Got a PM for Christmas

Hi everyone,

Merry Christmas to all. I have been lurking for some time as a PM was in my future.

Monday I had my sinus node completely ablated using a combination epicardial/endocardial approach due to phrenic nerve proximity (my phrenic nerve was paralyzed during an ablation in June, but has since recovered mostly). The surgery went very well and they were able to implant the pacer at the same time.

The doctor expected 1 night in the CCU and then moving to a regular room for at least a couple of days. But since my pericardium sealed up nicely on its own (did not require a drain) and everything went so smoothly, I went home the next day! I think I am doing very well considering everything.

He had to set my lower limit at 80 as junctional rhythm kicks in at 75 for me. He was able to get my junctional rhythm up higher when I was on "iso" on the table, so he thinks we might have to adjust the PM further to stay ahead of the junctional rhythm. I know some people deal with junctional rhythm okay, but I don't. It feels like impending death to me. I literally have to crawl on the floor to get places when it kicks in.

I have a single lead Boston Scientific Altrua 60 which he used because it has blended sensing (I'd like to be able to run and I weight train regularly).

If anyone has any experience with accelerated junctional rhythm and pacer settings to combat it, please let me know! My doc was going to set my lower limit at 60 which sounded like a good start to me, so 80 is a little disappointing.

Merry Christmas everyone!

Kim

3 Comments

Junctional Rhythm

by Pookie - 2009-12-25 01:12:06

Hi Kim.

I was just told that I too have JR. I had some adjustments to my pacemaker a couple of weeks ago and so far I feel a tiny bit better. The only thing is: I've not educated myself all about JR, so I've got a lot of researching to do. However, my JR seems to bother me when my heart is beating around 64.

I will see my EP again in the new year.

Do you get shortness of breath? Do you experience a thumping & pounding sensation? Do you experience a type of exhaustion/fatigue that is beyond description? All I know is when I am in JR, I feel pretty crappy. It's so hard to explain. Then I think anxiety kicks in so it's hard for me to figure out what is happening to me: is it the JR or is it a mini panic attack? I hate it.

My pacer (Medtronic Enpulse) is still set at 60 for my lower setting and 140 as my high.

Since the EP "tweaked" my pacer I'm still not feeling a lot better, however, I do feel a bit of a change. I'm thinking it's going to take quite a few trips to the clinic to fine tune me. I'm really trying to stay away from any beta blockers and a cardiac ablation.

I'd love to stay in touch with you as I need all the help and support I can get to understand all about Junctional Rhythm!!!!!!!!

Happy Holidays,
Pookie

Welcome to our family!!!!

by harley63 - 2009-12-25 08:12:17

Kim,

So ya' got some internal bling bling from dear ole Santa, eh?? I did too back in 2006. Have grown to love it. I never have to worry about losing it, never have to dust it, never have to fear it being stolen.. ya' get the picture, right? lol.. must find some humor in this life!

I dont' have JR, but my dear pal Pookie does. She'll listen to you for hours.. so connect up with her. I'm more of the cheerleader...rah ...rah... (imagine a cheering Maxine).

Take care and again, welcome to our family!
Harley63

Junctional Rhythm

by ChicagoKim - 2009-12-26 04:12:19

Hi Pookie and Harley :)

Yes, Pookie, all the things you described. When JR kicks in, I feel like I can't get enough air and if I don't sit down I will faint. I pretty much drop in my tracks. There is a feeling of impending doom that always accompanies it. My heart feels like it is pounding out of my chest and there is pressure. I've had this problem on and off since my first ablation in June.

My JR kicks in between 75 and 77 bpm. So my PM is set for a lower limit of 80. Not an ideal lower limit, but I don't know any other options yet. I will discuss it with my EP when I go for a follow-up.

Right now I'm okay if I'm just sitting or walking casually. Stairs or getting up and down will cause my JR to kick in. I wonder if that won't calm down as my heart heals. I'm sure there is a good deal of trauma that is healing after having my entire sinus node ablated from the inside and outside (ports through the groin and chest).

Pookie, has your EP considered setting your lower limit to 65 or 70 since your JR bothers you at about 64? That should "suppress" the JR, as my EP says.

My EP said we might need to tweak the rate responsiveness of my PM so when I'm active, the PM will kick in and stay ahead of the JR. I need to learn more about this though. I know just the basic mechanics of what is happening.

Hope you had a great Christmas! :)

Kim

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