Bardy monitor results

Hypotension

by AgentX86 - 2023-05-01 00:19:47

Pacemakers rarely affect blood pressure.  BP is controlled mainly by the parasympathatic nervous system. Beta blockers stabilize/slow nerve response so lower heart rate and BP.

Atrial rates that high sound like flutter.  A short run like that probably wouldn't be symptomatic but it doesn't take many (1) PVCs to get your attention. If I have one PVC in ten beats, I feel short of breath.

Gallery

by Mae11 - 2023-05-01 09:27:09

I was highly optimistic switching to the CLS, hoping it would mostly resolve my issues. I don't have a significant improvement in the extreme fatigue or orthostatic tolerance, but haven't had a syncope episode since we tried turning it off. 

As you suggest, I wasn't symptomatic enough to activate a recording during the AT. Most of my button pushes were for runs of PVCs and sustained tachycardia between 130 and 140. 

I'm going to add an image of the AT recording and would love your thoughts I it looks like flutter or not.

you will find a way through this

by Gemita - 2023-05-01 11:35:02

Hello Mae, nice to hear from you and I am sure you are making progress even though it may not feel like it.  Yes please do post an ECG in the Gallery for us all to have a look at and give an opinion.  At least I will try with my limited ECG reading ability!

What treatment options for your assortment of arrhythmias are available?  Firstly depends on how poorly you are tolerating your symptoms?  If high rates are only occurring intermittently for very brief periods and you tolerate any symptoms well, I would probably say do nothing and see if they resolve naturally, but if your symptoms are really troublesome, I would ask your EP what additional treatments are available.  I believe you were about to trial the med Ivabradine?

It sounds to me from your post that your ectopics might be causing as much trouble for you as are your tachycardia events.  The ectopics may even be triggering your tachycardia in some instances.  This is clearly my experience with my atrial ectopics for example.  My solution:  a higher base rate setting - 70 bpm - together with lower doses of my beta blocker are really helping to keep my arrhythmias under control.  I am now only on low dose Bisoprolol and actually my symptoms have vastly improved and my arrhythmias are still well controlled.  My theory is that as my heart rate falls during rest, my arrhythmias become more active. I have confirmed bradycardia induced arrhythmia, so by keeping my heart rate slightly higher I can prevent some of my arrhythmias from being triggered. 

Since we both share a health condition - Ehlers Danlos - I wonder whether fewer meds or reducing your medication doses over a long period, might help you too?  It is worth discussing all these possibilities with your EP before you go down the ablation route. 

Ultimately an ablation might be recommended, but there is always a risk since IST can be difficult to stop in the long term, with a high recurrence rate. Personally I would continue to try experimenting with medication, lifestyle changes and with your pacemaker settings before going down the ablation route, especially if your symptoms are reasonably well controlled?  But listen to what your EP suggests and please let us know what he recommends?

As always I hope for the very best for you Mae.   Remember to trust yourself, since you know yourself best.  You will find a way through this.

Quality of life

by Mae11 - 2023-05-01 12:22:22

Thank you Gemita, as always for your thoughtful words and experience. I feel at this point, I am willing to do anything to have my quality of life back. I am really struggling! The orthostatic intolerance is probably the worst part, along with feeling overwhelming fatigue nearly all of the time. I have learned to pace myself and take frequent breaks, but that is so opposite of the way I functioned before! I'm not saying this is solely due to the tachy events, but I do know they are happening throughout the day and I am symptomatic during them. I have started the ivabradine and have had some relief from the tachycardia, but am still having breakthrough events and little relief from the symptoms. Which makes me question if an ablation would have a significant impact.

Our related condition was not Ehlers Danlos, but RSD/CRPS if I remember correctly. There are so many out there with related conditions, it's hard to keep them separate. 

Looks more like an "irregular" atrial tachy arrhythmia

by Gemita - 2023-05-01 12:26:15

Mae, the short strip Gallery ECG looks "irregular" to me, more like AF rather than "regular" Flutter?  However if you have fast atrial ectopics going on too (an irregular rhythm) you could be getting runs of these interspersed with any atrial tachy arrhythmia.  Both Flutter and multi focal AT can be "irregular" too just to complicate the picture.  Can anyone help please with a diagnosis?

Ectopic atrial tachycardia&ectopic atrial rhythm

by Mae11 - 2023-05-01 13:30:07

In his report he called it ectopic atrial tachycardia, but isn't it always caused by an ectopic site? I did have 34 couplet PACs, as well as the ectopic atrial rhythm while sleeping and once during the day. From what I've read ectopic atrial rhythm is the same as AT, but less than 100 bmp. I will add that strip to the gallery as well. 

Any insight from anyone else is greatly appreciated! 

Ectopics

by Gemita - 2023-05-01 13:45:32

Yes Ectopic Atrial tachycardia will originate from an ectopic site but there may be multiple sites unfortunately.  I have multi focal AT and it is truly awful when it occurs.  Yes Ectopic Atrial rhythm will be described as AT if the rate goes above 100 bpm.  I didn't know until recently that ectopics can come in at such high heart rates.  No wonder they can lead to Atrial Tachycardias and deteriorate into AF.  Sort the ectopics out and we may control atrial tachy arrhythmias like Flutter/AF.

PS Sorry about giving you the additional diagnosis of Ehlers Danlos!  You can certainly do without that and yes it was RSD/CRPS we both have in common, but I am scratching my head as to who has Ehlers Danlos now?  I will try to be more careful next time. My apologies

No apologies needed!

by Mae11 - 2023-05-01 14:21:38

Oh no worries at all! You reach out to nearly everyone on here, no need to apologize!

I can't help but wonder though, if the ectopic site as well as IST could be ablated.. would I have symptom relief??

From what I've read the new hybrid sinus node sparing ablation can be quite effective. We'll ser what my EP suggests on Thursday.

Ablation

by Gemita - 2023-05-01 14:46:15

With the right surgeon and providing they can trigger the arrhythmia (or arrhythmias) during the initial EP study which precedes any ablation and they can ablate all trigger sites, you may well be successful and have complete symptom relief.

I would ask your EP whether one ablation can fix your arrhythmias or whether you would need more than one ablation?  I was told I would probably need at least two with my several arrhythmias.  It might be that he will focus on the IST first and to see whether your other arrhythmias naturally settle afterwards, but clearly you have more than one arrhythmia going on, so an EP Study will be very helpful and give the EP lots of useful information Mae.  If you are so symptomatic, what have you got to lose?  It is worth a try if you have confidence in your EP

What have I got to lose?

by Mae11 - 2023-05-01 14:57:56

That's exactly how I feel.. what have I got to lose! All I want is an improvement in my abilities and quality of life. I was such an active person and mother,  and want that back so badly! 

He also has mentioned moving my pacemaker to my side/breast aread because of how sensitive it is/protrudes. He also saw some issues with my ventricular lead placement that he would like to fix. It would be amazing to be able to tackle all of that at once!

ECG strips

by Rch - 2023-05-01 23:37:51

Hi

I am not an expert on ECGs and the best source for you are your PCP and EP. Nonetheless to give you an opinion, the strips look like an assortment of NSR, ST, AT,  and a few beats of ectopic atrial rhythm as evidenced by the inverted p waves. I don't see any saw-tooth pattern. Once again, please discuss with your PCP or the Cardiologist who have a longer tracings and better printout than what we see on our smartphones. I hope you will have an answer soon and I wish you well.

Has Atrial Fibrillation or Atrial Flutter ever been seen?

by Gemita - 2023-05-02 05:28:09

Mae, your EP has seen your two week Bardy monitor results and his conclusion is that inappropriate sinus tachycardia (IST) is the main culprit.  He certainly didn’t mention seeing Atrial Fibrillation or Atrial Flutter which I am sure he would have reported, if found, but this is something you could ask him about on Thursday for peace of mind?  

Has Flutter or AF ever been seen on your pacemaker downloads by chance?  Your pacemaker should report on any high atrial rate episodes and log these if they meet specific parameters for their storage and recording.  Additional longer term external monitoring may be required if you think Flutter or AF is occurring.

There is no doubt that arrhythmias including benign ectopic beats can cause horrible fatigue for many of us during and for some time after any prolonged episodes, but very short runs of a “regular” atrial tachy arrhythmia, unless these are occurring round the clock, should largely pass unnoticed.

Your EP sounds very caring and honest and has told you so much, even admitting that it is hard to tell what is overdrive pacing by your CLS and what is not, so some of these short runs of tachycardia may indeed be pacemaker induced.  Hopefully your EP now has a better picture of all your difficulties, including the positioning of your device and ventricular lead.  Take one step at a time though Mae and all will be well

Thank you!

by Mae11 - 2023-05-02 08:51:09

Thank you both for your responses. I read back over his report and he says there was no atrial fibrillation or flutter. My old EP noted some atrial arrhythmias, not sure if the parameters were different or what. We shall see what he says in person on Thursday.

You are right to keep insisting on feeling good

by Gotrhythm - 2023-05-02 12:12:14

I'm not knowledgeable enough about CLS to comment on the specific arrythmias you are dealing with but I have experienced the quality of life issues that arise when there is interplay between orthostatic hypotension and arrythmias. I can't prove it, but I believe that arrythmias can trigger orthostatic hypotension, and make it worse.

Certainly, I have felt the sudden drop in BP that can accompany a run of PVCs or a tachy episode. While prolonged episodes are more dramatic, there is also cumulative exhaustion that results from having many short episodes.

Keep advocating for yourself! You are doing the right thing to keep insisting on a better outcome. I'm sure the medical professionals you are working with are doing their best, but if you can't get the answers you need where you are, don't be shy about going somewhere else.