Hi Patty-
First if all, welcome to this great site. You'll find answers to many of your questions. Someone is bound to have had similar things happen to them.
My husband has two mechanical valve replacements, aortic and mitral, plus has had a repair on his mitral for a paravalvular leak. He also has a pacemaker. Before his mitral valve implantation, his tricuspid valve had a mild leak. But nothing had to be done with that during surgery.
The reason he had a pacemaker implanted was because he had several faints caused by a low heart rate, plus the heart may have been pausing for too long. This was also complicated by the fact that from time to time his heart rate would be extremely high. He is in chronic afib and sometimes aflutter.
The pacemaker keeps his heart from beating too slowly, and he is also on digoxin and Metoprolol which control the rapid rate. A lot of the time he is in normal sinus rhythm, but not always. The pacemaker did the trick for him. He does not faint any more, nor get dizzy, and he never feels his pacemaker "going off".
Some of the other heart conditions he has are secondary pulmonary hypertension and CHF. He is on diuretics to control the CHF, and it stays pretty much controlled. He also has to stay on a very low salt diet.
Are you working with a cardiologist or electrophysiologist on your particular problems? Have you had a Holter monitor work up, or an echo or TEE?
Here is what the American Heart Association has to say about heart block:Heart Block
The heart has four chambers. The top two are called the atria. The bottom two are the ventricles.
The heart's "natural" pacemaker is called the sinoatrial (SA) node or sinus node. It's a small mass of specialized cells in the heart's right atrium. It produces electrical impulses that make your heart beat. For your heart to beat properly, the signal must travel from the SA node down a specific path to reach the ventricles. As the signal goes from the atria to the ventricles, it passes through specialized conducting tissue called the atrioventricular (A'tre-o-ven-TRIK'u-ler) (AV) node.
On an electrocardiogram (e-lek"tro-KAR'de-o-gram) (ECG or EKG), a portion of the graph called the P wave shows the impulse passing through the atria. Another portion of the graph, the QRS wave, shows the impulse passing through the ventricles. As long as the impulse is transmitted normally, the heart pumps and beats at a regular pace.
What is heart block?
Sometimes the signal from the heart's upper to lower chambers is impaired or doesn't transmit. This is "heart block" or "AV block." This does not mean that the blood flow or blood vessels are blocked.
Heart block is classified according to the level of impairment -- first-degree heart block, second-degree heart block or third-degree (complete) heart block.
What is first-degree heart block?
First-degree heart block, or first-degree AV block, is when the electrical impulse moves through the AV node more slowly than normal. The time it takes for the impulse to get from the atria to the ventricles (the PR interval) should be less than about 0.2 seconds. If it takes longer than this, it's called first-degree heart block.
Heart rate and rhythm are normal, and there may be nothing wrong with the heart.
Certain heart medicines such as digitalis (DIJ'ih-TAL'is) can slow conduction of the impulse from the atria to the ventricles and cause first-degree AV block.
What is second-degree heart block?
In this condition, some signals from the atria don't reach the ventricles. This causes "dropped beats." On an electrocardiogram, the P wave isn't followed by the QRS wave, because the ventricles weren't activated.
What is third-degree or complete heart block?
Complete heart block (complete AV block) means that the heart's electrical signal doesn't pass from the upper to the lower chambers. When this occurs, an independent pacemaker in the lower chambers takes over. The ventricles can contract and pump blood, but at a slower rate than the atrial pacemaker. On the electrocardiogram, there's no normal relationship between the P and the QRS waves.
Complete heart block is most often caused in adults by heart disease or as a side effect of drug toxicity. Heart block also can be present at -- or even before -- birth. (This is called congenital heart block.) It also may result from an injury to the electrical conduction system during heart surgery. When the pacemaker in the ventricles isn't fast enough or reliable enough, an artificial pacemaker is put in.
