In a condition called inappropriate sinus tachycardia, patients tend to have elevated resting heart rate and/or an exaggerated heart rate response to exercise. This is different from condition called postural orthostatic hypotension syndrome where patients tend to have normal baseline heart rates and exaggerated sinus tachycardia in response to changes in posture. Tilt table study to rule out postural orthostatic tachycardia syndrome can be performed. Increased heart rate might be due to suddenly standing up, but it is not clear why you do not have symptoms when standing during the day or when you are getting up in the morning. sometimes atrial arrhythmias that arise from the right atrium can look like sinus tachycardia and an electrophysiologic testing may be necessary to determine the exact nature of this arrhythmia.
Both CONCOR and valsartan have been shown to be beneficial in CHF. The combination of beta blocker and calcium channel blocker would slow down the heart rate. In your case, if your symptoms are not controlled with present dose of medications, it might be worthwhile increasing the dose of medications since the pacemaker would prevent the heart rate from dropping to very low heart rate. The other option would be radiofrequency ablation. Post maze atrial flutters can sometimes be challenging but most of them can be successfully treated with mapping and radiofrequency ablation. Contact an electrophysiologist who specializes in complex arrhythmia ablation in your vicinity and seek consultation. You have not been tried on other antiarrhythmic drugs like Dofetalide or sotalol which are worth looking into.
From the information you have provided us , it appears that ECG performed for atrial fibrillation screening showed ST segment changes. The results of ECG are normally interpreted in context of symptoms and history which include presence or absence of chest pain, shortness of breath, palpitations, dizziness and exercise capacity (distance you could before you feel short of breath or experience chest pain). ECG is not recommended in patients who do not have symptoms or who have a low risk of coronary artery disease. ECG alone does not reveal much information in an asymptomatic patient apart giving information about the patient's rhythm. In your husband's case, ECG was performed to rule out atrial fibrillation ( irregular rhythm). I hope the test results showed that he does not have atrial fibrillation.
A recent retrospective study showed that there was no evidence of an increased risk of heart attack, cardiac arrest, or stroke associated with the use of ADHD medications. The FDA also recently (in Dec 2011) relased safety information about a study in children and young adults exposed to certain ADHD medications which did not show any association of heart attack, cardiac arrest or stroke and ADHD use in that population.
The peak levels of Tambocor in blood is seen 1.5 to 3 hours, so the medication kicks in at 8-9 pm after you have taken the medication at 7 pm. Atenolol is taken once daily , in your case at 7 PM daily. It is likely that the levels of Tambocor in blood decrease towards the evening. The dose of tambocor may have to be increased. It is not clear whether you are taking 50, 100 or 150 mg of Tambocor. I recommend that you follow up with your doctor, who might consider increasing the dose of medication. The other possibility is that your AF is simply breaking through. You may need change of the drug or consider AF ablation.
Sore throat and coughing could be due to intubation during general anesthesia. In most patients , these symptoms resolve in two weeks. Also ulceration of esophagus may happen in few patients undergoing AF ablation , but the symptoms resolve over a short period of time. Lets hope that both sore throat and cough resolve in next two weeks. If she continues to have unresolving cough, painful swallowing or significant reflux it is worth mentioning this to her electrophysiologist who performed the procedure.
It is not clear why you have popping sensation when you breathe in. If the pain or popping sensation increases with taking deep breaths, not associated with sweating, dizziness and not related with exertion, it is unlikely that it is related to heart. It could be either be musculo-skeletal pain (related to muscles and bones in the chest region) or a condition known as costo-chondritis. Treatment will involve taking anti-inflammatory medications like ibuprofen as and when needed. If the pain continues to recur, I would recommend you to follow up with your primary care doctor.
If you have had no episodes of Afib and A fib is under control, your doctor could consider stopping rythmol and re- assess if you have AFib recurrence and there is any change in PVCs frequency. Rythmol by itself cause PVCs in 1-2 % of patients taking it. Since you have undergone 4 ablations it is more likely that you may be one of those patients who may have extensive substrate changes with scar and require anti-arrhythmic medication for control of atrial fibrillation. If the PVCs are significantly impairing your lifestyle and your current antiarrhythmic drug is not doing the job, your doctor could consider changing to another anti-arrhythmic medication and reassess if there is a decrease in frequency of PVCs
In the recently published study , Dr.Narayan and his group compared FIRM+ conventional approach to conventional approach alone and showed that FIRM techinque was able to terminate or slow down atrial fibrillation in 86 % patients before conventional approach. The early data is very thought provoking and warrants furhter studies. This study was a non-randomized study and did have limitations. This techique requires further validation in larger populations before the findings can be extrapolated. Also further randomized controlled studies are needed to demonstrate the overall safety and efficacy of this techique in all population groups. Like any other idea it needs work to tease out the details. If you are not willing to participate in the early phases of the research you may definitely want wait until we get further data.
We have put out team to work to find which institution in this area provides cryoballoon therapy. We will have the names of a few specialists soon.