Just wondering:

Sounds strange.

by AgentX86 - 2018-06-30 00:19:20

Do you know why the odd pulse?  I'd want to know (if for no other reason than to know that they know why).   Since you've had an AV ablation, you're ventricular paced (dual/CRT?), I assume.  Do you happen to know the mode your pacemaker is set up for?  Number of leads?

Just like a Christmas goose!

by donr - 2018-06-30 01:11:46

What you are having are most likely PVC's - Premature Ventricular Contractions.  Not only that, you are having them as Bigeminy (SP?).Here's the clue - the THUMP, followed by a wimpy little thump. They actually are part of a pattern that goes "thump, thump, thump, thump,    pause    THUMP! thump..."  Where: thump is a normal beat, thump is a wimpy beat, THUMP is the hard beat. 

The thump is wimpy because the Ventricles contract too soon & are not full of blood.  The pause is there because the sinus node is independent & keeps its rhythm intact, so the next V contraction comes on a more than normally full pair of Ventricles & is hard as all the extra blood is pumped out. 

You don't specify if your AV Node is dead from an ablation.  I'm assuming it is not - or the ablation failed & the node regenerated.  The node is not a fixed, highly differerentiated spot, but is an area that could have some cells that did not get ablated - just enough to trigger the ventricles to contract. 

This  is a V node arrhythmia, since the contraction comes without a preceding Atrial contraction - something triggers the Ventricles to contract w/o the normal S Node wave - called a P wave -- that causes the atria to contract.  It is a common arrhythmia.  I have had them by the millions & they have not killed me - yet.  

Your nurse is correct in one respect - the  mechanical sensing automatic machines are NOT as sensitive as the human ear.  I've had some readings that were off.  For true diagnostic work, you need the electronic monitor that reads the electrictical activity.

Donr

Thanks, DonR!

by DAVID H - 2018-06-30 11:55:51

Your explanation appears to be right on! Part of the summation from my Mayo visit last year:

"IMPRESSION/REPORT/PLAN
#1 Nonischemic dilated cardiomyopathy, EF 20%, stage C, NYHA class I
#2 Chronic atrial fibrillation treated with rate control (AV node ablation) and anticoagulation status post previous ablations
#3 CRT-D currently 93% pacing likely due to PVCs"
Evidently, the periods of PVC activity wax and wane.  I'm guessing that if the PVC's were not present, my pacing would be 100%, correct?  I've currently switched from 12.5mg carvedilol 2X daily to Metoprolol succinate ER 100mg 1X daily, but I don't expect this drug to have any effect on the PVC's since it's not an antiarrythmic drug. 

Beta Blockers to the attack!

by donr - 2018-07-01 00:00:30

Carvedilol & Metoprolol are both a class called Beta Bockers.  Though not specifically an Aiti-arrhythmic drug, they both tend to "Calm" the heart & lead to fewer PVC's.  I was on Acebutolol (Another Beta Blocker ) and Flecainide (an antiarrthymic) & started having heavy loads of PVC's.  They switched me to Metoprolol in hope that it would do better than the Acebutolol.  Didn't do it!  Had a near heart attack in Jan 18.  Now I am on Sotalol (Beta Blocker)  that does have strrong anti-arrythmic properties & that has, for the moment, anyway, brought me back to near normal in the PVC dept..

Comment 3 leaves me scratching my head.  Your analysis makes sense - it seems that thery mean just that - were it NOT for the PVC's, you'd be 100% paced. 

Donr

Sotalol

by DAVID H - 2018-07-01 12:40:51

I'll be meeting with my EP in a few weeks and I'll bring up the subject of sotalol.

--Dave--

Sotalol

by AgentX86 - 2018-07-01 19:22:03

Be very careful with sotalol.  It's really an antiarrhythmic that depresses heart rate and can cause serious problems in people with low heart rates.  It did in my SI node (SSS and sinus pauses).

Another angle

by dwelch - 2018-07-01 20:09:10

Another angle on this is there are a number of threads on this site about the fitbits and other devices with heart rate monitors.  It could simply be that your device and that automated blood pressure machine arent compatible.  Our electrical signals arent quite normal, so those devices may not read right.  You could try to volunteer to work with them to get it right, be their lab rat, I suspect they will decline.

You can try taking your pulse while the monitor is running if possible, if you were at 80 just before and 80 just after then it should be less than a second per beat, if it goes to more than a second per then perhaps the device is right.  I suspect the monitor is not compatible with you/us and for blood pressure all it really needs to do is know when the cuff has completely blocked curculation and then released circulation.  check it against your neck with your free hand not against the wrist that the blood pressure machine is using.

So I agree with the nurse...the machine sounds like it is just counting half of the pulses...

Agent X86:

by DAVID H - 2018-07-01 22:51:18

I've been a sotalol user in the past ( sometime in the 2011 - 2015 time frame) Many different drugs were thrown at me at the time - including amiodarone.  Typical heart rate these days - via the finger on a carodit artery is around 74. Carvedilol use dropped my BP into the 95/55 area and triggered dizziness. I'm also a former Entresto user ------way too much intense dizziness.  Metoprolol use has BP in the 105/65 range with PVC's along with some continuing dizziness.

Sotalol vs Amiodarone

by donr - 2018-07-02 01:02:55

Both can be bad news.  Their use depends upon where you live, believe it or not.  MY former EP in Atlanta, GA did not like Amiodarone for all its bad issues - deleterious, irreversible effects on lungs, LIVER, thyroid.  See more detail here: https://www.uptodate.com/contents/amiodarone-pulmonary-toxicity 

The where you live part is that it seems to have regional loyalties.  F'rinstance, where we are in Mississippi, the EP's like it & prescribe it regularly.  The Atlanta EP's are more prone to prescribe Sotalol.   I am now on Sotalol, courtersy of my old EP in Atanta.  I have adapted well toit, & it is doing its job quite nicely.  It has brought my arrhythmias under control, while NOt suppressing my BP.  Lucky!   Oh, as an aside - Amiodarone is solube in body fat, so you have to take a ton of the stuff to saturate the fat before it does you an good for yur heart isues.    You stop taking it & you have to get it all out of your body fay.  It has a "half life " of 58 days (roughly), so it takes nearly a year to get rid of it  (Rule of thumb - 5 half lives to get reid of anything from the body.  5X 58 is nearly 300 days - pushing a year).

Donr

Donr

by AgentX86 - 2018-07-02 23:36:00

I'm in Atlanta, too, but I doubt the drug preference is regional.  I was on ameoderone a couple of times, for about 6 months each time.  My EP didn't want me on it any more so put me on sotalol after an ablation.  It depressed my heart rate too far (to where he said it was "toxic"), so took me off.  My heart rate didn't recover.  Fortunately, my thyroid appears to have.  I see my endocrinologist in a couple of weeks.

You're absolutely right about the metabolism of ameoderone.  None of these antiarrhythmics are good but it's the worst.