Valve replaced -- do I need a Pacemaker?

[DanielB]

Hi all, had my AVR done on Monday and it was a complete success, maybe. The operation went fine and I was in the ICU until Tuesday night before being moved into the general carearea oof the hospital. I was walkiong the same day and off all except a pacer by Wednesday. AS long as I stay ahead of the pain with meds, I'm doing good. I remain in the hospital though because the doctors are not confortable with my heart rythms as they sit., At first, my heart rate was too low, so the external pacer was installed. By the next day, my heart rate was a stable 70 with the pace maker being used only as a safety net. I am now told They want to see my rytems to be more normal. If thsat does not happen by forst of the week, I believe I am looking at a pacemaker being installed.

Anyone else had a similar experience and had to have a pacemaker installed or have this sort of thing clear up?

Dan

 

[Julian]

Your story is identical to mine. I stayed an extra 4 days in the hospital because of a pacemaker. After surgery my rate was too low and I was using an external pacemaker for the first several hours after that I never used it again but had it attached as a safety measure. At first they were going to try cardioversion to get my rhythm normal but after they decided to put in a pacemaker. I wish I didn't have to have it but in the big picture its not too big of a deal. I'm on 28 years old so having a pacemaker is kinda a bummer but I see it this way, in 20 more years pacemakers will be that much farther along and the things that bother me about it will probably be a none issue with future advancements. I guess you can say time is on my side. BTW I only use my unit less than 14% of the time there are rare cases where people come out of heart block and don't need the unit down the road. I hope you don't need one but if you do know that its not too much of a bother in the big picture.

 

[ElectLive]

I had a very different situation, but hopefully one that will help reassure. I developed heart block as a result of my valve replacement. My rate was around 40 or so, and I was paced 100% of the time after the operation. However, even in my more severe case, pretty much everyone (surgeon, arrythmia team) thought it could go away. I was kept on the temporary pacemaker for 3 days. No improvement, so they put in a permanent one. They continued to think it could go away, or at least ease off with time.

Now, as things have turned out, 1 year later, it has not improved. But my situation is pretty rare, about 1% odds I think. For others, heart block is often only temporary, as my team kept encouraging me. In any case, your pacing issue sounds less severe, so from my perspective, that should be good reason to hope. Further, as Julian said, even should you end up needing a pacemaker, big picture it's not that big of a deal. It might even just become a "backup" device, not something you depend on.

There are a lot of other potential complications from valve replacement surgery I could have ended up with, and given the option, I think I'd probably choose my pacemaker complication 9 times out of 10. Glad you are doing well otherwise. Hang in there and best wishes for improvement.

 

[DanielB]

Thanks for sharing your experience. I had not thought of cardiovdersion. I know others have similar stories and if I get one, so be it. Of course, I'd rather not. I'm still pretty happy about making it to this side and am grateful for that. What an adventure it has been.

Dan

 

[Lynlw]

Dan, Justin has a history of going into and out of heart block and much too low heart rates after interventions. He actually got a pacemaker when he was 10, from going into complete heart block and very funky rhythm during an interventional cath the day before, and was 100% paced the next 6 months then didn't use his pacer at all. After surgery or caths he would have heart block for a couple days than kick back into his normal rhtym. Anyway he had his pacer eremoved when he was 16 (long sotry) and had a few OHS since that he went into all kinds of weird rythms fot a couple days, but soon would be fine so hasn't needed a new pacemaker yet.
IF you get one, like the others said, even when Justin wasn't using his, I kind of felt better knowing it ws there incase he did need one

 

[DanielB]

thanks Lynlw,

Mine is odd in that initially the pacemaker was used because my rate was too low, then , after a day, it was out in 'back-up' as my rate rose to 70 bpm on it,s own -- the pacer was just there in cae it wnr below 60. It has not in the past few days, staying around 70 until lat night around midnight when it jumped to 116 (not very comfortable) It dropped to around 108 this morning and so far has stayed there. They took a ekg that a cardiologist is going to review, but the PA seemed impressed with all my other progress, so I'm still waiting and seeing.

Dan

 

[camgough]

My heart block went away (mostly) 10 months post-op. Still need the pacer since I do go into block at higher HRs.

 

[DanielB]

UPDATE: a cardiologist looked at my heart monitor history and a new ekg and decided to do a proceedure where they give me a strong beta-blocker (I forget which one) to quickly lower my rate to a low level while being monitored. The results told him I DID NOT need a pace maker been started on metropolol . I am told if this puts my rate inline, I may get to go home tomorrow (wohoo!)

Dan

 

[Scott]

Dan. I was on 150mg of metroplol for weeks. It made me very tired. Long story but I am now on pacerone (amiodane?). I am told it has risks but I should only be on it for 60 days. I also take 25mg of metroplol. Your surgery was just 4 days after mine. I had a-flutter twice and was in the er both times. I think my heart just needed to heal more and needed time to stay in rhythm. My cardiologist said it takes about 90 days for the heart to completely heal. Until then, it's not uncommon to have your heart to weird things. If you are taking pacerone you might want to ask your cardiologist if the amount you are taking is ok for longer use. I was on 400mg a day when I left the er. By the time I saw the cardiologist 10 days later, she said that she only keeps people on that high a dose for a week. She lowered it to 200mg a day. It builds up in your body and has a half life of 30 days, i think.
Anyway, I just wanted you to know that it's not uncommon and to hang in their!

 

[DanielB]

thanks Scott!

Dan