AV node ablation after pacemaker implantation

[AVNA]

Is it normal to be short of breath after 2 months of AV node ablation and pacemaker implantation? Any comment would be much appreciated, thanks.

[BobD Volunteer]

How recently has your PM been adjusted?

[AVNA in reply to BobD]

Thanks, Bob. On 12/12/2023 PM was set down to 70, which was down from 80 which was set four weeks earlier, after the AVN ablation. I appreciate your comment.

[CDreamer]

What is your PM range set to? I had to have my PM tweaked several times before finding a range which suited - first resting rate was set too high and high rate restricted, then gradually adjusted for activity until it was acceptable.

[AVNA in reply to CDreamer]

Hi, I was only explained that PM was set to a Resting Rate of 80 but nothing else and four weeks later reduced to 70 then will be at 60 as my baseline. Perhaps, as you say, it is restricted because even though I feel exhausted doing anything or walking a bit uphill, my HR does not rise much. I feel fine sitting down or walking indoors. In a couple of weeks, have to go to the next appt and I will ask the technician about that. Hard to see EP or GP these days. Your comment is very helpful and much appreciated. Thanks.

[CDreamer in reply to AVNA]

It was only when my range was increased to 120 for walking that I began to feel anything like OK walking. You don’t need to see or to speak to a GP or doctor - just ring your Pacing Clinic. The PM’s are regulated by the Cardio Physiologists who are usually incredibly kind, full of information and can often give you an appointment to tweak the device within days/week or so but obviously the holiday period there may be a bit of backlog but you can always speak to someone on the phone. Do you have a beside bed monitor or an app on your phone? They will be able to see everything your heart is doing from the downloads.

Sounds to me as though you are doing well and it will improve with time. Still early days but you should have had a pacing clinic review at 6-8 weeks so get on to them. The number should have been given to you or will be on the card you are given when you had the PM.

[AVNA in reply to CDreamer]

Hello Dreamer. I contacted the clinic regarding PM reprogramming but, of course, no chance of getting an earlier appt. on this holiday time, so I will relax and wait until the one, next week. Yes, I do have a monitor by the bedside, which makes me think nothing to do with the PM…just that I’m an anxious individual. Reading your post 😣 helps and I’m prepared to ask questions about the ranges and if they can see that my heart rate doesn't rise much… etc. Glad you have replied to my story, thanks.

[Golfer60UK]

Hello AVNA, had mine 2021 and there are occassions when I do get periods of shortness of breath, but they don't last long, minutes really

Good comments from BobD and CDreamer

Dave J

[AVNA in reply to Golfer60UK]

Thank you Golfer. Yes it is a bit more complicated than I thought. Have lots to learn, and I agree that the above comments are very helpful. Perhaps I have to wait some time to get used to it, as you say,

[Tricia239]

I had mine at the beginning of October, pacemaker now down to 60, but I am still quite breathless too. I live in hope but will soon start asking some serious questions.

[AVNA in reply to Tricia239]

I also have questions in the next appt. As CDreamer mentioned above, perhaps my PM is restricted, since I have noticed that HR doesn't go much above 80 even when I'm feeling exhausted.

[Delta110]

When I had PM implanted it took almost one year to set proper settings - in 2016 I was electrocuted (240V almost lethal) and my whole conduction system (including sinus node, AV node) was damaged - I am paced A-78%, V-98%. Additionally (one year post PM implant) I had left atria cryoablation (paroxysmal atrial fibrillation) and my heart needed 3-4 months to adapt to the new conditions and I was short of breath too -> after 4 months I still had quite high level of troponin . Sometimes your heart needs much more time to re-adapt, especially it was AV ablation. 1. heart must heal the scar after ablation, 2. PM has to be re-adjusted to the new situation and has to be perfectly synchronised. Another thing is of how PM was implanted - traditional R atria-R ventricle, Atria and Hiss bundle (which is more complicated) or Micra . Sometimes lead (if its a traditional PM with leads) obstruct the tricuspid valve and there is a backward leak into the R atria. - it can be shown on Echo test.

3. Is everything ok with "pipes" - arteries ? no blockages etc ?

There are too much factors to give one answer without more details however we are not a doctors and you shouldnt take advices from non professionals. I highlighted most common issues because I went through the whole process in hard way. Electro-physiologists try to reduce ventricular pacing for many reasons however in your case (after AV node ablation) you are (I suppose) paced 100% so, the problem can be as I wrote above . Take care and wish you fast recovery and a Happy New Year.

[Golfing2022]

I had P&A Feb/22, after 2 months I was very much like you breathless & tired. I remember thinking this didn’t work, at 3 months it was like someone turned a switch & I started improving shortly after that I was golfing 18 holes. Hope this helps we all heal at different speeds, Happy New Year