Is it the pacemaker?

While I was on, I figured I'd post my Bardy monitor results.. even though it leaves me with more questions than answers. In the summary it says "Although pacemaker indication states yes, there were no instances of pacemaker activity." The next line states "Symptom episodes of Ectopic Atrial Rhythm and AT may actually be atrial pacing." Maybe I'm not understanding correctly, but these seem like completely contradictory statements..  He did say in office that he was leaning towards it not being the pacemaker because of (I believe) an inverted p wave.

Only 11 episodes of atrial tachycardia, and the longest was only 11 beats, so that's good. Although the fastest was an average of 179 bmp up to 213. (Which seems impossible for the CLS to do.) Numerous episodes of sinus tachycardia up to 166 for prolonged periods. And the horrible episodes of PVCs. I'll post a picture of that in the gallery for anyone interested. He told me "Don't worry too much about your PVCs, I have patients who would be jealous of the number you have." This really irritated me because ONE PVC does not bother me, but when they are coming in every second or third beat for up to ten minutes at a time, I nearly pass out and get extremely weak. He suggested I try Flecainide 50mg twice a day to suppress them if they are bothering me that much, which has helped. I've only had a few runs of them and much shorter duration.

Still having the squeezing chest pain, so I'll be having a CT angiogram done February 9th. He says there is a possibility of "weird anatomy" or bridging or compressing of one of the coronary arteries. All I know is that it would be a relief to have a definitive answer as to what is causing it..

If you've read this far, thank you! If you have any ideas, experiences, or wisdom to share thank you even more!

 

 

5 Comments

Ectopics

by piglet22 - 2024-01-11 06:06:17

PVCs are not normal or trivial.

In people with healthy hearts and rhythm, the occasional ectopic may not be noticed, or it might be a little flutter or even felt as a skipped beat.

With a pacemaker on board, it's a different matter and can seriously interfere with the device timing to the point where you can experience significant periods of heartbeats with less than effective pumping efficiency.

This leads to low blood pressure, poor circulation, and the inevitable dizziness through to complete loss of consciousness with all the risks involved.

That's the situation I'm in right now, though mostly under control by a hefty dose (10-mg) of Bisoprolol.

I don't know if this is going to be the long-term solution, but the Bisoprolol is impacting on my ability to carry out activities that a year ago wouldn't have been a problem.

Hills that I cycled up now have to be walked and when the legs get too achy, it's time to stop for a few minutes.

As I understand it now, the last consultant I saw could not offer a pacemaker or pacemaker setting that would accommodate PVCs.

A word of warning. You might hear the "pacemaker is working fine" line. Technically correct, but just remind them that you might not be fine.

Not alone

by Mae11 - 2024-01-11 09:44:00

Thank you both for your replies. Sometimes the best thing to hear is, you're not alone. Being told not to worry about something when you are so symptomatic is just about the worst! 

You are most definitely not alone

by Gemita - 2024-01-11 16:20:53

Mae, I am sorry for the delay in answering.  We had a late Christmas lunch today and have been out all day.

Yes the statement "Symptom episodes of Ectopic Atrial Rhythm and AT may actually be atrial pacing” is somewhat confusing. The sinoatrial node as we know has the highest rate of spontaneous depolarization and therefore suppresses the other pacemakers. Atrial tachycardia and other ectopic atrial rhythms occur when a site outside of the sinus node, but within the atria, creates electrical activity. This ectopic focus then becomes the predominant pacemaker of the heart. When the atrial rate is greater than 100 bpm, the rhythm is atrial tachycardia. If less than 100 bpm, then the term “ectopic atrial rhythm” is used.

Because the origination of this electrical activity is not from the sinus node, the P wave would not have its normal sinus appearance.  It would have a different morphology depending on exactly where it originates. This is referred to as an “ectopic atrial rhythm” or “ectopic P wave”.  Maybe this is what your doctor was referring to when he said your ECG showed abnormal (inverted?) P waves?

I don’t think this is your pacemaker causing the problem, but your heart.  After an ablation our heart can trigger more in the way of ectopic rhythms.  I was warned about this and as I mentioned before, the healing period following an ablation can be long, even beyond six months for some of us.

I know exactly what you and other members are going through with your intermittent, frequent runs of tachycardia and ectopic rhythms.  If we just had the odd one we probably wouldn’t even notice but when they are frequent, firing from multiple sites they will cause symptoms and our pacemaker, as Piglet states, has no answer to treat them.  I can see your tachycardia is not long lasting but because of the speed it is sometimes coming in at, you might find yourself short of breath, unstable or having chest pain.  I know I experience these symptoms.

Unfortunately doctors only seem to be interested if we have a significant long lasting tachyarrhythmia that requires medical help to stop it.  When we go in and out of sinus rhythm multiple times a day, they don’t seem to be too interested.  And as for PVCs or PACs which may develop into non sustained VT in the case of PVCs or AF/Atrial tachycardia in the case of PACs, they are even less interested, leaving us feeling so unsupported.

I was on Flecainide for three years.  It can trigger atrial tachy arrhythmias, including Flutter if not taken with a rate control med like a beta blocker but Flecainide was a good med for me.  Good luck with the CT Angiogram on the 9th Feb. Hopefully nothing will be found.  As you say, it would be reassuring to receive a diagnosis but I think you have plenty of rhythm disturbances going on at the moment and I wouldn’t be at all surprised if these are causing some chest discomfort from sub optimal blood flow when your arrhythmias are active.  I hope you will feel better soon

Gemita

by Mae11 - 2024-01-12 22:06:52

Gemita, i apologize in return for my late response. My only reason is life in general, as well as not feeling great these past few days. How was your Christmas lunch?

The part that puzzles me the most, I think, is the statement "No instances of pacemaker activity. My pacing percentage was 46% during the monitor so I don't know how this could be true. (Percentage now up to 82% after raising the base rate to 70.) Maybe this is a stupid question, but could it be the unusual lead position that was mentioned before why it is registering as ectopic rhythms or pacemaker activity on the monitor??

Also the fact that we are now looking into a third explanation for the chest pain, when I don't feel that the others have been either excluded or confirmed. Plus as you said, the arrhythmias could well be the cause. Though I do feel it quite frequently without arrhythmias present.

My statement about the test came across wrong. In no way am I hopeful that there is something structurally wrong. Just a definitive reason from my doctor would be nice. 

Thank you as always!

Mae

by Gemita - 2024-01-13 10:49:44

Mae, no instances of pacemaker activity could refer specifically to the period when the ectopic rhythms were recorded/seen, not for the entire duration of the monitoring period when your atrial pacing percentage was recorded as 46%, if that makes sense.  Very confusing though and needs clarification.  Additionally your doctor is minded towards this being Ectopic Atrial Rhythm/AT because of the P wave appearance and since he has full access to the stored data, I think we should trust his judgement. 

However, I can see why you are wanting to know whether these new rhythm disturbances coming from different sites in the atria are being triggered by a poor lead position.  From your history, this is possible too. I would perhaps also consider remnants of pericarditis or some other inflammatory/fibrotic process triggering these rhythms.  Perhaps new scarring from the ablation too. An ablation can and does unmask other arrhythmias. There are so many potential causes but my feeling is that this is still related to the ablation healing process and that some of your ectopics should be helped now that your lower rate limit has been raised to 70 bpm.

Hopefully any additional scarring or remodelling of the atria can be reversed as your disturbances settle and you stay predominantly in normal sinus rhythm.  The heart has a wonderful way of healing itself but it is still feeling sensitive following your ablation/pericarditis, I suspect.

Some chest pain could be still coming from the inflammatory process caused by your pericarditis.  Maybe the CT angiogram will help confirm the cause for the chest pain.

The Christmas lunch was good, French Onion Soup, Sea Bass fillets and Seasonal vegs with roast potatoes and Pear and Almond dessert topped with Mascarpone.  No wine or coffee.  Just nice conversation instead!  No arrhythmias in sight.  I have been so lucky Mae but I have worked hard to control them.  I hope you will soon have similar success. 

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