Fast heart rate - do I need a PM??

So glad I found this site! I just joined tonight because I desperately need help, and soon! I am 86 years young and had a mitral valve replacement 7 years ago. Prior to surgery I was in a-fIb. They did the MAZE procedure during surgery. I have been in sinus rhythm this entire time (6+yrs), until just now, in January. I was short of breath and my pulse was 150. I went straight to the ER and have been on various oral meds since Jan 3rd. untilNow I have a fast heart rate 80-140, been wearing a monitor for 30 days. Have had (2) 4-sec pauses (both at 5:30pm few days apart from each otheI also have sleep apnea. I am tall and thin (weight not an issue). My cardiologist is insisting I get a PM, and yet I have no symptoms - never been dizzy, never passed out, no fatigue, excellent blood pressure. She said because I have had pauses it's imperative I get a PM. Everything I read says PM is for low heart rate which I have never had. She has me on Diltiazem 240 ER and just put me on 25mg Metroprolo (12.5 in AM/PM). The Metroprolo makes me short of breath.  I requested to see an EP and she denied my request, telling me he would say the same thing - "get a PM".  So, do I get a PM merely because I have have (2) 4 second pauses? I don't like having such a high heart rate but I guess she wants to put in a PM so she can try other drugs to get my HR down (?). Since I already had the MAZE and I am soon to be 87, they say there are no other options than to get a PM. Is this true? Also I had an echocardiogram and my left ventricle is fine/normal. Would really appreciate some advice! I have an appointment in 2 days and need to make a decision. Thanks very much. 

5 Comments

Both you and your Cardiologist are right

by LondonAndy - 2017-03-12 07:01:46

I don't have A-Fib myself, but do have a Pacemaker and have learnt a lot from my neighbour who is in her sixties and does have A-Fib and faces many of the same issues as you, and has now had the maximum number of ablations she can have.

You are correct: a pacemaker is a "safety net" - it helps for slow heart rates and pauses, and on its own does nothing for fast heart rates.  However, having one enables other treatments to be tried, which can include ablations to deliberately disrupt the natural electrical functionality of the heart given that it is "out of control", so to speak.

My neighbour is resisting the pacemaker route too, as she is worried about being dependent on the pacemaker and generally does not respond well to medication.  My pacemaker was inserted because of surgical complications during open heart surgery for a replacement valve, and so I am 100% paced and have no issues with the device at all.

I am sure others will be able to provide better comments, but hope this helps.

 

Drug-induced bradycardia

by IAN MC - 2017-03-12 09:16:26

Your situation has changed :-

Although you have never had a slow heart-rate in the past , you have now  and  that is why you are experiencing cardiac pauses.  Both diltiazem and metoprolol will be reducing your heart-rate which possibly makes it more likely that you will have pauses.  Finding different drugs to satisfactorily treat your fast heart-rate may not be easy.

There aren't any drugs which can treat cardiac pauses or bradycardia 

You could go the rest of your life with 4 second pauses but the pauses may lengthen and you may start fainting. Fainting really is a bad idea because it happens in the most inconvenient places.

 A pacemaker would add extra heart beats and prevent this from happening. Also having a pacemaker allows your doctors to be more aggressive with the drugs without worrying about sending your heart rate too low.

It sounds as though you have had a good run of over 6 years being symptom -free but regrettably you have developed new problems. New problems need new solutions and  having a pacemaker really is no big deal.

Best of luck

Ian

My thoughts

by Gotrhythm - 2017-03-13 14:04:14

I echo the above comments. Even though a PM might seem counter-intuitive in your situation, if the pauses become longer or more frequent you could be in big trouble.

However, I also think seeing an EP would be a good idea, even if the recommendations for treatment are the same. You have complex heart rhythm issues, which EPs specialize in. Additionally, if you do get a PM, well, a cardiologist can do a pacemaker, but an EP is far more experienced in the implantation process. And experience counts.

Tachycardia and PM - thank you

by SBMom - 2017-03-13 14:18:34

gotrhythm, and everyone else - thank you so much for taking the time to leave comments for me! Your I put helps me and I appreciate it so much. 

I requested to see an EP but my cardiologist is denying a referral which makes me upset. She says it is not necessary. To go outside of Kaiser I can't find anyone who will see me until April(!) it's March now and I am scared to wait that long. 

I've been wearing the event monitor for 30 days and my heart rate is consistently 100-150. It has never dropped below 60. I don't want my heart to get "worn out".  Especially since I have a tissue mitral valve. 

Any further advice? My appointment is tomorrow (3/15/17) 

 

Vagus Nerve sensitivity causing pauses

by SBMom - 2017-03-26 04:33:52

I just posted in "General" - tomorrow is my big day, getting a pacer! 

With that said, since I've been in the hospital for the past 8 days (due to Dr over medication for a-flutter), I discovered that I have pauses when I drink hot water or eat large pieces of food - apparently my vagal nerve is stimulated and a pause occurs, up to 4 seconds. This explains 2 pauses I had on the 30 day heart monitor. So mystery solved, sort of. I am still getting a pacer. I enjoy eating and want to continue to!! 

Anyone else have vagus nerve issues? 

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