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Q. I have atrial fibrillation, and my reports say narrow QRS. Kindly help me.

Answered by
Dr. Tanmai Yermal (jain)
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Aug 31, 2021

Hi doctor,

I have atrial fibrillation, and I recently had an ablation. I first had atrial fibrillation on three years ago. I was put on blood thinners and cardioverted a month later. I did not have another episode until last year and cardioverted again. I had another cardioversion after four months and then again this year beginning. I went into atrial fibrillation again two months ago and was in the hospital for three days as I would not cardiovert back. Eventually did and moved up the ablation list. I had an ablation last month. I am having symptoms after ablation in reaction (I thought) to Rythmol. I went off Rythmol, and the symptoms did not end. I had tests (stress, echocardiogram, Holter, blood) done. I do not understand the reports completely, but I am scared they are wrong. I am taking Edoxaban 60 mg and Paxil 10 mg. I am attaching the reports. Kindly help me.

#

Hello,

Welcome to icliniq.com

I went through your query, history, and reports (attachments removed to protect the patient's identity). Your Holter report suggests baseline sinus rhythm with VPC (ventricular premature contractions and APC (atrial premature contractions) that are ectopic beats. So actually, it is good that your rhythm is not back into atrial fibrillation.

But ideally, to make sure there are no atrial fibrillation episodes, you should have done extended Holter for 72 hours or more. Your echocardiogram report is normal with mild LA (left atrial) enlargement.

Can you please send the entire list of medicines that you are currently taking?

I hope this was helpful.

Hi doctor,

Thank you.

All the medicines are just Edoxaban 60 mg and Paxil 10 mg. That is it except for Vitamins.

In my Holter report:

1) What is "narrow QRS"? Is it good or bad?

2) What are non-specific ST abnormalities? Is it good or bad?

3) The RR variability numbers are low. The SDNN and especially the pNN50.

These things make me feel very uneasy and like I am a candidate for a heart attack soon.

Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

I thought you must be on some rate control medications as well, so I just asked again to confirm your medicines. Narrow QRS is better than wide QRS. Broad ones are alarming rhythms and, at times, can have life risks. RR variability numbers are low means you have a baseline normal sinus rhythm. So it is good. I hope this was helpful.

Hi doctor,

Thank you.

But the internet says low HR variability is a risk of death. What about non-specific ST abnormalities? I know this is bad, but how bad?

RR variability that is low like mine is bad so says the internet. It says low is a high risk for death. Also, non-specific ST abnormalities? I know that is bad, but how bad? Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

Non-specific ST abnormalities are not bad.

Basically, I need to see the ST-T changes on your ECG (electrocardiogram) strip. RR variability interpretation has to be patient-specific. Do not worry and think much about the internet information. The Internet gives general information applicable to a large group, not patient specific. So just forget about all such things and stay calm and relax.

I hope this was helpful.

Hi doctor,

Thank you.

On the echocardiogram, it says that my EF is 76%. That is too high. This is a sign of a type of heart disease. Also, the report at the top says everything is normal, but there are quite a few things outside normal. For instance, the IVSd is 12 (normal is 6 to 10). How is this not a problem?

My symptoms that I believe are heart-related are:

1) Light headed after climbing one flight of stairs. Stay that way and maybe have a bit of headache for five to ten seconds. I can do Stairmaster for 15 minutes and stationary bike for half an hour and hike all day with no problem. If I stop a vigorous exercise, I may feel lightheaded. I believe it is either my blood pressure. I have always had a little high blood pressure (135/87) until I lost 35 pounds in the last six months, and since then, my blood pressure has dips low sometimes (110/70) or even down to (90/60), and this is not enough pressure for me maybe. After a strenuous bike ride, it will drop below 90/60 for a little while.

2) My heart rate does not go up like a normal person's. I am very out of breath, but I am doing a heavy workload (more than most others do), but my heart will not go past about 130. And then it does not recover very quickly (see HRR on stress test was only 6). It might be 8 when I measure it. My resting is 75 to 80 since my ablation. It was 60 to 65 before ablation. My heart used to go up to 135 prior to ablation (and maybe prior to COVID time and gyms being closed)

3) Can some of my troubles be related to the ablation and recovery. The cardiologist did not tell me anything about recovery and side effects. He does not tell me anything.

I did take Rythmol for three weeks post-ablation but was taken off it due to apparent side effects. Dizzyness (that did not go away), double vision, multiple visual migraines (I still get three a week. I got 10 in the eight days post-ablation).

4) I am somewhat out of breath sometimes, too that does not seem natural.

Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

Your EF (ejection fraction) of 76% is normal. They must have done it by measuring LV (left ventricular) dimensions. So it is normal to get high values sometimes. I'd (end-diastolic septum thickness) of 12 is not a significant problem. The values can alter slightly. Up to 15 mm, there is no reason to worry. We, the doctor, see the patient and his findings as a whole and do not treat each and every value or finding on the echocardiogram.

Blood pressure (BP) varies as per the level of activity you are doing. Say the heart rate and blood pressure tried to adjust as per the requirement of our body. So variation in heart and BP is a natural physiological phenomenon. But if your BP is persistently below 100 and you have symptoms at that time like dizziness, or so then we need to evaluate it further. Otherwise, no issues.

Rythmol (Propafenone) tablet your cardiologist must have given post-ablation just to make sure you remain in sinus rhythm till recovery. And then he must have stopped it as you had some side effects and was in sinus rhythm. So that is fine. Now since you have atrial and ventricular ectopics, you should be on some beta-blockers like Nebicard 2.5 mg (Nebivolol) or so, provided your BP is not persistently low.

I hope this was helpful.

Thank you doctor,

Thank you. So, my low heart rate variability and low heart rate recovery is not a big deal. I read online that low values in those 2 things are bad signs and predictive of death. I think they are related because they both rely on the vagal nerve. I catch my breath quickly after vigorous exercise and I am breathing normally in 15 to 20 seconds , but my heart rate does not come down. It takes about 10 minutes to get from 130 beats per minute to 90 beats per minute. Also, I have taken Bisoprolol in the past, but my blood pressure and heart rate go too high. My resting heart rate will not go too low as it is higher since the ablation. What other things could cause dizziness when I get up and go up to the stairs?

A nurse at the clinic suggested that I may have a clogged Carotid artery?? Heart rate went too low on Bisiprolol. But now maybe it will not become low due to raised resting heart rate due to ablation. I just received another Holter Result five months back. It is attached. I am concerned with "Second degree AV Block Mobitz 1 and 2:1 Av Block seen sleeping" and "There were no pauses greater than 2 seconds" and the it says "longest pause 2.306 seconds" and further down it says 33 pauses less 2 secs.

#

Hi,

Welcome back to icliniq.com.

I went through your recent Holter as well. There is nothing alarming in it except for the pauses that are seen in your Holter. Your baseline rhythm is sinus rhythm. It is better to avoid beta-blockers for time being. Initially, you got frequent APC and VPC. But now those events are rare. So just continue with your present medications. If you have any symptoms that correlate with your pauses then we need to further act on it. As you are asymptomatic due to pause and the pause is less than 3 seconds and you do not have any high degree AV block, so you do need not worry. But keep a watch on your symptoms and rhythm intermittently.

Thank you doctor,

Why are the pauses particularly alarming? Now on the most recent holter, I had no pauses and no av block. Why? Where did the pauses go? Where did the av blocks go? This holter was before the first one I originally sent you. Did my afib ablation make them go away? Why are pauses worrisome? They were at night when my heart went down into 40 seconds. Could I die in my sleep from pauses? The holter I just sent you is done five months back. It is prior to my ablation. The first holter I sent you is after my ablation. Why are there no pauses on my newer holter and no more av block? And you say “high degree” block. What do the type I have to do to me and what does a high degree do? Will mine become a high degree?

#

Hi,

Welcome back to icliniq.com.

Pauses are alarming if the duration of the pause is longer more than 3 seconds. Your recent Holter does not show any pause. So do not worry. During sleep, a low heart rate is common for everyone. So you do not need to worry about that as your recent Holter is not showing any pauses. Your ablation procedure has nothing to do with the recovery of your pauses in your present Holter. Basically, you do not think much about it and do not worry about death. But if you have any symptoms, get an evaluation done. Just treating on the basis of investigations is not recommended.

Thank you doctor,

On my blood work, my platelets were 445. This is high. What does this mean? Should I be worried? Does it raise my stroke risk because blood is more likely to clot?

#

Hi,

Welcome back to icliniq.com.

Nope. There is no reason to worry about platelets of 4.46 lakhs. This level of platelets are solely not likely to cause a stroke.

Thank you doctor,

What do you think? I should ask my doctor regarding my lightheadedness upon climbing a flight of stairs and upon standing up.

#

Hi,

Welcome back to icliniq.com.

It could be orthostatic hypotension. So you should get your BP checked in the supine position and then on sitting and then on standing after 1 and 3 minutes. And then see the variation in BP. Till then do not stand immediately after getting up from bed. Get up in lateral position from supine and then sit for 5 minutes and then stand and start walking. See if it works for you.


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