rhythm is slow and not from the atria).
A normal echo is a good thing. Despite this, if the arrhythmia (whatever it is) is causing symptoms, then it may need to be treated with medications, ablation, or device.
In your situation, it may be advisable to see an electophysiologist (EP) who can evaluate your rhythm, determine exactly what you have, counsel you on what it is and how to manage it, and from there determine if you need any procedures.
First, you comment on junctional rhythm. This is a rhythm where the AV node (the junction of the atria and ventricles) is the initiating site of the electrical signal which goes to the ventricles, instead of it starting in the atria. There is no medication to treat this, and no ablation procedures. Junctional rhythms occur because there is no stimulation from above (the atria, which typically has the fastest timer in the heart) so the next fastest site (the AV node) kicks in to stimulate the ventricles. Sometimes this is caused by disease or medications which slow the signal start in the atria so the AV node has to kick in. If medications are being taken to slow the heart, they should be stopped to see if no further junctional rhythm is noted and allow the normal electrical signal to occur. If the heart rate is slow enough to cause symptoms (lightheadedness, passing out, chest discomfort or other symptoms), then pacemaker may be indicated to prevent your rate from getting too low (junctional rhythm is usually in the 40s-low 50s).
Atrial tachycardia (atach) is a completely different rhythm, where the atria are going too fast, thus causing your heart to race (junctional rhythm is slow and not from the atria).
A normal echo is a good thing. Despite this, if the arrhythmia (whatever it is) is causing symptoms, then it may need to be treated with medications, ablation, or device.
In your situation, it may be advisable to see an electophysiologist (EP) who can evaluate your rhythm, determine exactly what you have, counsel you on what it is and how to manage it, and from there determine if you need any procedures.
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