Heart Rate Variation

Been having some issues with different modes of heart rate pacing. Missed beats, going into Afib, heart rate too slow.... too fast. Interested in any resources to help read up here. My original pacing issue is full heart block from mech aortic valve replacement , resulting in pacemaker for ventricle pacing.. and some subsequent aortic pacing issues over the past few years.

Good morning

Sorry to read of your difficulties. I'd say that discussion with your cardiologist is warranted.

May I ask how the mechanical valve caused the heart block?

pellicle said:

Good morning

Sorry to read of your difficulties. I'd say that discussion with your cardiologist is warranted.

May I ask how the mechanical valve caused the heart block?

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From what I've read, it is the physical install of the valve into that part of the heart. 30% of the time, this causes permanent signal blocking of the pacing signal from the atria to ventricle

JWalters said:

From what I've read, it is the physical install of the valve into that part of the heart. 30% of the time, this causes permanent signal blocking of the pacing signal from the atria to ventricle

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ahh ... my mistake, I was thinking of when the blood supply was blocked (an ischemic event), not a neural issue involving the AV or SV nodes. However its much less than what you've suggested, I understood it was more like 3 ~ 6% (and increases on each iteration of a redo. I did a bit of reading and found its apparently much higher in TAVR

https://pubmed.ncbi.nlm.nih.gov/25011716/
One more thing to be cautious about in selecting a valve for a TAVR future.

pellicle said:

ahh ... my mistake, I was thinking of when the blood supply was blocked (an ischemic event), not a neural issue involving the AV or SV nodes. However its much less than what you've suggested, I understood it was more like 3 ~ 6% (and increases on each iteration of a redo. I did a bit of reading and found its apparently much higher in TAVR

https://pubmed.ncbi.nlm.nih.gov/25011716/
One more thing to be cautious about in selecting a valve for a TAVR future.

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Hmm, I see now it is more like 3-6% for Aortic valve replacement.... On a positive note, this has really been my only problem 6 years post surgery. Warfarin management and a clicking mechanical valve are non-issues.

Sorry to hear about your heart rate issues. I also require a pacemaker post valve replacement due to complete heart block. It sounds like these issues are new? Have you consulted with cardio and pacemaker tech? If so, have the shed any light on the cause? Could it be in part, a pacing issue?

I can’t offer much as I have limited experience with what you are going through except to say that the pacer tech can likely provide a lot of info. Having a pacemaker is a lot like wearing a 24/7 heart monitor and every beat is tracked. At my last follow up the tech was able to tell me that I had 2 very brief episodes of irregular heart beats last a couple of seconds each. She said that most people have these all the time, so no immediate concern. The reason she pointed it out, is that I had never had any before. She was able to tell me the time and date. All I could come up with was that it was post Covid and both occurred during a very busy time.

She said they were so minor and common that it was unlikely the my cardio would be at all concerned about this. But she gave me the info so I could stay informed. Have you had your pacer interrogated lately? Is it working as it should? And can the information captured shed any light?

One last item I thing everyone with a pacemaker should be aware if is recalls and alerts for their device, I have an Abbot Assurity and chose to have it replaced last year due to a recall that was the result if moisture ingress. The problems reported with devices range from minor to complete loss of pacing which is catastrophic if you are pacemaker dependent.

Any new meds added recently?

I also have a pacemaker, subsequent to tissue AVR almost 13 years ago. Sometimes, when my pain clinic doc injects steroids for inflammation management, the steroids force me into afib.

Since I have a tissue valve, I am not normally taking an anticoagulant, but when other drivers put me into afib for more than 5 or 6 hours, I am to take Xarelto for 30 days to be sure the afib episode passes. (My pacemaker tattles all to the device clinic daily.)

@pellicle -- Hi, Mate!

epstns said:

@pellicle -- Hi, Mate

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Long time no see
Hope all is going well on your side

epstns said:

Any new meds added recently?

I also have a pacemaker, subsequent to tissue AVR almost 13 years ago. Sometimes, when my pain clinic doc injects steroids for inflammation management, the steroids force me into afib.

Since I have a tissue valve, I am not normally taking an anticoagulant, but when other drivers put me into afib for more than 5 or 6 hours, I am to take Xarelto for 30 days to be sure the afib episode passes. (My pacemaker tattles all to the device clinic daily.)

@pellicle -- Hi, Mate!

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Hi, nothing changed regarding diet or meds. Been eating a little cleaner , so was wondering if sodium was low, but that was ruled out.

Update 1: After 2-3 weeks of irregular pacing, I have had the last 3 days with no noticeable issues. So, local Cardiologist advises to stay the course for a while since it seems I'm coming out of it. Device check this upcoming week.

John W

Closing this out with a summary of TEE findings , followed by : my thoughts/questions

-Septal dyssynchrony : Meaning left to right ventricle not correctly phased in time ... I suppose this could be improved with a 2nd V lead
-R Ventricle mildly dilated : The pacemaker lead for pacing the V is in this chamber
-R Ventricle systolic function mildly reduced : I suppose because pacing is not as effective as natural signal actuation
-Borderline aortic root dilation / Borderline dilated proximal ascending aorta : I don't know what this means exactly. Is borderline 'worse' than moderate ? I see I'm at 3.7cm for Ao Diameter... but this has been stable at this value every year since surgery. Thoughts from the team here?
-EP Cardiologist says no other intervention is necessary

JWalters said:

Borderline aortic root dilation / Borderline dilated proximal ascending aorta : I don't know what this means exactly. Is borderline 'worse' than moderate ? I see I'm at 3.7cm for Ao Diameter... but this has been stable at this value every year since surgery. Thoughts from the team here?

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I believe that in this case borderline means on the border of normal and mild. 3.7cm is near the border for normal and mild aneurysm. If that has been stable every year since surgery, I doubt that they will be very concerned about this. But, as always, good to keep an eye on it during your periodic follow up echos to see if anything changes over time.

JWalters said:

Closing this out with a summary of TEE findings , followed by : my thoughts/questions

-Septal dyssynchrony : Meaning left to right ventricle not correctly phased in time ... I suppose this could be improved with a 2nd V lead
-R Ventricle mildly dilated : The pacemaker lead for pacing the V is in this chamber
-R Ventricle systolic function mildly reduced : I suppose because pacing is not as effective as natural signal actuation
-Borderline aortic root dilation / Borderline dilated proximal ascending aorta : I don't know what this means exactly. Is borderline 'worse' than moderate ? I see I'm at 3.7cm for Ao Diameter... but this has been stable at this value every year since surgery. Thoughts from the team here?
-EP Cardiologist says no other intervention is necessary

Click to expand...

Next visit, talk with the cardio about the results. Should be able to talk with your doctor. Good luck.