Holter results, do I really need a pacemaker

[lynn]

Just got a copy of my Holter which was done 1/4/07. While I don't understand it all, the cardio over at Shands is still talking pacemaker as insurance on the lower HR as I was in heart block out of surgery. I'm on 12.5 mg. of Toprol XL and have been for about 3 or 4 weeks. Blood pressure is in the low 100's/ and sometimes drops in the upper 90's/. You guys pick it apart!

The patient's baseline rhythm is sinus with a minimum heart rate of 80 beats per minute and average of 105 beats per minute and a maximum of 140 bpm. There are no significant pauses. There are no runs of bradycardia evident. The patient had rare ventricular ectopic events. There is no ventricular tachycardia, couplets, triplets or bigeminal (sp?) runs. The patient had frequent PAC's with a total of 23,930. There is no prolonged atrial flutter, atrial fibrillation (yay, the MAZE worked) or prolonged SVT. The longest SVT was only four beats. The patient kept a diary where she listed palpations, dizziness, chest discomfort and heavy chest. These correlated with sinus rhythm and occasionally her symptoms correlated with PAC.

Summary:
1. Baseline rhythm is sinus without evidence of significant pause.
2. Frequent PAC
3. No evidence of prolonged atrial flutter, a-fib or supraventricular tachycardia
4. Rare premature ventricular contractions without evidence of ventricular arrhythamias

 

[bvdr]

Lynn, I can only speak for myself but if that was my holter monitor report my physcian would have to make a stronger case for a pacemaker than that. Your heart is still healing and I would be more inclined to believe that in the future you would be even less apt to need a pacer than you do right now. How does getting a second opinion sound to you? What does your gut say?

 

[lynn]

Betty...I have a call into my local card and I may fax it to my PCP. I'm more worried about the high HR as it's been running about 116ish today. I was wondering about those *almost* 1000 PAC's per hour!! My gut says hold off

 

[Lisa in Katy]

Lynn,
The report sounds pretty good to me as well. I would expect your heart rate to slow down as your heart heals. Mine was over 100 shortly after surgery and 70-80 now. I get PAC's with every heartbeat when I am tired or stressed. You are probably both right now and at 100 beats a minute and 60 minutes in an hour, your heart beats 6000 times an hour, so PAC's every 6th beat are probably not that bad. If it was me, I would hold off on the pacemaker. The surgery is minimal, and you could argue that it's better to be prepared, but every surgery has its risks, and I'm not sure the benefits outweigh the risks.

I am not a doctor so this is simply my opinion!

 

[lynn]

Lisa that's what I'm thinking. I am really gonna think on this, I'm just starting to feel normal and certainly don't want another surgery....especially if it's not needed! Seven surgeries in the last 4 years (with one year off) is about all I can take! I'm ready to get on with life!!

 

[tobagotwo]

The Holter doesn't seem to indicate any pattern of dangerous arrhythmias. Between the low systolic and the frequent PACs, there might be a case for some fatigue, but a still-healing heart frequently exhibits raised heart rate, PACs/PVCs, and roller-coaster pressure variations. Your left ventricle should be remodelling (returning to its more normal, smaller size), and this frequently causes temporary arrhythmic outbursts - and pressure anomalies, as the actual size and shape of the LV are changing.

I assume the Toprol is to lower the heart rate, but it also lowers the blood pressure - apparently his main reason for the pacemaker. I'd hate to think he wants to implant a device in your chest just so he can prescribe a stronger beta blocker without having you pass out every time you lift your head. A pacemaker is not a convenience item to simplify drug treatment for the cardiologist.

I'm not a doctor, but if it were my heart, I would be more in a wait-and-see mode. If I were strongly pressed, I would definitely seek different medical opinions before yielding to a pacemaker. I'd have to have more than one physician explain to me, "Where's the danger here?"

Best wishes,

 

[lynn]

Bob....thank you, I was waiting to see your opinion!!

 

[jeffp]

Lynn,
I had a very similar holter report at about 4 months post op. My cardio kept upping the Toprol and I kept getting weaker and faint more often. When he started discussing a pacemaker, I knew it was time to move on. Bob was pretty much right on target where he said,

I assume the Toprol is to lower the heart rate, but it also lowers the blood pressure - apparently his main reason for the pacemaker. I'd hate to think he wants to implant a device in your chest just so he can prescribe a stronger beta blocker without having you pass out every time you lift your head. A pacemaker is not a convenience item to simplify drug treatment for the cardiologist.

My new cardio got me off the betablocker and we went through a few heart meds thereafter (I still give him a hard time - I hate having to take pills). It took a year and a half to get an EKG that was "normal" and without all the artifacts of the surgery.
My vote, for what its worth, is to wait a bit and see how you do further down the road. It doesn't look like you're passing out from low heart rate.
Also, with regard to heart rate; I was over year getting down to the 70's; I don;t think I'll every be back in the 50's where I was pre-op.

 

[Mb]

I read this post with great interest, as my husband is having a pacemaker installed at the end of next week .....hopefully.

He is in chronic a-fib, and has frequent ectopic beats, heart rate pauses of 2.9 seconds, bradycardia (down to 30 at times), and tachy at times (over 150 after climbing one flight of stairs). He has been told he needs a pacemaker for a number of years. This past year he has been presyncope a number of times, and had one episode while driving.

From what I read on your Holter, I agree that there seems to be little, if any, indication for rushing into a pacemaker implant. As you can tell from my story above, you can even live with some arrythmias, and not be in great danger. My husband's doctor is so convinced he needs one at this point, that he first have to have a tricuspid annuloplasty to tighten up the annulus of the valve, before they can implant the lead. That surgery is scheduled for next Wednesday.

If it were me, I would get another opinion.

Marybeth

 

[lynn]

Well, after today's fiasco with the cardio sending me 2 hours (and, 2 hours back) to get clearance from an *infectious disease* doc and getting there and she talks to me a bit and then hands me a script for lab work......which I can get done in my hometown, this cardio is being replaced! My hubby was furious driving 4 hours for that, he doesn't trust the cardio or PA. I guess I'm going to ask them to release me back to my local card and put off the pacemaker like you all suggest and see what happens.

Thank you all for your suggestions....I don't dare take my BP right now or the husband's!!!

I just want to get back to work, back to those smart-alecky middle schoolers

 

[tobagotwo]

Ask yer local card about trying something other than the Toprol. Although it's mild, everyone's chemistry is remarkably different wiht these drugs. You might have more luck (and less semisyncope) with something else.

We should have a Heave-Ho thread for when members dump their washed-up cardios...

Just nosey, MaryBeth - and forgive me if you've already covered this somewhere - but has your hubby ever had a MAZE procedure done?
Unfortunately, they don't always work, but when they do, they can improve life dramatically.

Best wishes,

 

[lynn]

Yes, let's start that thread! I'll throw 2 in right away!

MaryBeth, I had the MAZE done, apparently it worked....one thing that makes me happy!

 

[lynn]

Just got a call from the surgeon's PA and we talked at length about this. He explained that the reason the *electricians* are suggesting a pacemaker is that when I came out of surgery I was fine but a day or two later developed first right bundle block then left bundle block. Again, the pacemaker is insurance in case this were to happen at some point down the road again, apparently my electricity is messed up!

The saga continues................

 

[Mb]

Hmmm.....no he did not have a MAZE procedure done. Frankly, it was never brought up. He has been in chronic a-fib for around 6 years at this point, and has been seen by three electrophysciologists. I cannot imagine why it was not brought up. I do know, that he does NOT want to be ablated, and depend permanently 100% on the pacemaker. That has been discussed ad naseaum with his cardiologist. Could someone explain what the pros/cons might be?

Marybeth

 

[Marguerite53]

Hi Lynn. Of course you already know what I think....

At this point, if I were you, I'd insist on having one of those "electricians" give me a call. Somehow when you're being tossed around from doctor to doctor a lot can get lost in the translation. Try to have your husband (or any other set of ears) on the phone when (notice I said WHEN, not if) you get this rhythm specialist to speak to you. They will make it abundantly clear exactly what they see as the situation. THEN you can make a more qualified decision. I found my rhythm specialist to be very, very fast talking, no-nonsense and clarifying.

BE A PEST!!! Get some clearer answers. Keep asking until YOU are comfortable and really feel like you understand the situation. You have too many questions now, and too many non-professionals here offering up opinions (and I agree with them) but maybe that's not safe. Once you get back to work, you'll forget about it all. That may be good.....that may be bad. Try to get a clear picture before your normal life gets back on the front burner.

My two cents!

Marguerite