NCS & IST

Just over a year ago I had a pacemaker implanted because of NCS, now I have been diagnosed with IST Inappropriate sinus tachycardia. Until two years ago I was the picture of health ate right and exercised daily and my resting pulse rate for the last twenty years was approx 45 bpm. When i first started to feel faint & almost blacked out 21/2 years ago my Dr. sent me for a stress test. I ran on the tread mill for almost one hour before I reached the target rate to do the echo, I think some where around 165 bpm. I blacked out about six months ago while wearing a Cardonet monitor that showed my rate was 179 stopped at a traffic light and I blacked out. I saw the EP on Friday because I was feeling short of breath & week and the Medtronic tech said besides the 254 rate drop events in the last month my heart went up to & over 200 bmp almost 100 times. I have a series of test scheduled over the next two weeks, stress & echo and the Dr. talked about Sinus node modification. I am just besides myself, the procedure does not sound very promising. Any advice from someone that my have the same problems would be great.
Thanks Joe Correia

3 Comments

NCS

by peter - 2008-02-06 03:02:49

As Im expect you are aware doctors cannot make up their minds as to how Neurocadiogenic Syncope should or could be treated satisfactorily. What I dont like is your heart going over 200 bpm. This is dangerous. Im surprised they have given you a pacemaker as its considered to be the least likely treatment to help patients with NCS despite the confusion.It would make some sense to fit one to control the ventricular rate though. You did not say what type of pacemaker and leads you have, which chambers they are pacing or how they are supposed to help you. I would be a lot happier if they had used a crt pacemaker with an av node ablation(It strikes me that you have the wrong type of pacemaker fitted) This would keep your ventricles in synchrony and control the ventricular rate.Although it would leave you with disynchrony between the atriums and the ventricles but the heart is able to cope with that . I dont like the idea of sinus node modification. That to my mind is a rare experimental and very risky proceedure that could leave you even worse off, or on the way out. Could you please tell me how old you are? Sorry I cant help you any more. You could contact me direct on pcounsell@btinternet.com cheers Peter

IST but not NCS

by Carol - 2008-02-06 08:02:59

Hi joec,
I was diagnosed with IST approx 4 years ago and was managed with beta blockers effectively. Thankfully at its highest my HR was "only"170 (still too darned fast for me, but also thankfully I never passed out or got dizzy- just felt breathless and a little spacey as one could expect) Anyway last year I developed a 2nd Degree AV block and had to have a Dual chamber PM placed. At my last interrogation they determined that my atrial lead pretty much just "senses" and that my right ventricle lead "paces" about 8% of the time. I think that my cut off rate is 130, and I continue to have bouts of tachycardia (Pacer can't help that) but so far nothing over 120, but it does sometimes feel like the the upper and lower are out of synch as I am very sensitive to my heartbeats. I'm rambling but I just wanted you to know that someone else has IST and a PM and that you're not alone. Also, I myself would be hesitant to permanently obliterate anything, but I'm not a doctor and don't know your exact circumstances and I tend to lean on the "cautious" side of things. Are you on medication to control your HR or is that BP just too low because of your NCS? Keep us posted please and feel free to IM me anytime if you need to "compare notes". Good luck with your tests- Carol

NCS with high bp

by joec - 2008-02-09 12:02:55

Carol,
I was diagnosed with NCS which in most cases is treated with beta blockers. In my case being asthmatic they are not an option. To make matters more difficult I also have very difficult to control high blood pressure. My pacemaker is setup for rate drop, a drop of 40 bpm is 15 sec. or less which I avg. 250+ per month. When the pacer intervenes my rate in increased to 100 bpm for two min. During the day the rate is set at 60 and at night they let me go down to 45 bpm. I am 46 years old and for the last 20 years I was used to my rate being about 50 to 55 bpm during the day so when the pm kicks me up to 100 I thought my head was going to blow off. It took some getting used to but now this IST thing just stinks. I knew when I was short of breath and feeling bad my heart was beating fast but until the other day when the doctor & tech down loaded the info from the pacer did i know that 200+ is the new magic number. There seems to be no good fix for this one now so unless this causes me to black out or do damage to my heart I am not ready to try anything permanent. Wednesday I go for an echo to see if there has been any changes. Wish me luck and tahe care.
Joec jc158@comcast.net

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