Sinus tachycardia noted on 7 day monitor - concern?

I have had a 7 day halter monitor on since last Sunday, with a few hiccups and blips here and there, but nothing of significance, that I noted anyway. Later yesterday, and last night, I was feeling like my hearbeat was kind of fast and not real strong, and was concerned. When I went to bed, it was definitely feeling fast. I realized that I had forgotten to take my Atenolol that morning - but only take 12.5 mg.... - so got up and took it. I shaved off some from a 25 mg. tab so may have had closer to 20mgs. or so...I fell asleep soon afterwards.

When I called the LifeWatch line today to see if anything was noted - feeling scared it might have been AFib.. - they said it wasn't, but it was a bout of sinus tachycardia - pulse rate at 120 bpm. The guy said it was for about 90 seconds, as far as he could tell. My average pulse rate seems to be between 65-80 bpm.

Should I be concerned about this? It's now been 6 months since my Natale ablation. I have had a few times when I felt like my heartbeat was difficult to pick up...weaker feeling and probably fast...not sure. No AFib has been noted on any of my recordings over the months that I've been using an event monitor, and I think this is the first show of anything during the 7 days (could be wrong about that..I haven't met with the Dr. yet).

About 30 years ago I had some tachycardia, and was put on a beta blocker. Then I got pregnant, was told to get off of it, and as far as I know, haven't had the problem since....yesterday?

~ Barb

Hi Barb,

It was because you skipped your BB combined with the somewhat faster baseline HR from a more extensive first ablation. Nothing at all to worry about as it was sinus tachycardia.

You probably notice its slowed down some now after taking the missed dose and getting a good night sleep, right? Be sure your electrolytes are good too and you might either be too low on potassium or perhaps too high if you are taking large dose of K and do not monitor with a Cardy-meter, though that is unlikely..

In any event, be thankful not a blip of AFIB in 6 months post ablation! Everyone gets an occasional day of faster HR for a while or some runs of ectopics here and there, but as long as you are not in sustained full blown tachycardia, flutter or AFIB, its nothing to write home about.

You can discuss it with Dr Barrett soon. When do you get the TEE, that is what Im looking forward to learning about, and one way or the other it will be fine and the next phase will be clear.

You did have a significant amount of LA fibrosis or scarring originally found during your first ablation from your long time bout with AFIB, and that is why the need for the more extensive first ablation. There is also around a 35% to 40% chance for a quick touch up to a LAA isolation ablation being needed due to the need to approach that area more delicately in the initial full isolation, with its thinner-walled structure. Something that Dr Natale is exquisitely skilled at doing safely and effectively.

One way around having to do even a touch up, should that ever be required, is with the Lariat or an Atriclip both of which will further re-establish electrical and structural isolation of the LAA for good once they are added to an original LAA isolation by ablate. Plus, the added bonus of getting rid of the anti-coagulation issue once and for all as well. In any event, those are things you can discuss with Dr Natale after getting your TEE, assuming it's even an issue.

In the meantime, relax and enjoy your Sunday Barb. It can take up to a full year and a half for your baseline HR to go back down to normal range after a good size ablation and that is perfectly normal and expected.

Shannon



Edited 1 time(s). Last edit at 03/23/2014 06:37PM by Shannon.

Hey Barb,
Same here after I workout and use the steam room I also go into a high pulse rate maybe 100-110 for a few minutes or more but it always comes down, no afib from what I can tell feeling my pulse or ECG from LifeWatch monitor. I'm on 25 mg BB my choice too. I'll be at 10 months Friday March 28, can you imagine that....

McHale



Edited 2 time(s). Last edit at 03/24/2014 02:14AM by McHale.

Hi Shannon - could that really be from skipping the beta blocker when I was only taking 12.5 mgs? If so, I'll be sure to not forget again anytime soon. I AM glad that if it was going to happen, it was caught on the heart monitor.

I changed my appt. for the TEE from this Tuesday to April 8th, as I didn't have anyone that could go with me or meet me in the city this Tuesday. (they were booked for next week). Should I assume that Dr. Natale will also be made aware of my results, even though I'll be seeing Dr. Barrett? I am hoping that's the case.

We need to change your wording on your last post from "your first ablation" to "your ablation"! Isn't that a bit like saying "I hope you and your first wife have a happy life?" Haha... I'm hoping this is my one and only ablation, but yes, you have prepped me for the possibility that it may not be. I would like to prove you wrong this one and only time

McHale - no, I can't believe it's already been 10 months! So I guess a higher heart rate on and off is "to be expected..don't worry much about it"...hoping that's true. Were you on a BB before your ablation? I was...in the very beginning, one of the cardiologists had me on 100mgs/day! I still remember him saying, "well, I think we have it pretty much under control"..meanwhile, I was still getting Afib regularly. Glad we can both put that nonsense behind us.
What is the Pulse for life watch monitor, McHale?

~ Barb

Hi Barb,

Yes first and last ablation it is .... until otherwise notified which hopefully will be never. :-) And just skipping a BB regardless of dose can trigger a short term spike in HR from the rebound effect. This can be even more pronounced had you been taking a higher daily dose, but some of that HR increase is no doubt from your ablation still. When Dr N has to branch out more around the outer regions of the left Atrium including the LAA it seems to take a good deal longer for the HR to finally settle back down to normal range. Likely because of the wider dispersion and total volume of pacing cells that were temporarily zapped and have to regrow and kick in again or that were stunned for a long period and are lazy and take their sweet time in waking up again and getting back on the job of maintaining your own natural rate control. It will over time, no worries.

Just don't forget the BB and if you go off even taper that small dose by half every five days until you are zero for the absolute minimum of noticeable rebound.

Shannon

Thanks, Shannon I'm guessing the higher heart rate is why I find myself winded a little more easily when climbing and brisk walking, etc.
Will be happy to have that quiet back down.

I had an Echocardiogram on Friday, from my cardiologist. Just stopped the 7 day heart monitor, so next step is the TEE, which will be on April 8th.

Keeping my fingers and toes crossed!

~ Barb

Barb,
I corrected my post above, meant to say feeling my pulse and and using my LifeWatch monitor.

Be Well,

McHale

Hi McHale,

Just curious, Do you still have a Lifewatch monitor or is that your AliveCor monitor you are using now?

Best,
Shannon

AliveCor monitor sorry for the mixup.

McHale

Thanks McHale, I know Lifewatch has a number of new models now and I didn't know if they have one for more or less permanent use by the patient. The AliveCor is a handy little device. Not quite at 24/7 convenience yet, but very useful for sure.

Shannon

Just curious McHale...why are you still using a monitor? Your own choice or did Dr. Barrett or Dr. Natale suggest it?

Barb

To check for silent afib or when I get ectopics or pacs and when I feel my heart jittery and want to make sure my R to R intervals are properly spaced out.

McHale