roadbuzz

I'm soliciting others experience or opinions.

Recently I visited my Dr. to investigate a mild but persistent fatigue I'd been experiencing for 6+ months. I was concerned there might be some cancer developing or something. During the exam they gave me an EKG. As a very active cyclist, I've always had a low heart rate, but it was 32bpm, way slow even for me. And there was a crazy arrhythmia between the p-wave (atrial contraction?) and r-wave (ventricular contraction?).

Subsequently, I went to a cardiologist, wore a monitor for 24 hours, had a stress test, heart sonogram(?), etc. The diagnosis was a moderate heart block, i.e. interference between the electrical signal for atrial contraction and ventricular contraction. But, when the atrium doesn't contract, eventually the ventricle contracts anyway. Long story short, it works and it's not a critical health risk at this time. On the other hand, my heart isn't circulating blood at a normal rate while at rest. It's probably about 30% low. Based on the diagnosis, the cardiologist feels like I don't have to have a pacemaker, but could install one to maintain a higher resting heart rate. And he thinks that improving the volume of blood circulation at rest couldn't help but improve the fatigue and well-being issues I've been experiencing.

Under the circumstances, the cardiologist won't strongly recommend a course of action. We could wait and monitor the condition year to year, or go ahead and install the pacemaker. It will probably need to be done eventually in any case.

So, we get to my question. I'm not totally comfortable with the pacemaker if I don't have to have it, but I will probably need one eventually. Reduced fatigue is always a good thing, but there are no guarantees about that. I've tentatively said I want to go ahead, but still have time to back out. Do any of you have personal experience? In any case, I'd like to hear your thoughts.

TIA,
Bob

DnvrFox

Whoops!

One never knows what is just around the corner, does one.

I don't know a thing about pacemakers except I know a couple of folks who use them (one is a 78 year old member of my singing group, who travels the worlds, etc., with his pacemaker, and does GREAT).

Don't they have ones that respond to your need for more circulation as you exercise more - IOW, increase the heart rate as needed?

Personally, when I had the 24/7 atrial fibrillation for one year, I noticed the 30% drop in blood flow and corresponding energy loss, and that was my prime motivator for havng my heart repair (called an "ablation.")

EDIT:

I'm not clear as to whether or not the pacemaker is only for increasing the resting heart rate, or is it for all heart rates?

making

There are several different kinds of heartblock some never cause a problem, others can be fatal. Of course, do exactly what your cardiologist says. Did he review all your medications with you. Did you tell him about every single medication you take, even over the counter? I am kinda suprised the doctor would not give you more guidance than that, 32 bpm is pretty slow.

Spinz

2nd opinion. Lp

Mobiker50

I have a defibrillator, not a pacemaker, but understand the implantation and connection to be somewhat the same. Concern: with my defib, I can't undergo an MRI or many other scanning procedures because the leads would react to the magnetic field. Check with your cardio-dude about that one; it's not easy (or possible???) to remove the leads in the event you need such a test. Of course, in my situation, the defib is not an option, so I have to give up the MRI option.

Best of luck.

Yen

Something to think about. My dad had a pacemaker installed just a month before he fell down the stairs at home and broke his neck. With the pacemaker, they couldn't do an MRI to determine the full extent of his injuries and if they were repairable. That said, the injuries we did know about probably ended his life anyway, without or without a pacemaker interfering with an MRI. Still, it's something to add to the list of considerations.

In any case, definitely get a second opinion.

making

After thinking about it a little more I highly reccommend this.

Dchiefransom

I was told that it wasn't the leads I needed to worry about, but the MRI would mess up the settings of my pacemaker. Maybe different answers from different people. The next time I see the guy on my mail route that works for St Jude, I'll ask him.
Ask your cardiologist about the specifics of what your pacemaker would sense, and how it would react in different situations. Take into account what would normally happen if your heart was at the end or start of an event that would normally cause in increase or decrease in heart rate, finishing a run or ride, etc.

roadbuzz

Denver: Whoops is right! I'm a healthy guy... this stuff wasn't supposed to happen. I just goes to show ya. For my situation the pacemaker would just be for elevating the HR while at rest. Based on the stress test, I guess they felt my heart response to exercise was okay.

making: Alas, my cardiologist is leaving the final decision to me. I did tell him about all meds *and* supplements, something I don't always do. His recommendation was to drop the herbal supplements I was taking... you don't always know all the ingredients. I have done that.

Spinz: Why is it that the most obvious advice is so easy to overlook. I will do that. Thank you!

MoBiker (and Yen): The cardiologist mentioned the MRI issue, and said I'd have to use an alternative technology (ct scan?). I will elevate it as a concern.

Yen: I read about your father while searching the threads prior to posting. You have my deepest sympathy and you are in my thoughts and prayers. Thank you for sharing. I lost my mother October 22... it is hard.

Dchief: I do need specifics... they use to warn about microwave ovens, now I hear I would need to consider cell phones, etc. I would be interested in what you find out, and I will check back with my cardiologist.

Thanks so much everyone for your input. First up, I will be pursuing the 2nd opinion.

UberIM

Humble suggestions:

Is C-ville-Charlottesville? UVa med school is there........
Go see an electrophysiologist -a cardiologist who specializes in the electrical wiring of the heart.
Find out exactly the name of the condition and check it out on the internet.
The issues around MRIs and what generically are called implantable electronic cardiac devices IECDs are not small. If you need the pacemaker, then you need it.....but otherwise you would be best served not having it...........plus, the placing of it while not major surgery is not without risk. There are many other issues and types of pacemakers..........so go with a pad and pen, take notes, and have someone else listen with you..........This is quite complicated stuff............
Buena suerte

Old School

For what it is worth, a pacemaker only activates when your heart rate slows to a predetermined rate. As long as your normal heart rate is above that threshold, it stays quietly in the background. Not a bad idea if you like "redundancy". However, as with most significant medical procedures a second opinion is a worthy consideration.

DnvrFox

I would strongly second the electrocardiologist (electrophysiologist).

I would also recommend the Cleveland Clinic if you have any access. Rated by almost everyone as the best heart place in the USA (and perhaps the world).

Check out their web site and do a google on their ratings.

Kurt Erlenbach

I don't know anything about hearts or pacemakers, and my opinion is not worth the electrons used to transmit it. But I do want to point out threads like this are further evidence of the quality of this forum. When not here, I'm usually in the A & S forum. Folks there frequently post questions about the law, a topic about which I do know something, and the level of idiocy in the responses is appalling. With age comes wisdom, and the ability to recognize the line between what we know and what we don't.

UberIM

[QUOTE=DnvrFox;7820054]I would strongly second the electrocardiologist (electrophysiologist).

I would also recommend the Cleveland Clinic if you have any access. Rated by almost everyone as the best heart place in the USA (and perhaps the world).

Check out their web site and do a google on their ratings.[/QUOTE

I admit this is a pet peeve of mine-what I think is a particularly American concept of rank ordering things/people/etc. And assuming that what we have in the US is always the best. This is not meant as an attack of you DnvrFox-most academic centers are very good and have multiple subspecialists........Cleveland Clinic IS a good place..........But how do doctors get rated or teachers or lawyers? I love that cities print out the "Best Doctors." What does that mean? How is that determined?
How do you know? Here in Maine we have teacher of the year. How does one determine this? comparing a phys. ed teacher to a librarian to an 11th grade chemistry teacher?

Is the Cleveland Clinic really the best cardiology center in the world? DnvFox did you have the pulm vein mapping or just the avnodal ablation? If you had the former the world's foremost practitioner is probably an Italian-no one can do the PV mapping as rapidly or as consistently accurate as he can.........

My guess is that UVa will be fine.

FWIW-my mo in law went to a world renowned center to have her afib pulm vein mapped and ablated and she ended up with a stroke.........just goes to show ya...........

I don't mean to stir things up..........just happens to be a pet peeve of mine-this notion of "The Best."
Perhaps because I am not the best at anything............

DnvrFox

I asked cardiologists around here where they would go and who they would have for an ablation - in the USA.

I asked on a very active internet forum - well, actually 3 of them.

I asked a MD cardio who trained under Andrea Natale, MD, would Natale or the guy I was talking to do a better job. He said Natale.

My own cardio told me not to have it in Denver, as they were still in a learning mode as regards ablations.

I looked at "success rate" research statistics.

Hey, you got to do the best you can. None of it is perfect. It sure beats gong to the local market and asking if they have an ablation on the shelf.

Sorry, I can't buy your rationale nor commiserate with your pet peeve. Each of us has decisions to make, and we use all the info we can to make the best decision possible. Maybe we goof it up, but we have to try.

DnvrFox

Err - Natale trained in Italy, as I recall.

ANDREA NATALE- CURRICULUM VITAE

Andrea Natale, MD, FACC, FHRS

Graduated with Honors in Medicine and Surgery at Universita' degli Studi di Firenze of University of Firenze in 1985
Specialized in Cardiology at the Catholic University of Roma, 1989
2005-2007 Medical Director of the Center for Atrial Fibrillation and Head of the Cardiac Pacing and Electrophysiology Section, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation Cleveland, Ohio, USA
Currently, Executive Medical Director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Clinical Associate Professor of Medicine, Case Western Reserve University, Cleveland , Ohio; Consulting Professor, Division of Cardiology, Stanford University, Palo Alto California
Member of the Chairman Society of the Heart Rhythm Foundation
Fellow of the American College of Cardiology, American Heart Association and Heart Rythm Foundation
Author of more than 200 peer-review publications in the field of arrhythmias
Editor and co-author of several books on arrhythmias
Reviewer – PACE, The Official Journal of the North American Society of Pacing and Electrophysiology
Reviewer – Journal of the American College of Cardiology
Reviewer – American Journal of Cardiology
Reviewer – Journal of Cardiovascular Electrophysiology
Reviewer – American Heart Journal
Reviewer – Circulation
Reviewer – Journal of Electrocardiology
Member of the Editorial Board of the Journal of Cardiovascular Electrophysiology
Associate Editor of the Journal of Interventional Cardiac Electrophysiology
Member of the Editorial Board and Advisory Committee of the Japanese Journal of Cardiac Arrhythmia
Program Committee Member for the Heart Rhythm Foundation
Member of the FDA task force on Atrial Fibrillation
Member of the Heart Rhythm Society task force for the preparation of a Consensus Document on Atrial Fibrillation.
Member of the Editorial Board of Advances in Arrhythmias
A pioneer in some of the present catheter based cures for atrial fibrillation.
The first cardiac electrophysiologist in the USA to perform percutaneous epicardial radiofrequency ablation.
Since 2004, he is named among the “Best Doctors in America”.

Kurt Erlenbach

To qualify as a "best" doctor or hospital requires two things - high volume and substantial research experience. The Cleveland Clinic meets those criteria. Many doctors or hospitals do a volume business (practice may not make perfect, but it helps) but without research they could make the same mistakes over and over. Without the volume, a doctor won't get the judgment that experience provides.

By the way, getting the best results is not always the mark of the best doctor. The best doctors take the sickest patients, meaning the won't always get the best results.

roadbuzz

This is all good info. The original cardiologist referred me to another who is an electrophysiologist working at the same clinic. That is the cardiologist I am working with now. From the web page bio (Dr. John Zakaib, Cardiovascular Associates of Charlottesville) "He continued his training in Cardiovascular Disease at the Cleveland Clinic where he served as Chief Fellow in Cardiology."

Kerlenbach: "But I do want to point out threads like this are further evidence of the quality of this forum."
I absolutely agree. Thanks again to all, you guys are awesome.

Yen

roadbuzz, I'm sorry for your recent loss of your mother. It is hard.... actually, very very hard.... but it does get easier with time, lots of time.

UberIM

I think the guy I was thinking of is Pappone-he still is in Italy.
So, did you have the PV mapping?
I assume it went well which is terrific........

bobkat

Your rpblem seems to be probably a 2nd degree block, and your first cardiologist doesn't seem all that keen to pop a pacemaker in.
I'd definitely recommend a second opinion. Go to any well known name brand teaching hospita, many have been named above and there are many more.
In my experience in medicine for well over 40 years I've found that the good ones all pretyy well do things about the same way, and I sure disagree with this silly ranking thing they have. (Even though I was on the list one year - still a silly system and should be tossed out or put on the shuttle and put into orbit!)
Anyway, it is possible that you might get the same "we can try it and see what happens" suggestion from a second or third opinion. Sometimes there is no clear cut RIGHT or WRONG way to do things.
By the way many pacemakers also contain circuitry for a defibillater as well. Also, atrial fibrillation and ablation is treted very differently from heart block problems. The only common denominator is that they are both electrical problems with the heart, but otherwise are completely different.

Ames

My son (early 40's) suffers from a low heart rate and after passing out twice when under hard exertition and was fitted with a pacemaker to keep his heart rate up but does not have any blockage . Has had it over 5 years and has had good results. Get a qualified second opinion from a cardilogist with an exercise background. Most cardilogist are used to treating "couch potatoes" so you may have to travel to get to the right one.

roadbuzz

Just an update, if anyone is interested.

I got a second opinion from Cleveland Clinic, it concurred with the opinion of the primary cardiologists. For what it's worth, it was actually an online consultation using the reports, stress test results, holter monitor strips, ECG, and sonogram from the primary cardiologists. I also went to a UVa Cardiology seminar on pacemakers and implantable defibrillators. They're doing some neat stuff, but it's oriented towards people in much more at risk than me. I'll be gettng the pacemaker implanted this Tuesday.

making

Glad to hear you are doing ok.

hotwired

The most gifted transplant surgeon in Wisconsin for the last 25 years was Dr. Mark Adams who was the head of transplant surgery at Froedtert Hospital in Milwaukee Wisconsin. Dr. Adams was truly a world class surgeon who saved my wife's life, and the lives of many others. Dr. Adams had a heart condition and was given the choice of a pacemaker or in the alternative exercise coupled with meds and a strict diet. Dr. Adams opted for diet, meds and exercise which he complied with religiously. He died of heart failure at the age of 62. I can not begin to tell you how many transplant recipients grieve over his untimely death. Consider your options with the greatest care possible. Hotwired in Milwaukee