Pacemaker

Hey folks! We all seem to hang in there with this beastly curse. I wish everyone the best and hope we all find peace.
Ive been a bit absent for the past few years. My last Natale ablation in 2017 to me was a huge success.
I still suffer a bunch of pacs but they are weaker in nature.
From my 6 overall ablations my atrial node took a lot of damage and I beat now in Junctional rythm have consistently
since 2017 or maybe before. My heart rate never climbs correctly. I seem to manage altho uncomfortable a lot! So obviously i’m looking at a pace maker at some point in life
My last ep visit here in Lex KY left me with these misunderstandings and questions, any help is appreciated!
1. The ep mentioned my ventricle node was healthy but eluded it may become damaged?? if my heart rate consistently stays low?? my norm is 65 bpm with dips in 50s and prob never exceeds 80 something Theres some bundle block stuff in there (left)
2. I feel like a lot iof pacs are due to my heart wanting to be more “vigorous “ whats your thoughts ? Would a lot of pacs diminish pacing me at normal rates
3. Im very active, not necessarily aerobic active (62 yr) would i feel a lot better with a pacer? I have coped with my situation
Heavier activities obviously im out of breath etc
4. Will increasing my heart rate make pacs etc more pronounced? I feel Natale was spot on in his ablation Even when i have something it’s faint. (no afib tho)
5. What is the negative to getting this done?
Cheers
Tim Scott

5a. Replacing the pacemaker every 12 years when the battery runs out.
5b. Depending if you trust your life to a TSA employee’s advice- an extra wait at the airport if you decide on getting a pat down instead of going through the security machine which some may say it’s safe. I don’t think it’s worth any risk so I wait and get groped in public. Same with a magnetic wand. I ask them to change their gloves. I don’t know where their hands have been. By law they are required to change their gloves upon request.
5c- if your av is totally damaged or you end up with an AV node ablation, you may need future regular Echocardiograms to rule out ventricular pacing induced cardiomyopathy.



Edited 3 time(s). Last edit at 01/21/2024 10:36PM by susan.d.

Sounds like what you are asking for is a PM with Rate Response.

Rate Response or Rate Adaptive Pacing is used in patients with chronotropic incompetence. Chronotropic incompetence is defined as the inability of the heart to appropriately increase its rate with increased activity or metabolic demand that leads to exercise intolerance. Usually, there is a problem with SA node function.

The pacemaker utilizes its sensing ability with the aid of sensors that can sense motion or minute ventilation changes according to the activity and pace the heart at a required rate.

You may want to read this article:
Source

2. No. You will still feel PAC’s but with luck your pacemaker can be programmed to terminate some AF and tachycardia episodes. Twice in the ER I requested a Metronics tech to stop by (free) and was converted by getting a boost therapy of zaps. Saved me a ECV or chemical conversion.

Pro- a pacemaker download (interrogation) is a 100% accurate full time Holter monitor. If any time you question your heart, you can manually download to your EP a reading. I get interrogations every 3 months. Just had one and I have a pdf saved to my phone if needed.

1. I don't know how a perfectly normal heart rate of 50-65 could damage anything, so I think you misunderstood something.

2. PACs are caused by individual cells firing on their own at random times. I don't think a lot of PACs will have any effect on pacing. If anything, I would expect the PM to reduce PACs somewhat.

3. Yes, you probably would feel better. You're probably out of breath with heavier activities because you can't get your heart rate over 80 (see George's answer).

4. Unlikely.

5. Well, just look up all the complications of having a pacemaker. After you're fully terrified by reading all that, relax and go get a PM. It sounds like you would benefit from it.

I’m sure most of the complications were due to incompetent unskilled operators. You should be OK. You get a 4-6 day setback where you wear a sling so you don’t raise your arm and pull out the leads. It’s not a painful procedure. Depending upon if you stopped your NOAC or not, you may get a swelling hematoma which with a heat pack will deminish In a few weeks. A few months of not lifting over your head and you will be adjusted and fine.

I have a pacemaker for chronotropic incompetence, and yes it works. If you get one my advice is to ask for it to be “buried” rather than right under the skin!

LOL. Thank you Carey. Appreciate you! I know i need one just been trying to tweak
the timing. I know it will be another mental blow for me. Im a very young 62.
Even tho I tolerate being out of breath and weird rythm upon exertion it is getting old for sure!

Thanks Susan those sound like they all go in my negatives column!

Thank you Daisy! so they can bury them deeper? Is that what you mean? I actually don’t like the idea of it being just under skin!

Thanks as always George! Yes i would say that’s exactly what i need
Thanks for article im reading now!

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tsco
Thank you Daisy! so they can bury them deeper? Is that what you mean? I actually don’t like the idea of it being just under skin!

Yes, mine is buried in the pectoral muscle so it is barely palpable. By the way my EP did not cut the muscle but rather spread it open manually—at least I think that is what happened! You are generally awake for the procedure with just a whopping dose of lidocaine, plus a bit of IV “chill” from something like versed and fentanyl. speaking of lidocaine, by default it contains epinephrine (adrenalin). Some of us don't do well with that so you can ask for lidocaine without epi and they will have it available--they just have to use a bit more.

And yes, a clever EP or pacemaker tech should usually be able to convert you out of Afib through your pacemaker--mine did once.



Edited 1 time(s). Last edit at 01/22/2024 03:03AM by Daisy.

I was under anesthesia. Every surgeon uses different methods I speculate if you were awake during yours. My pacemaker surgeon was recommended by Dr Natale who sees his patients. My husband’s cousin just had a pacemaker two weeks ago at Kaiser with a different surgeon and was put under as well.

I do wish my PM was buried because it was only enclosed by a thin layer of skin possibly because I am slim or during my mastectomy there wasn’t enough to bury. A patient who I met during my walking around in the hospital hallway had his ablation first and mine followed had his pacemaker also under his skin and not buried.

I am a lurker here and have only posted a few times. Last July 17th 2023 I had a PM installed under anesthesia and woke up just as he was pushing the dressing down. It was a strange sensation. I have Afib and flutter and have an ablation appointment for sometime this spring/summer.

I have the PM because when I came out of A Fib my heart would always pause, I never knew for how long the pauses were but the day I went into the hospital they caught the pauses on the EKG all were about 9 seconds. 2 days later I had a PM and I have not had a pause since. When being prepped for the surgery the nurse freaked out as the pause was 18 seconds, I was then wheeled into surgery.

I would always look forward to the blackouts/pause because it meant the end of the A Fib event. It happened twice the previous week before getting the PM while driving, not good!

I knew nothing about putting it deeper so mine is under the skin and I can feel it if I think about it and it does feel weird when sleeping on my left side. At the 3 month checkup they turned up the rate so that I was not so tired during exercise and now I walk 4 km, 6 days a week at a much higher heart rate.

I don't know why they can't have a Bluetooth enabled device that the host can manage using commands. The device should be able to operate autonomously, or automatically, but when exercising, why can't the the host use an app to tell the unit that he/she is going to exercise and needs it to co-operate up to a predefined upper/lower limit? This can all be done on a trial basis between the applying physician and subsequent care providers and the host. Over a two or three week period, keep adjusting the unit until the patient can maintain a steady state of exercise, with the host and the unit both learning from each other. Would be poop simple software-wise.

Bluetooth might not work well because the signals only penetrate human flesh about 85 mm. That's why my chest strap monitor doesn't work if my cell phone is in my back jersey pocket.

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gloaming
I don't know why they can't have a Bluetooth enabled device that the host can manage using commands. The device should be able to operate autonomously, or automatically, but when exercising, why can't the the host use an app to tell the unit that he/she is going to exercise and needs it to co-operate up to a predefined upper/lower limit? This can all be done on a trial basis between the applying physician and subsequent care providers and the host. Over a two or three week period, keep adjusting the unit until the patient can maintain a steady state of exercise, with the host and the unit both learning from each other. Would be poop simple software-wise.

With the latest pacemakers you don’t have to input this kind of information as it will be there in the settings. There are at least 10 different types of settings that will automatically and smoothly take you into exercise zones and back out of them. I have had mine adjusted as to how fast these adjustments are made by the pacemaker, like how quickly it will respond to exercise. You need keeps notes on where it is not responding seamlessly in your daily routines and ask for it to be adjusted accordingly. When it is adjusted properly you should not be aware of it at all.

Thanks, Daisy. It is good to know that the modern device has a range of parametric adjustment.

I don’t think any patient should be allowed to tweak their pacemaker settings.

This would be through an app, Susan, ostensibly designed by engineers and physicians to permit needed inputs for when one's cardiac demand might be greater or lesser than 'normal'. I have no experience with pacemakers, so maybe my thinking is entirely moot...they already adjust automatically...but I wouldn't know. If they don't, though, and I want to go out for a run/walk combination for an hour or more, I don't want it stuck on a low, but programmed, rate.

There is a performance setting an EP could tweak for exercise. settings varies with each patient. I get an interrogation (download) automatically every 3 months and a tweaking by the PM clinic every 6-9 months to check the battery settings. I just had my performance settings turned off because of mycomplaints of my hr being 60 pacing sitting and the act of walking to another room would just jump to 104.

Y'all are actually quite lucky. When I first got into EMS pacemakers didn't have activity sensing. When you got a PM it was set to 80 bpm and that was that. Asleep, walking, running -- didn't matter; 80 was what they got.

Susan, I'm a year post ablation as of Wednesday, and even now, with my history of fitness and competitive running, when I get up and walk for any distance, whether out to our garage or to the kitchen sink, my pulse jumps immediately to at least 90, and if I walk for a whole minute or more, it climbs to between 105 and 132, depending on the pace. You know yourself better than anyone, so I would be interested in why you felt that an HR of 104 was alarming. I could see being alarmed if it stayed near there for more than a couple of minutes, especially if just standing or taking your seat once again. But I can't seem to do anything without mine climbing to about 100 inside of maybe six seconds or so. A physician I used to train with at running competitively told me he thought my heart was too reactive to be a good runner. I never was a 'good' runner, so maybe he was right.

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Carey
Y'all are actually quite lucky. When I first got into EMS pacemakers didn't have activity sensing. When you got a PM it was set to 80 bpm and that was that. Asleep, walking, running -- didn't matter; 80 was what they got.

That sounds like hell! The trick is tweaking the settings to respond naturally to an individual’s movement patterns and metabolism so that you never even feel the pacemaker. Cardiologists often don’t seem to tell patients that it will take a bit of tweaking and to keep track of any situations where you are aware of the pacing so that it can be adjusted. My EP had a pacemaker tech in-house and any time she made an adjustment she would have me test it by jogging, suddenly sitting down etc. to see if it felt completely natural.