Pacemaker check

Hi everyone. I'm due for a pacemaker check on 1st October following pacemaker (July) and AV junction ablation in August. They have set my pacemaker to 80bpm but I've noticed following the ablation I still get fast heart rate between 85-110bpm. Is this normal? It was mentioned before I was discharged from the hospital that the next plan for pacemaker check is to change to 60bpm. Is this safe considering I still have fast heart rate? I would like to hear your thoughts and advice. Thank you.

Rona

11 Replies

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  • I think you need to ask your Doctor about his reasoning for the different setting.

    My husband's pacemaker is set at 60, which I believe is the normal setting for bradycardia as it ensures the heartbeat doesn't go under that figure, but he hasn't had AV ablation so it only kicks in when the AV doesn't.

  • Thanks. I shall ask them when I go for my appointment.

  • Hi Rona, Surely it is still very early days being less than a month by the sound of it. I doubt the heart has recovered yet enough for things to have settled. I also have a sneaky feeling that they tend to leave a small amount of AV node behind to keep you alive if the machine failed and it is possibly this playing up. Usual proviso -no medical training just been around a long time. Remember that the pacemaker won't stop the fibrillation either but your ventricular rate should be steady whatever it is. I thought normal setting was 72 but some of the newer machines are intelligent and vary according to demand I thought.

    Bob

  • Thanks Bob. I've read from the report that I have a escape beat of 45bpm when they turned off the pacemaker so is this comforting when you mentioned they tend to leave a small amount of AV node? I'm not good with jargon but do you mean by ventricular rate is heart rate? If you mean by steady I.e. no skip beats? How would affect individual's heart function is they set the pacemaker to lower rate? Thank you in advance for answering my questions.

    Best,

    Rona

  • Yes ventricular rate is the pumping rate i e what you feel at your pulse. The purpose of the atria is to pass blood down to the ventricle which does all the pumping and is the largest muscle of the group. Your "escape rate" sounds as you suggest but I'm not an expert. Steady is that but ectopic beats -- the odd "missed" beat affect is not dangerous as all people get these from time to time. Up to 200 a day on average I'm told. You should not experience the chaotic pulse that AF causes even though the atria may still be fibrillating as the pacemaker controls the ventricle. Don't forget you have the right hand side which also pumps but in that case it pumps used blood into the lungs for re-oxygenation and this is not normally affected by the pacemaker.

    The pacemaker with your situation is the main control for your heart rate so if they set it too low then you may struggle to walk up hills or exercise too much. For those with bradycardia the pacemaker is a long stop to kick in when the rate falls too low.

    Bob

  • Thanks Bob for explaining well. I will certainly bring these points when I go to my appointment. As the pacemaker is now the main control of my heart rate it worries me so much that if the pacemaker stops working I might die. It is a frightening thought. Sorry to sound negative.

  • But it sound like you have a small amount of back up left. Anyway live for today. A piano might fall on your head at any time. (Ref Top Gear) . LOL. Stay positive as it makes so much difference. You will learn to cope in time and we are all here to help and support.

    Bob

  • Yes 45bpm "escape rate" doesn't sound a lot of back up. I am trying to stay positive and I'm sure once I've recovered I'll feel much more acceptance of my condition. I do appreciate all the support here. I don't feel alone anymore.

  • Hi Rona. Ive been through 3 pacemakers in the last 20 years and dozens of pacemaker adjustments and cardioversions. I understand your situation after a newly implanted device. There are a few things that can be the cause. Obviously an unsuccessful AF ablation is one of them. The electrical circuits can find a way even when scar tissue has formed. But in the majority of cases its just finetuning of the pacemaker settings to you as an individual. At first my internal sensors would jump my ramp up rate so quickly with only limited movement. When high it took a long time to settle down too. This was programmed out of it after adjustments were made by the technician when I did a few quick walks at the pacemaker clinic so he could see what was happening. Another issue might be noise on the pacemaker wire causing chaos with the mode switching (as I recently had experienced). The dodgey signals on the wire trick the pacemaker that you are active when you are not and the pacemaker increases your heart rate. Depending on which wire, they can program around it too. Last of all is if you are still in AF and the sensor picks up the it high pulse rate and mode switches to a higher rate. The base rate can be adjusted higher to make the pacemaker ignore any rate under it. e.g if in AF at 140bpm consistently the pacemaker can be adjusted to sit you at 70bpm until it sees 140bpm then mode switch to a higher pulse rate. Its pretty technical and the technicians will make it better for you as you go back for finetuning. But dont suffer and wait. If its not feeling right make an appointment and get it looked at. A 10-20min visit is all that stands in the way of you feeling crap for weeks/months to feeling a little bit better. its one step at a time with some new pacemakers. Usually dual lead pacemakers are easy enough to sort out and you can live life like you didnt even know you had one implanted... but those damn biventricular pacemakers take many visits to sort out timing and synchronisation.

  • Thank you so much for the feedback. It found it helpful. Like you what is happening is that my heart rate race just walking inside the house. Once I'm back on the bed, it goes up. I have only single lead it was explained that one lead is only required. I have managed to get an appointment for 1st October and like you I will do some walking so that they will see what is going on.

    Best,

    Rona

  • The other cause is your ectopic beats (underlying beats) confusing the pacemaker that you have a high heart rate and it switches over.

    Worrying about it is not healthy physically or mentally so see a technician at your earliest convenience.

    My heart doesnt have an underlying beat of its own since 1996. Im completely relying on each pacemaker to do its job. I had the same worry thoughts as you = what if it fails etc but you cant live life like that. You soon get on with life as they keep doing their job.

    All you need to do is have regular checkups and If anything seems out of sorts, youre tired or dizzy for no reason, getting extra palpatations, pain, nerve twitches on the ribs etc, seek attention immediately.

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