Once benign post-surgery AV block has now gone bad

[Terence]

Hi everyone,

I had a valve and ascending aorta replacement in 2008. (St Jude valve). The surgery went well and things have been pretty good since. Ever since surgery, an AV block started showing up on ECGs. It was asymptomatic though, and short, so no one worried about it.

However, in the past 3 months I've passed out three times. I was living in Port Moresby at the time. And the cardiologist I saw there thought it was probably because the AV block had worsened (it's not his fault, but his diagnosis had to be tentative as he didn't have good diagnostic equipment). I'm now back home in New Zealand. The AV block has definitely become longer (my GP confirmed that with an ECG). I see a cardiologist for an echocardiogram here next Friday.

The one other symptom worth noting is that I've had SVTs twice over the last 3 years, and the odd mild case of odd pulses and the like.

I'm curious if anyone else on the forum has been through anything similar, and what their experience has been?

I'm guessing perhaps I will end up with a pacemaker? Does anyone know how well they work when coupled with an artificial valve?

Thank you.

Terence

 

[pellicle]

Does anyone know how well they work when coupled with an artificial valve?

all I can tell you is that quiet a number of people here have one after they've had a valve replacement because the AV node was damaged during the surgery.

So to my understanding fine, it is after all the heart muscle they trigger, and the valve is entirely not muscular at all. Hopefully someone else will come along with a direct report, but thought I'd just add this while you're waiting.

Hopefully the cardiologist in NZ will shed some light on it.

Anyway, why are you in Canberra and The Land of the Long White Cloud ?

 

[Martin1962]

I developed complete heart block as a result of my mitral valve replacement surgery last year (mechanical On-x valve). Had to have a dual lead pacemaker implanted which delayed my discharge from hospital. No problems, it works fine, not even aware of it most of the time.

 

[Dana]

Hi everyone,

I had a valve and ascending aorta replacement in 2008. (St Jude valve). The surgery went well and things have been pretty good since. Ever since surgery, an AV block started showing up on ECGs. It was asymptomatic though, and short, so no one worried about it.

However, in the past 3 months I've passed out three times. I was living in Port Moresby at the time. And the cardiologist I saw there thought it was probably because the AV block had worsened (it's not his fault, but his diagnosis had to be tentative as he didn't have good diagnostic equipment). I'm now back home in New Zealand. The AV block has definitely become longer (my GP confirmed that with an ECG). I see a cardiologist for an echocardiogram here next Friday.

The one other symptom worth noting is that I've had SVTs twice over the last 3 years, and the odd mild case of odd pulses and the like.

I'm curious if anyone else on the forum has been through anything similar, and what their experience has been?

I'm guessing perhaps I will end up with a pacemaker? Does anyone know how well they work when coupled with an artificial valve?

Thank you.

Terence

They work fine with an artificial valve. I have 3 artificial valves. My pacemaker implant was actually before any valves and it was necessary for worsening AV block. (AV node damaged by radiation 40 years prior to its failing.) The PM is an easy decision and I would try to schedule it ASAP because of the serious risk of AV block. It could save your life. If your AV becomes completely blocked there is a possibility that you won't die and your heart will go into what is called an escape rhythm where one or more of your heart cells starts to act like a pacemaker on its own and paces your heart. Not everyone has it and you would be lucky but your escape rhythm is usually much slower than normal rate. Mine is 30 beats per minute barely enough to keep me alive and not enough to live on. EP doctor tests this by temporarily shutting off my pacemaker for say 1 sec to see if the heart starts beating on its own. I don't usually give unsolicited advice but if you asked, it would be: get a pacemaker!
-Dana

 

[erricojj]

I'm curious if anyone else on the forum has been through anything similar, and what their experience has been?

I'm guessing perhaps I will end up with a pacemaker? Does anyone know how well they work when coupled with an artificial valve?

Yep, another case here...my story.

In short, my AV node damage was likely caused by aortic valve replacement. I received my pacer about 8 months after the SAVR. They tell me the battery life of my particular model is around 14 years.

 

[Julian]

I developed complete heart block as a result of my mitral valve replacement surgery last year (mechanical On-x valve). Had to have a dual lead pacemaker implanted which delayed my discharge from hospital. No problems, it works fine, not even aware of it most of the time.

I have a similar story. Arotic valve replaced with On-X and had ascending aorta replaced with graft. Node was damaged during surgery. I was a little disappointed to know I'd have to live with an additional piece of hardware. Overall the pacemaker has been easy to manage. I too am not aware of it most the time. Going on 13 years post op. Probably due for pacemaker replacement in the next 1-2 years.

 

[Lynn]

Terence, I also have a pacemaker as a result of my vave replacement surgery. The AV node that allows the atria (upper chambers of the heart) to pass an electrical signal to the lower chambers (the ventricle) lies close to the aortic valve and mine was damaged during surgery resulting in complete heart block Immediately post surgery. Similar to others on this forum, this meant a pacemaker prior to leaving hospital. I was initially pretty bummed and worried about it, but for the most part it hasn’t been an issue. The surgery to implant is also minor compared to valve surgery.

The pacemaker works great and keeps me alive, but I did get a bit of a shock last summer to find there was a safety notice and recall on my pacemaker. As it has not been demonstrated that I have any “escape” rhythm, I opted for replacement vs just monitoring. The road to replacement was a bit if a struggle, and that’s another story, but in the end it was replaced in a timely manner without issue.

There are many types of heart rhythm issues that result in the need for a pacemaker, but if you are like many of us who have needed one post valve replacement, it is heart block. Which, while very serious, is also easy to manage with a pacemaker. What I mean by this is the pacer can be set to detect the rhythm of the atria and follow along. This allows for a very natural feeling rhythm and thus, I seldom think about my device.

I would echo what others have said, heart block can be very serious so I wouldn’t wait. I also know now, that pacemakers are not benign, they do fail and monitoring should be taken seriously. But they also work great and allow for a terrific quality of life; exercise, travel ect.

Lastly, the settings in the pacemaker matter. So talk to your tech about them, they need to be low enough to accommodate your resting heart rate and high enough to allow you to exercise. Mine is set with a min of 50 and a max of 160. This allows me to do cardio with my heart chambers staying in sync.
Best of luck with this.

 

[Terence]

Thank you everyone! That's very helpful advice. It's great to know my case is not unique - indeed not even unusual. It's also good to hear about the practicalities of Pacemakers. I see my cardiologist on Friday, I'll get results from the Halter Monitor test and an echo. I'll know more then I hope.

@pellicle , I'm a New Zealander, but I work for an Australian university, a lot of my research is focused on Papua New Guinea. When I signed up to this forum (in about 2010?) I was living in Canberra. But my wife and I moved back here (NZ) just before Covid for her work. So I live in NZ now, although I move between all three countries for work as needed.

 

[vitdoc]

I too had a pacer placed after my third aortic valve plus aneurysm repair. My escape rhythm of my ventricles was zero. So without a pacer I would not be writing this. I am a bit surprised at the lack of urgency given your story of several episodes of passing out. You may have a decent escape rhythm keeping you alive but you could easily have an episode while driving or you could just fall down and hit your head.
Maybe the cardiologist knows something that makes him/her feel that you don’t have heart block but something else. In some places you would be placed on a cardiac ward in a hospital and monitored closely. Usually just on an EKG there is evidence of second degree block which is a significant delay in the signal getting to the ventricles with occasional block. When the signal doesn’t get through at all then it becomes third degree.

 

[Terence]

Hi Vitdoc,

Thank you. That is good to know. I presume I must have second degree block, but don't know yet. There's always a chance it's something else. Assuming it's a block, it must be slowly deteriorating, as I've had a fist degree block with no symptoms ever since surgery, and it was thought/hoped it would stay benign.

At this point I'm moving as fast as I can with respect to seeing a cardiologist (as fast as I can get an appointment). In the meantime, I'm not driving at all. I'm not cycling either. I'm also being careful with walking - walking on paths with grassy verges, or the beach, when I go for a stroll. Beyond going for strolls I'm not exercising (and not surfing, which is reason for haste alone).

It's good to get a sense of the possible urgency. And good to hear of other people's experiences. Really good to know I'm not entirely alone in going through this.

Terence

 

[LondonAndy]

I'm guessing perhaps I will end up with a pacemaker? Does anyone know how well they work when coupled with an artificial valve?

Another pacemaker dependent valver here - had mine inserted a week after the mechanical valve, and it was four months or so before I even thought about what do I need to know about pacemakers. The original lasted 8 years of 100% pacing, and a replacement was inserted last October and is expected to last 12 years.

Whilst any surgery can have complications, pacemakers are a comparatively easy op, mostly done without even needing an overnight hospital stay. I went home on the train after my October op!

 

[pellicle]

Hi

It's good to get a sense of the possible urgency. And good to hear of other people's experiences. Really good to know I'm not entirely alone in going through this.

I suspect that's one of the problems that one experiences in NZ, smaller population, therefore (given equal percentages) a smaller group. There are a few kiwi's here, but mostly they have their issues sorted and are then more engaged with life.

 

[Terence]

Another pacemaker dependent valver here - had mine inserted a week after the mechanical valve, and it was four months or so before I even thought about what do I need to know about pacemakers. The original lasted 8 years of 100% pacing, and a replacement was inserted last October and is expected to last 12 years.

Whilst any surgery can have complications, pacemakers are a comparatively easy op, mostly done without even needing an overnight hospital stay. I went home on the train after my October op!

Thank you!