AF/tachycardia is the chaotic irregular beat or the extreme fast beats the main problem?

[shwills]

Hello

I have had AF/tachycardia for many years now, I also have 2 leaky valves one of them is tricuspid valve, heart block and now heart failure. I also have a 3 lead pacemaker which has stopped the long sinus pauses and bradycardia. The HF has been caused by the AF as well as the leaky valve according to my Consultants at Barts London who I have been with for many years. Last week I saw my heart failure nurse who said now my beats are not constantly over 100bpm which they have been for an awful long time, my beta blockers have got it down to 80/88. However I am now in persistent AF gone from paroxysmal AF to persistent and it is chaotic irregular and just awful. My heart failure nurse said that the high beats cause the problems not irregularity/chaotic way it beats

I am puzzled about this I thought all of it can cause problems - heart failure and leaky valves. My AF consultant wants me to have an AV node ablation which I have fought against for years, I have had 4 ablations obviously not worked but the AV node ablated is drastic

So anyone can throw some light on my question is very much appreciated

[CDreamer]

Like you, I don’t think it is just the fast heart rate although many doctors and nurses seem to put such an emphasis on keeping HR low but my understanding of that is under 120? I talked to my EP about this and he said the high HR is not an issue in itself - I found I could manage quite well with tachycardia up to about 130 HR - above that I folded. But in AF and HR of 100 I felt appalling and I don’t have any structural issues!

I think that the chaotic rhythm causes lots of chemical changes in the body, anxiety and for me - BP goes very low and chaotic and that all contributes so your body is in severe chronic stress - and that causes massive symptoms.

Like you, I have ReSynchronisation Therapy PM - implanted in preparation for AV node ablation but the PM helped me so much that I cancelled the AV ablation - but I now am not in AF and I’m not that symptomatic. My understanding is that the AV node ablation won’t stop the AF - you will still feel it - but because the fast rate will not be passed through to the ventricles, your pulse will be steady and controlled - therefor you may, and the word is may, be less symptomatic. Fewer symptoms = less stress = better QOL.

I think you need to take the advice of your specialist in this matter and I think in your position it may be worth considering? It sounds to me as though it might help you to be able to talk this through with a knowledgeable person who can empathise and advise on your prognosis in order for you to make an informed choice.

Best wishes CD

[mandysmith34]

Gosh. You've got more or less the same as me. Mine was caused by a congenital massive hole in the heart. Have had permanent AF for about 12 years. Had mitral valve replaced 7 years ago and have a single lead pacemaker. Now in chronic heart failure (mainly RH side), need an urgent tricuspid valve replacement, my liver is enlarged and I have rampant ascites and need a more appropriate pacemaker. My consultants reckon it's a combination of the AF and the dodgy valves. I think higher HR causes issues quicker but the chaotic beats often cause more discomfort and day to day problems for us. I have no answers I'm afraid, just sympathy from someone in a very similar boat!

[shwills in reply to mandysmith34]

Hi

Yes you are certainly going through it as well, my HF is moderate so not as troublesome as you. Think my AF is hereditary my father had it and my sister has it. I have a large hole which has been caused by the 4 ablations, there is discussion between my consultants about patching it so wait to hear

Thank you for your thoughts on what I have asked about, I did have super ventricular tachycardia as well but the beta blockers have controlled the rate which I something I suppose