What does this EKG look like to you

I had a decent run of nearly a week post mitral valve repair surgery and a Maze Procedure. On Day 7 (first 6 consecutive days in NSR) I went out of NSR for about an hour and days later went in and out for 10-15 minutes or so. Last two days I've had similar Ekgs as the one attached here. Today is actually my 14th day post surgery and I'm still well within the blanking period. The only concern I have is this arrhythmia has lasted most of two consecutive days now and I haven't seen NSR for the last two days. I have a follow up appt with my surgeon tomorrow but I'm curious what that EKG looks like? Is that AFIB or Aflutter?



Edited 2 time(s). Last edit at 03/13/2024 03:20AM by cornerbax.

Definitely not afib. Could be flutter but it's almost impossible to diagnose flutter without a 12-lead. So it's sinus tachycardia, or flutter at worst. Whichever it is, the 120 bpm needs to not be allowed to continue.

Thank you, Carey. I think they will be doing a 12 lead EKG on my first and only follow up with my Surgeon, tomorrow. When I was in NSR for the first week my resting heart rate was around 60bpm. On day 7 my rhythm changed from NSR and my rate went to 140-155. Within an hour I reverted to NSR.

My doctor then prescribed metoprolol and the next few instances of any arrhythmia lasted less than 20 minutes and where the rate didn't go above 115. So Metoprolol definitely helped. I then went back into NSR for days until the last two days where I've consistently had Ekgs like the one I uploaded. That ekg says 111 bpm on the echo itself where did you see 120? Were u manually counting?

I will try to relax and sit and see if I go under 100bpm and take another Kardia to see if it's the same arrhythmia as the one I uploaded at 111bpm.



Edited 2 time(s). Last edit at 03/13/2024 03:21AM by cornerbax.

I got 120 from doing a quick measurement on the QRS spacing. It could be off by 10 bpm because I only measured a small sample but the device averaged the whole thing. Anyway, 120 vs 111 doesn't matter. It's tachycardia either way and shouldn't be allowed to continue uncontrolled.

By the way, it's not an echocardiogram. It's an ECG (or EKG). Totally different things. An echo is when they put a lubricated ultrasound wand on your chest and move it around, looking at your heart's movements. It doesn't produce an ECG.

Hey Carey, thanks for pointing out the echo aspect. I 100% just wrote that incorrectly. I definitely know what an echo as I've had 6 of them as well as a TEE. Not sure what made me brain fart and write Echo But I've corrected it to EKG. I also agree 111 at rest is still too high. When I lay down or during sleep I'm around 80bpm but sitting or standing the last two days I've been over 100bpm.

I was told after the surgery I had (mitral valve repair, Cryo Maze, and LAA Closure) there would be a lot of inflammation and I could definitely see rapid heart rates or other arrhythmias sooner vs later, at least within 90 days. Regardless, two days with a resting heart rate over 100bpm doesn't sound great. I see my Surgeon tomorrow. I believe it's the first and only time I'll see my surgeon for a post surgery follow up. Any other appointments with be with my cardiologist moving forward. I will mention the heart rate to them. I believe they are doing a chest ex ray tomorrow as well as a 12 lead ekg so we'll see what that says.

Carey, I just took another Kardia EKG and this one shows 96bpm at rest. Still not great but better then the 111bpm earlier. Does this EKG look the same/similar to the first one? Do you still suspect Aflutter or Sinus Tachycardia?

Yeah, same thing.

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Yeah, same thing

From your experience how accurate is Kardia? The reason I ask is the EKGs I've taken look similar but Kardia classifies some of them as '' unclassified'' and some as POSSIBLE AFIB. They don't ever use the term definite AFIB or just AFIB just' ''possible'' Afib. The reason I ask is because the first EKG I attached here was labeled as UNCLASSIFIED while the last one I attached was labeled as possible AFIB.

I also paid for a year of Kardia Premium which is supposed to reflect Sinus Tachycardia. None of the EKGs I've done say Sinus Tachycardia which is why I'm wondering how accurate Kardia is. As you said, it could be A Flutter and Kardia does not detect that, probably because you really need a 12 lead EKG to detect Flutter like you stated.

In short, Kardia classified the last two EKGs as Unclassified and Possible Afib. I'm wondering why the last EKG wouldn't be Unclassified the same way the first one was but instead listed as Possible Afib? Any ideas?

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cornerbax
how accurate is Kardia? In short, Kardia classified the last two EKGs as Unclassified and Possible Afib. I'm wondering why the last EKG wouldn't be Unclassified the same way the first one was but instead listed as Possible Afib? Any ideas?

It's how you define "accurate".

Kardia produces single and six lead medical grade ekg's that can rival and even surpass the quality of some Holter devices. So in that sense, the ekg's are extremely accurate and every ep I've spoken with uses them for diagnostic purposes, although sometimes a 12 lead is needed for more precise analysis.

On the other hand, Kardia's AI "determinations" (afib, unclassified, etc) while quite accurate can sometimes miss the mark. But keep in mind the same thing can happen with the AI analysis at your doctor's office with their 12-lead machine. That's why a good ep ignores what the machine says and just analyzes the ekg itself.

So if you have doubt what your Kardia is telling you, simply email the ekg to your ep for a more definitive analysis.

Jim

Thanks for the detailed post. It seems Kardia is very accurate overall. That's even more odd that with nearly back to back EKGs reflecting nearly the same, one would be Unclassified and the other Possible Afib. What's even more odd is I that I get 4 board certified Cardiologist reviews of my EKGs for the year. I used one of them on one of the Echos I attached and the cardiologist said ''possible Afib.''

My guess is that they couldn't decipher Sinus Tachycardia and Aflutter as Carey mentioned should have a 12 lead. I don't think on those board certified EKG reviews they can put Unclassified so he just put Possible Afib and no secondary condition such as PVCs etc.

It would be nice if the consistency were there and not back to back EKGs reflect different classifications when they look essentially the same.

They look essentially the same to you but the computer is seeing things you don't, and an EP might also. ECG interpretation is not a trivial skill. Small, subtle changes that are easy for an unskilled person to overlook can be meaningful.

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They look essentially the same to you

Not to me, sir...to you. I asked here for a professional opinion and you responded that both EKGs uploaded looked the same to you. I actually just got back from my first post surgery follow up and my NP said the EKG is sinus Tachycardia. My cardiologist was able to glance at it from a text from my NP and they said it is Sinus Tachycardia with possible slight Flutter. Nearly exactly what you said, Carey.
Not sure what ''slight flutter''means specifically but it seems like I'm in mostly sinus Tachycardia with occasional beats of flutter somewhere in between.

My cardiologist will review in full later and likely send to my EP for further review. Either way, as you said the EKG is far from Afib and can not be confused with AFIB so I do honestly feel a little slighted by not just Kardia saying possible Afib (when it's not even close) but also a board certified cardiologist with Kardia reviewing the EKG and also saying possible Afib. It isn't back breaking but it's still $99 I paid for the year I think Kardia can do better. At least have the cardiologist say Unclassified arrythmia or something to that effect vs possible Afib when it isn't even close to Afib. My hunch is since there is a $99 charge they have to have the cardiologist classify the EKG as anything BUT Unclassified. Again, I think that's wrong but maybe I'm asking too much..



Edited 2 time(s). Last edit at 03/14/2024 12:08AM by cornerbax.

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Unclassified

Sometimes, actually often, the unclassified tag is related to "noise," hands not in the optimal position etc. Natale's NP gave me a heads up on this. Try taking your reading in a room with no appliances or electronic interference. Also have your hands on a table right in front of you instead of below, and moisten your finger tips for good contact. At least with the "advanced" level of Kardia membership if it says Atrial Fibrillation rather than Possible Atrial Fibrillation, it is usually correct--though it can again get confused by runs of PACs. It is a good tool but can't fully replace a 12 lead read by someone knowledgable.

When you say advanced you mean the $299 a year fee? I don't see a big benefit of paying $299. The premium is $99 a year and that still says possible Afib. The EKG I sent to the board certified cardiologist said possible Afib but as pointed out, the EKG looks nothing like Afib at all so I think there should be more options for the board certified cardiologist to respond with. I can understand some EKGs being hard to decipher but it seems that Afib looks massively different than do the EKGs I posted so to have a board certified cardiologist state possible Afib is crappy.

Thank you for the heads up on the quiet room and moist fingers/thumbs. I will do that and see if less Unclassified EKGs reflect. As mentioned, you must pay $299 for the top tier plan as my Premium plan is $99/annually and still says Possible Afib and not ''Afib''. But again, none of my recent EKGs reflect afib in the least so saying possible Afib isn't a help. Unclassified I definitely get as Kardia can't decipher Flutter. My own cardiologist is gonna have to look very closely at the EKG 12 lead to fully decipher it and likely send to my EP for further review. All that is understandable but a board certified cardiologist partnering with Kardia shouldn't say Possible Afib when the EKG doesn't look remotely close. You don't agree on this?

I just saw the EKG in my portal and it was reviewed by my EP. He wrote sinus Tachycardia but can NOT rule out Aflutter. So I guess even with a 12 lead and a solid EP (he heads the EP Dept at Cedars-Sinai) some EKGs are still complex.

My atrial rate was 112 and my ventricular rate was also 112 at the time of the EKG. They are changing up some medications to help lower my rate. They are pretty adament on the amount of inflammation and healing the first month and that this (faster heart rate and/or A flutter) is very common during that time frame. Many people also get Afib during this time frame, but fortunately and knock on wood I haven't yet and don't. The next two weeks or so is big for me as if I return to Sinus Rhythm when my body heals more and there's less inflammation, hopefully I revert back to my rate when I was in NSR which was around 60bpm at rest. Hoping and praying that is the case very soon.



Edited 1 time(s). Last edit at 03/14/2024 03:11AM by cornerbax.

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As mentioned, you must pay $299 for the top tier plan as my Premium plan is $99/annually and still says Possible Afib and not ''Afib''.

They must have changed their structure. I have never paid for a membership as I was grandfathered in as I bought my Kardia quite a few years ago. Evidently my membership corresponds to the $299 tier as I get 6 possible diagnoses and never "Possible Atrial Fibrillation", only Atrial Fibrillation (before I had my ablation). I have also had some of the others: Sinus Rhythm with Supraventrical Ectopy etc. Too bad that they are charging so much. I have never sent a strip for review with one of their certified cardiologists as I just sent them to my own EP and more recently to my nurse navigator with Dr. Natale.

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All that is understandable but a board certified cardiologist partnering with Kardia shouldn't say Possible Afib when the EKG doesn't look remotely close. You don't agree on this?

No, that does not sound good. I wouldn't send them any more!

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No, that does not sound good. I wouldn't send them any more!

I didn't think I was being overly critical I just want what I pay for, nothing more. I can always send my EKGS to my cardiologist or EP but I don't want to bombard them. Right now I'm being very attentive to my EKGs as I'm two weeks out from open heart surgery and I want to monitor my rate and rhythm as closely as I can during this time.

With the $99 I paid Kardia, I get 4 certified board cardiologist reviews of an EKGs for 12 months. I chose to send one of those EKGs posted here and where Carey (just like my cardiologist and EP today) said it definitely isn't AFIB. To pay for this service and have a cardiologist ''board certified'' analyze and write Possible Afib is like saying the color Orange is Possibly Blue. That's how I see it anyway, when there was 0% there was possible Afib from that EKG.

My gut feeling is Kardia touts the 4 EKGs from the board certified cardiologists to be specific so if you send them an EKG and they can't decipher it and they write back UNCLASSIFIED that's just gonna make people equally as upset as the whole purpose of the cardiologist review is to have specifics to the EKG and not be labeled as Unclassified.

Either way, I doubt I'll send them anymore but I do feel I threw $99 literally down the toilet.

On a bright note you definitely got in at the right time to get a grandfathered advanced membership free that now sells for $299 annually. However, if it's anything like what I experienced with my EKG, anyone that pays $299 is likely not getting what they are paying for either.



Edited 2 time(s). Last edit at 03/14/2024 03:52AM by cornerbax.

I have Atrial Tachycardia, PACs, Bigeminy, and the Kardia always says unclassified or possible Atrial Fibrillation. From my understanding, the standard Kardia, no subscription, is really only able to tell you if you have NSR, or absolute Afib. Anything else will read unclassified or possible afib. On the same token, when I use my Wellue, it tells me SVT, or bigeminy right off the bat. I like the multiple lead feature of the Kardia, but for the actual diagnostics, it falls short and the Wellue is a better bet for determining rhythm.



Edited 1 time(s). Last edit at 03/14/2024 03:13AM by MeganMN.

As mentioned I have NEVER had my kardia say Afib.... EVER. I paid for the subscription days ago but for over a year I had the no subscription. Prior to my robotic mitral valve surgery I was in AFIB 100% of the time. My zio and every EKG I took all said Afib. I wore the Zio for two weeks and it showed a 100% Afib burden. This wasn't really a shock to anyone as the mitral regurgitation I had was 50%+ going backwards into my Left Atria. I had this along with AFIB so getting into NSR was nearly impossible once the regurgitation went from moderate to severe.

Even with a 100% Afib burden and clear cut Afib EKGs my Kardia still NEVER said Afib it ALWAYS said possible AFIB.
Since the $99 I paid recently I've probably run a dozen EKGs and they all either say Unclassified or POSSIBLE AFIB. Never once, even with the $99 Premium membership has it said Afib for me.

I wonder if I had the premium membership when I was in AFIB 100% of the time if the Kardia would of said AFIB.



Edited 1 time(s). Last edit at 03/14/2024 03:54AM by cornerbax.

Thanks for the 12-lead but it's only a narrow slice of the results since it's a screen shot from a phone. If you can't download a PDF or something from the portal you got it from, don't bother unless you're on a PC or Mac with a screen large enough to display a full ECG. Phones are really limited in what they can display and ECGs are beyond those limits.

Carey, I will upload it from my pc tonight or tomorrow thank you for the heads up.

Also, if this isn't odd I don't know what is. I just logged into my Kardia account and the that 96bpm EKG I uploaded here (where Carey stated it's definitely not Afib as did my NP and Cardiologist) now says Advanced Determination and AFIB! It no longer says Possible Afib. The only thing I can think of is I just paid for the premium account within the last 72 hours and maybe some features didn't upload in my account initially. Right now though it has a note that says advanced determination and says AFIB.

This actually seems WORSE though, as that EKG isn't even CLOSE to AFIB. I tried to take a screen shot of the EKG showing advanced determination in purple font and AFIB but Kardia doesn't allow screen shots. I could take a Pic with another phone and upload it here but I don't think it's necessary unless someone wants to see it. The question now is how an EKG like that which doesn't remotely resemble Afib be classified Afib and Advanced Determination. This is equally as bad as the board certified cardiologist.

At least the EKG tracings from Kardia seem to be as good as they get for at home devices but their classifications and professional cardiologist reviews are way off, at least in my case.

I don't know. Things are getting a little confusing with all your recordings. I'd have to see the two full recordings side by side to see why they might be different (or not).

Carey,

Scroll to the top of this thread I posted both EKGs back to back. One at 111bpm (where you said that rate needs to be controlled) and the next at 96bpm where you said both EKGs look the same to you.

Edit: I just took a picture of the EKG that reflects the ''advanced determination'' and states AFIB and am attaching that as well as the 96bpm EKG stating Afib. Not ''possible'' Afib just Afib. It's the same EKG I posted at the top of this thread that you stated is not Afib. Do you see anything different now?



Edited 2 time(s). Last edit at 03/14/2024 05:53AM by cornerbax.

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cornerbax
I just took a picture of the EKG that ...

The Kardia ekg at 96bpm look like afib. The first ekg you posted in this thread does not. Did Kardia tell you the first ekg was afib?


Jim

It seems you have a recording that is likely afib and another that isn't. Okay, so what is the underlying question here? I don't understand what you hope to learn from comparing the two.

Carey, when I posted both recordings at the start of this thread I asked if they both look to be the same arrhythmia. You wrote this:

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Yeah, same thing.

Both of those recordings were taken very closely to each other so I was curious if they were likely the same arrhythmia or not. When you said they were the same thing (which you previously said was sinus techycardia or flutter at worse) and I saw Kardia flagged it as afib I figured Kardia was wrong and you were correct. You and Jim are now saying the second recording is different from the first. If the second recording is Afib that means I went from multiple arrhythmia in a short period of time.

When I posted the recordings I just hoped to know the arrhythmia and was hoping it was NOT afib as I had a Cryo Maze procedure and I'm going on week 3 from the Maze so I was hoping the recordings were anything but AFIB. Even though it can take as much as 60-90 days for the scar tissue to develop to completely prevent Afib, I have read studies that say that Early Onset Afib can be a predictor of the likelihood Afib will come back persistent after the blanking period. There are a percentage of people that don't have Afib episodes (or extremely few or for short periods of time) within the first 90 days and with little to no Early Onset Afib there's a better predictor of it being completely eliminated after the 90 day blanking period.

That's the main reason I was asking on the EKGs. Those are only the second set of EKGs I've ever posted on this forum so I don't ask EKG opinions regularly. Also, when you said that the second EKG was the same as the first I assumed you were right and Kardia was wrong. I posted the first one at 111bpm because it was flagged as UNCLASSIFIED. I took some deep breaths and sat down and shortly thereafter my Resting heart rate was under 100 but the reading was flagged as AFIB not Unclassified. Again, when you said both looked to be the same to you I assumed Kardia was wrong which opened another can of worms as I had a classification of definite Afib when it didn't appear to be.

Now from both you and Jim it actually does appear to be. Makes things a little different. Either way, if it is Afib I wasn't in it long and as mentioned the 12 lead EKG from my Doctors office yesterday reflected sinus Tachycardia with the note that Aflutter can not be ruled out.

Lastly, I just checked and the EKG that I sent to the Kardia board certified cardiologist was at 99bpm (2 days prior to the two I posted here at the top of this thread) and which was flagged by Kardia as Unclassified. The Kardia board certified cardiologist reviewed it and stated it was AFIB. Next to Afib is a definition of what Afib is so they didn't type anything but seemed to hit a button that says Afib followed by a definition. Jim, the 99bpm EKG I attached now is the one sent to the Kardia Cardiologist. If that EKG does appear to be AFIB then it appears Kardia and the Cardiologist were actually right on BOTH of their assessments of the two EKGS. While I was hoping to not be in AFIB often, even early on, at least it gives some peace of mind in knowing Kardia is accurate and consistent, especially when flagging Afib and not possible Afib. I guess we'll see what is thought of this cardiologist reviewed EKG to see if that too also looks like Afib.

Carey, back to your question of what I hope to get from the recordings.

1) Did I have any bout of early onset Afib and if so for how long?

2) Is Kardia accurate in the recording that says Afib?

3) Is the Kardia board certified Cardiologist accurate with the 99bpm listing I attached here with their assessment it's Afib?

If you or Jim wouldn't mind sharing your thoughts on the EKG I attached now at 99bpm, number 3 will also be answered. Thank you both very much for your time and help.



Edited 3 time(s). Last edit at 03/14/2024 02:45PM by cornerbax.

If you or Jim wouldn't mind sharing your thoughts on the EKG

Yes, both the 96 and 99 bpm ekg's look like afib. The first ekg you posted in this thread (111bpm?) does not look like afib. Even though it was taken very close in time to the ekg that is afib, this is not unusual.

You can have multiple types of tachycardia's -- sometimes within a short time of each other -- especially in the blanking period. For example, my afib episodes often start out as a non-afib tachycardia. Then within minutes it might change to afib. So I have Kardia ekg's that show "Tachycardia" one minute and then "atrial fibrillation" the next. Both are correct.

That said, I always advise to confirm with an ep, but apparently you have already had confirmation from at least Kardia's Cardiologist.

Jim



Edited 2 time(s). Last edit at 03/14/2024 03:50PM by mjamesone.

If both the 96bpm and 99bpm appear to be Afib then BOTH the Kardia algorithm/software would be right as would the board certified Cardiologist. The cardiologist reviewed the 99bpm and deemed it Afib.

The Kardia itself classified the 96bpm as Afib. With you saying both look like Afib then BOTH kardia and Cardiologist would be correct. Thank you! Now I know I have likely had some bouts of Afib along with Sinus Tachycardia and possible AFlutter.

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this is not unusual. You can have multiple types of tachycardia's, sometimes within a short time of each other, especially in the blanking period. For example, my afib episodes always start out as a non-afib tachycardia. So I have Kardia ekg's that show Tachycardia and then another a few minutes later that say afib

This is also VERY helpful thank you! Thank you for your time and responses to this thread. I definitely got some things cleared up.



Edited 1 time(s). Last edit at 03/14/2024 03:50PM by cornerbax.

I definitely got some things cleared up.

Glad to hear. Yes, it can often be confusing, especially when you get different readings close together.

You were right to question what Kardia's AI told you, because it's not 100% accurate in its interpretations, however in this case, Kardia was right. And you had that confirmed by both Kardia's cardiologist as well as a couple of opinions here. But do send the ekg's to your ep and/or surgeon that did your Maze, so they will have everything on record.

As to early occurrences predicting late afib occurrences (ablation failure), it's only a matter of degree and many with early occurences during blanking, end up having successful ablations. Plus the studies you read on early occurrences were done with catheter ablations and may not be pertinent to a Maze procedure. So probably best to ask your surgeon about that, but my guess is that they will tell you it's to early to draw any conclusions.

Jim

Thank you again, Jim for the extremely helpful information.
I'm liking your posts more and more with all the great news
.... Lol. You are right the reports I read didn't specify maze vs catheter ablation, only that early onset often times lead to persistent Afib after the 90 day blanking period window.

I was told to expect a number of things from high heart rate to arrhythmia, within the first 90 days and especially within a 60 day window. Thanks for the reassurance on the Kardia I just want to make sure it's accurate a lot more than isn't. And from the clarification it appears on the two EKGS in question that kardia and one of their board certified cardiologists were correct in their assessment. That also makes me feel better about paying them an annual fee but the fee is far secondary to the accuracy of the results.

Thank you again for all of the fantastic information I've learned a lot and hope to get into and stay into NSR soon. The same to everyone here.



Edited 1 time(s). Last edit at 03/14/2024 07:01PM by cornerbax.

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mjamesone
You were right to question what Kardia's AI told you, because it's not 100% accurate in its interpretations, however in this case, Kardia was right. And you had that confirmed by both Kardia's cardiologist as well as a couple of opinions here. But do send the ekg's to your ep and/or surgeon that did your Maze, so they will have everything on record.

@cornerbax, since you have the subscription, on p3 of the PDF report, it shows heart rate vs. time report. It is a little unusual as the heart rate is graphed on the right Y-axis and increases going down and it is nearly a logarithmic scale. This is because it is scaling beat to beat time on the left Y-axis with time taking longer (getting bigger) linearly going up. In any case, I've uploaded 3 examples. The first,ecg- 20240315-042104, is NSR and you can see this on p2 of the PDF (marked p 3/4 at the bottom). The second, ecg-20240305-070729 is all afib (note the high variability in beat to beat rate), and the 3rd, ecg-20240305-112510, may have some flutter in it (constant beat rate, but elevated). This is a quick visual way to check what the algorithm is reporting.



Edited 2 time(s). Last edit at 03/15/2024 09:33PM by GeorgeN.

Thank you George that is very helpful as well. I am going to go over all 3 of these and try to get very familiar. I checked once today and Kardia actually flagged the EKG as Tachycardia. My heart rate was 107bpm and that's the first Tachycardia I've gotten but I did just pay for the premium a few days ago.

I have an android galaxy watch 6 and it's pretty accurate itself but definitely not as accurate as the Kardia. If the android watch doesn't detect NSR it almost always says Afib. There is an inconclusive option the watch gives occasionally but usually it's NSR or Afib not much in between. The Kardia is definitely more accurate and the Tracings of the Kardia are more detailed than the watch.

I only ran one Kardia EKG today and as mentioned it was Tachycardia. Next week is the 3rd week post surgery. I'm curios to see if I get back to NSR as my body starts healing more but I can definitely say I'd definitely prefer Tachycardia over Afib or A flutter so hopefully it gets better from here.

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cornerbax
I checked once today and Kardia actually flagged the EKG as Tachycardia. My heart rate was 107bpm and that's the first Tachycardia I've gotten but I did just pay for the premium a few days ago.

With the premium service, anything over 100 will be determined to be "tachycardia" unless it's afib, then it would be tagged "afib". Tachycardia could be anything from sinus tach to inappropriate sinus tach, to AT to flutter to another SVT.

Unfortunately, especially with a single lead, often very hard to tell one from another, even for an experienced ep. The Kardia 6L, with six leads, would be more helpful here, but even then an ep may not be able to make a definitive call.

If your ep or surgeon wants to pursue this, a 7-14 day ekg patch may be the way to go, as they can then see the transitions both into the tachycardia and out of the tachycardia. That is what has been suggested to me to help figure out what type of intermittent tachycardia I've been having. Alternatively, if you're a DIY, the Wellue 24/7 monitor might give you and your ep the same information.

Jim

Jim,

Thank you again that is more excellent info! I'm glad to know how Kardia flags over 100bpm with the premium service. I'm just under 3 weeks out from surgery so I don't think I'd have anything classify as inappropriate sinus tachycardia. My EKG from my doctor's visit last Wednesday was classified as Sinus Tachycardia but with a statement that flutter can't be completely ruled out.

I was in NSR the first week post surgery and then had some bouts with AFIB and the last week seems to be all Sinus Tachycardia. At the very least most. I have an appt with my EP in just over two weeks and he may want to have me wear a Zio again for 14 days. The only thing I'm concerned with is that it has been a week or so straight of Sinus Tachycardia. I haven't seen NSR on an ekg in the last week. If there is or was any NSR I didn't catch it.

If there is a bright spot it's that I don't feel my heart AT ALL. Not a single beat even at higher heart rates. Even when I had Afib I rarely felt it and had very little PVC burden. That's the bright spot along with not being in Afib all of the time. Regardless, I don't want to be in sinus tachycardia as to get my heart rate under 110 it's taking Metoprolol and amiodarone and amiodarone I'm being tapered down on weekly to the point where I won't be on it at all within the next few weeks.

Not sure if my EP will prescribe anything else. The metoprolol along with amiodarone keep my resting heart rate around 80-85bpm. When I was in NSR on those medications my rate was around 60bpm. I don't feel any different at 60bpm NSR or 85bm SINUS TACH And/or Flutter. It would just seem the extra 25bpm isn't great and the idea is to get off most of these medications and being in SINUS TACH isn't going to allow that.

Any specific medications work better for Sinus Tachycardia then the amiodarone and metoprolol combo I'm currently taking now?



Edited 1 time(s). Last edit at 03/18/2024 10:32PM by cornerbax.

The best combinations are individualized, so what works great for one person might not work at all for someone else. You're just going to need to work with your EP on this. Hopefully, metoprolol alone will work for you because you don't want to remain on amiodarone long term.

Carey,

I'm not sure if amiodarone is doing anything at all at this point. The reason I say this is my initial amiodarone dose for two weeks was 800mg total 400mg twice a day. When I noticed the higher heart rates and sinus tach and or flutter, I still had two full days of 800mg of amiodarone which I took before the taper down to 400mg. My rate hasn't changed at all going from 800mg a day to 400mg a day. Within the next week I'm supposed to taper down to 200mg once a day.

What DID lower my heart rate from 110 or so was doubling the Metoprolol from 50mg a day to 50mg twice a day for 100mg total. After my visit last week with my Surgeon, they didn't seem overly alarmed as they consider it normal while the heart is healing from the surgery. The only thing I am not getting clarity on is the continuous nature of the sinus tach or possible flutter. What I mean is I understand it can take 60-90 days to fully heal and get in and maintain sinus rhythm but during that time should I be in Sinus Rhythm some of the time while having intermittent faster heart beats? Or does it not matter that 7-10 consecutive days have gone by being in Sinus Tachycardia consecutively?

I would think even with the blanking period you would want some solid days or hours in NSR and over the last week I haven't seen NSR once.

Tachycardia for a week or so isn't going to hurt you, but you certainly can't remain in it for 60-90 days. Hey, it's surgery, not an ablation, so it comes with a lot more things like this. If your surgeon isn't concerned about it, I wouldn't be. Just don't let it go for weeks on end.

When you say you can't be in Sinus Tachycardia for 60-90 days what is it you're referring to that would be the biggest concerns? The reason I ask is I was in Afib 100% of the time for close to TWO YEARS prior to this surgery. I was on eliquis during that time (and still am currently) as well as Diltiazem.

I definitely want to be in NSR 100% of the time and hopefully will be at some point during the healing/blanking period. But with that said, what exactly do you mean when you say you can't be in Sinus Tach for 60-90 straight days? My heart rate is controlled to the mid 80s with medication and I'm on Eliquis so what would be the biggest concern?

Again, I hope I'm not in Sinus Tach and or flutter another minute, but being in Afib 100% of the time (and at a higher rate) for nearly two years... I would think between that Afib scenario and this Sinus Tach...the Sinus tach would be better of the two?



Edited 1 time(s). Last edit at 03/19/2024 12:04AM by cornerbax.

You can be in afib for decades without harm if your resting heart rate remains below 100 bpm. Afib in and of itself does your heart no serious harm. But tachycardia, even if it's sinus tachycardia, will do damage if it's allow to continue for long periods of time. It causes enlargement of heart muscle the same way being a runner causes enlargement of leg muscles. This results in reduced cardiac output (EF) because as the muscle grows thicker, the capacity of the ventricles shrinks and you can't pump as much blood. The end result of this process is heart failure. That's why controlling heart rate is so important in afib and all other cardiac problems.

That makes sense as rate is extremely important. If I were in Sinus Tachycardia at over 100bpm I assume it's likely under 100bpm would be sinus rhythm. I'll do more EKGs with the Kardia under 100bpm and see how it's classified.

Knowing the importance of rate, and assuming 85 bpm is normal sinus rhythm, I would assume there's no issues there as 85bpm is still considered within the normal range, right? However, assuming there is some semblance of Aflutter, if my average rate is 85bpm do you see any issues there? Or would it be the same thing as Afib where you can essentially go decades without harm to the heart as 85bpm is still a controlled rate?

It really is this simple:

HR > 100 = bad
HR < 100 = good

Whether you're in flutter or not doesn't matter much as far as long-term heart health goes. The rule above still applies. It would be better not to be in flutter for the same reasons it's better not to be in afib, but with both the rule above still applies. Neither flutter nor afib will do you any serious harm as long as the HR is maintained under 100.

That is what I figured it makes sense. Since I've been on 100mg of Metoprolol I've averaged around 85bpm so I'll take it. I have no symptoms at all so I'll take it day by day. In two weeks I meet with my EP and we'll see what they say.

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cornerbax
Any specific medications work better for Sinus Tachycardia then the amiodarone and metoprolol combo I'm currently taking now?

It's not unusual for Amiodarone and a beta blocker like Metoprolol to be given post ablation -- tachycardia's or not -- especially after a Maze. The Amiodarone to hopefully help keep things in rhythm until the heart heals during blanking. Some ep's and surgeons will keep you on it short term, some as long as six months.

But as to sinus tach specifically, it's often not treated unless the episodes are long and frequent and then would be with a rate control drug, like metoprolol, to keep your rate under 110, like you mentioned. For example, I have been having tachycardia's on the average of every 7-14 days, lasting between 5 and 30 minutes. My ep at the moment does not want to treat them either medically or surgically. If the burden increased, that would be another discussion. Good luck with your ep appointment and let us know what comes from it.

Jim



Edited 1 time(s). Last edit at 03/19/2024 05:49PM by mjamesone.

Jim,

Your tachycardia seems harmless I would guess. You have it for mere minutes every week or two? Even at a higher heart rate I wouldn't think that would be an issue at all. I've been in Sinus Tachycardia or some combo of sinus tachycardia and aflutter for 11 consecutive days now.

On my medication (mainly metoprolol) I've had a significant drop in rate. It still isn't NSR at least not regularly. Having some slight tachycardia as you are having isn't perfect but if you are in NSR all of the remaining time I think you're as close to perfect as can be under the circumstances.



Edited 1 time(s). Last edit at 03/20/2024 05:21PM by cornerbax.

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cornerbax
I've been in Sinus Tachycardia or some combo of sinus tachycardia and aflutter for 11 consecutive days now

Putting it in perspective, you're still very early in the blanking period after a more aggressive ablation (Maze) as compared to catheter ablation . For example, with MiniMaze, flutter is not that uncommon during blanking and will sometimes have to be cardioverted. However, in those cases, that's often the end of the flutter and from then on NSR.

Not saying that is going on with you, but it may just be a normal part of the healing process. You mentioned an upcoming ep appointment. Have you been in contact and discussed your ekg's with the surgeon who did the Maze? They may be a lot more familiar with recovery and treatment than an ep, who doesn't perform the Maze.

Jim