junctional rhythm, ? pacemaker

[shans 52]

Just a brief intro for my question. I am a 31 y/o female. about 6 yrs ago I was dx with innaproriate sinus tach. I had 2 ablations a little over 1 yr apart. I had ekgs after which varied from sinus brady of about 52 to up to 120. the 120 was during a painful episode of a ? kidney stone. I went to the Dr. the other day and after an EKG she discovered I am in a junctional rythm at a rate of 42. I did do cardiplogy nursing for about 2 years so have some knowledge. I have listened to my heart for long periods of time to see what it does. At night when I awake I listened and seemend to possibly go into an atrial fib with 2-3 second pauses. This is just my assesment. I guess what I am wondering is if I may need a pacer. I have many episoed of SOB, dizzyness, fatigue, swelling in my hands and chest pain. I also have fibromyalgia and recently discovered I may have secondary hypothyroidism( they are repeating my labs and doing other pituitary labs to confirm) I would appreciate youra advice. Thank you.

[shans 52]

thank you for your comments. I am going to the cariologist tommorow, he hopes to have a 24 hour halter to put on me. I havoe noticed my heart rate all the way up to 80 after running up 2 flights of stairs but I get so sob with everything I do that I have a hard time exerting myself. I would hope maybe a pacer would get rid of my severe fatigue, my chest pains and my SOB. I am very nervous that years of my heart either going too fast or not beating fast enough to meet my bodys needs has possible damaged it. I am a worry wart and I guess I will find out more tommorow.

[Lyn2]

Hi.  I have to comment, as my experience was essentially identical.  I had 3 sinus node ablations, felt lousy after the 2nd, had severe edema, finally was given a halter monitor.  I brought it in after the 24hrs. and was called before I even returned home after dropping it off.  Apparently, my heart was stopping for 6-9 sec, I was in a junctional rythm, and I was lucky to reach a peak of 40bpm in 24 hrs.  I was sent to the hospital for a pacemaker.  Since the pacemaker, I have developed a-fib and had another ablation of the sinus node.
I had my ablation at 29, along with pacemaker implant. I am now in my mid 30s.  I am on more meds. now than before the ablation.  Maybe I should reread your post, but have you had a 24hr.halter monitor since the ablation?  I would wonder how low you go at nighttime.  I think alot of problems happen as a result of sinus node ablations, so for anyone considering it, it should be a very thoughtful decision.  I hear alot about people ending up in these exact situations.  Good luck!

[KAD]

Shans,

I had an experience very similar to yours.  Had 2 ablations for IST.  Was fine after the second one for about a week.  Then I dropped into a juctional rhythm with a heart rate of about 35-45.  I also am a card. nurse and around your age-27.  They put me on a treadmill and found that the highest they could get my rate was about-50bpm.  Not high enough, so they put a single chamber AAIR pacer in about 3 months ago.  I feel quite a bit better with the pacer in.  Not dizzy or lighheaded anymore like I was with the junctional rhythm.  Also, energy level is greatly improved.  It's ashame to have a pacemaker at such a young age, but if it makes you feel better, then what's the difference.  Here is the clencher though.  It seems like over the past few days, that my IST rhythm might be coming back.  Rates over the past couple days have been up-100-120?  Isn't that weird?  Now I have this pacer in that I possibly don't need.  Well, good luck!

[shans 52]

thank you for taking time to answer my question.

[CCF-M.D.-MJM]

I shans,

If you think you are going into atrial fibrillation, a holter monitor will help answer your question, especially if it happens every morning or frequently.  If is infrequent, you may need an event monitor to evaluate for atrial fibrillation.

Regarding the pacemaker, one of the best way to objectively evaluate heart rate related exercise intolerance is an exercise stress test.  Not to evaluate for coronary disease but to make sure your heart rate appropriately increases with stress.  If it does, a pacemaker is not necessary.

These steps should help you determine a need for pacemaker.  As always, you doctor probably has a better picture of the whole story and knows you better, so his advice may differ.

Good luck.  I hope you don't need a pacemaker--you are very young.