Re: 4 mos post maze in NSR and feeling great

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Posted by steve giddings on August 02, 2002 at 16:03:07:

In Reply to: 4 mos post maze in NSR and feeling great posted by Tim Hawkins on August 02, 2002 at 12:12:06:

A slow Friday afternoon.

1) Chances are your HR won't increase much more after you stop the rhythmol. It has a bit of a rate suppressive effect from some beta blocker like acitivity, but not much.

2) Concerning your comments about discriminating PACs from PVCs by the presence of a compensatory pause and/or from QRS complex width. Both are clues, but what you have may still be PACs, or nodal beats. The QRS comlex becomes widened when the fascicles of the ventricular conducting system aren't used or stop working This happens with a PVC because the funny beat starts somewhere in the ventricular myocardium, not in the conducting system. The conducting system can also become refractory to an incoming signal. Typically this happens when a second signal comes so close to an earlier one that the conducting system doesn't have time to "recharge". Think of it as the recharging of a capacitor for a camera flash. If that happens, the impulse slows and the QRS widens, referred to as rate dependent ventricular block. You also see it in rapid AF. Similarly, the reason there is a compensatory pause after a ventricualr beat and none after an atrial beat is that the aberrant trial beat is sense by the SA node and it resets, and discharges at the same time interval from the previous beat, regardless of where it arises. After the maze procedure, the aberrant beat is less likely to get to the SA node, even if it arises somewhere else in the atria, because of all those maze lines.

Chances are, if your heart is healthy, these aren't vpcs. Even if they are they are in all probability benign. Bottom line, everyone seems to have a lot more "funny beats" after the maze, but for most of us they have no functional significance.

I would suggest that you might want to take your holter tracings to your cardiologist. But I don't know if you could get him/her to read them or not. This reminds me of the 12 days I spent in the ICU at Georgetown post op, in a junctional rhythm, waiting for my SA node to recover. I figured out how to get an atrial recording myself using aligator clips, my beside monitor, and my atrial wires. I demonstrated to the housestaff that my SA node was functional. All I had to do was bump my heart rate up a little bit by doing squats at the bedside and P waves would appear.

Their response- they took my alligator clips away. Major bummer.

Best to you all

Steve Giddings

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