Pacing

[marleyminnie]

I have a pacemarker fitted for 30years I have just got Alivecor and at the moment I am having episodes off fast beats and my Alivecor is saying normal can someone advise me on what to do

Tanya

[jan-ran]

Hi Tanya, your heart rate is clearly not high enough to make the alivecor register af, and it's also not irregular, or that would show up too. You could get reassurance from your gp, who could advise you whether you need to be alarmed. Good luck, Jan R

[marleyminnie in reply to jan-ran]

Thanks but heart rate was up at 92 so mind just send it off to my dr in Dublin as I feel it going fast

[Hidden in reply to marleyminnie]

Hi Marley,

I too have a pacemaker and started having fast heartbeats a couple of years ago. They are occasional and are showing up on my PM readouts as they are above the set upper limit of 130 bpm. I "feel" faster heartbeats but often they register at about 70-80bpm on my BP monitor (I don't have Alivecor).

In my case there appears to be a possible link between pacing which occurred over many years on the DDDR setting and the development of atrial tachycardia. This setting causes a lot of pacing to be passed down to the ventricles - (apologies for the crude explanation) and this ventricular pacing "can" cause atrial tachycardia, which I have now been diagnosed with.

I have no idea whether any of this is relevant to you or not, but you are welcome to message me if you would like to discuss in more detail.

I would talk to your pacing team about long term pacing effects and also whether your new app may be picking up "normal" fast heart beats/episodes which may be nothing untoward at all.

x

[Varina8 in reply to Hidden]

Missdiagnosis,

I also have a dual chamber PM since ten years; changed for a couple of years ago. This due to PAF, sick sinus and bradycardia. A few years I've had DDDR setting, if I remember right, to be able to excersize better. You mentioned that this setting has to do with your atrial tachycardia. Did I understand right? This last half a year I've had two nasty occasions of atrial flutter and EKG shows quite a few ventricular pacings which I didn't have earlier. Do you think these things could be connected? Is there anything to do about it. Do you still have DDDR? I'm on propafenone 150mgx3 for my PAF since oct 2013.

[Hidden in reply to Varina8]

Hi Varina,

The DDDR setting causes a lot of pacing to be passed down to the ventricles. This isn't ideal as ventricular pacing can cause problems. I originally didn't have AV block or any issues with my AV node, but a drug I had been taking and which I was re-prescribed seems to have caused AV disturbances / delays which were assumed to be permanent, so I was left on this setting.

I've been swapped from DDDR onto a different setting very recently called AAI-SafeR. This limits ventricular pacing and as a result my ventricular pacing has reduced from 70% to 0%. I was being V-paced at high levels. I think it is high levels of pacing which can cause the problems...although I am not completely sure. If your V-pacing levels are low and have recently started there may be another explanation, such as the progression of sinus node disease which I understand can progress to affect the AV node.

I developed what felt like a flutter (occasional) approx. 2 years ago whilst on the DDDR setting. More recently it's been diagnosed as atrial tachycardia and I've had a few episodes of fast heart beats. I have read that the DDDR setting can cause atrial tachycardia ... (again following high levels of v-pacing). I will dig out the article for you.

Another suggested explanation from the medical profession was that the tachycardia was simply the progression of sinus node disease to tachy-brady syndrome. I'd suggest you ask your consultant for his/her opinion on your own case. I'd be interested to hear what he says.

If you have a DDDR setting in place, I would find out how much your ventricles are being paced. Mine were being paced a great deal and mistakes were made. I am now paying the price for this as excessive ventricular pacing isn't good as you probably know.

Your symptoms however may simply be the progression of SND showing as the development of tachy-brady syndrome and AV node deterioration. I think you need to ask your consultant, but please don't worry unduly.

My case has been a bit of a nightmare and not typical....

[Varina8 in reply to Hidden]

Missdiagnosis,

thank you for your response to my question. Gives me a lot to think about and study further. I must get a better understanding of all this stuff. AF site is very good, but I think there is another one for PM patients. Do you know about it? I feel this is the time to get proper knowledge about pacing and consequensies. Thank you for giving me the insight.

[Hidden in reply to Varina8]

Hi Varina,

I understand how you feel. I knew very little for a long time and put my head in the sand about my pacing. I've made sure that I know a lot more now, because it matters. It can be complex though....these devices are quite high tech and the diagnoses are complex in terms of how pacing affects them. I've found it quite tough to get to the bottom of the issues affecting me. Ask lots of questions would be my advice and read up on pacing related issues.

There is a pacemaker club website. There are many very knowledgeable people on it from the US and Europe.

I was being paced at very high levels and it was through that site that I realised that something was amiss as my pacing %'s were so much higher than people with similar dx's.

Give them a try perhaps?

pacemakerclub.com/public/jp...

Hopefully this will help you a bit.

Alternatively speak to your consultant and ask for his/her explanation for the atrial flutter and ventricular pacing. These are important issues and you need to understand why they are happening and if they are significant. I wish I'd asked earlier for sure!

Good luck. You're welcome to ask me any questions ... I'll help if I can!

x

[Hidden]

drugs.com/cdi/propafenone.html

The important safety information section of this patient information states that the drug may affect the way that the pacemaker works. I think I would start by asking your consultant whether the drug prescribed for PAF could be affecting your pacing results in terms of the v-pacing.

It could be a simple explanation, but you need to know how much v-pacing you are going to end up with and whether it is arising from this drug or from issues with your AV node ... or something else? I'd want to know whether a different drug would stop the v-pacing if the drug is the cause....but I'm very wary of drugs. You may not be.

x

[Varina8]

Hi missdiagnosis,

For about 8-9 years ago I was prescribed another class IC drug, flecainide. It really did mess about my PM and was discontinued. After that I was taking bisoprolol 10mg daily without any heavy side effects. My PAF tends to go over 200/min. When PAF progressed to more frequent attacks, 3times a week each lasting 12 hours, propafenone was started. For nearly a year I had no attacks, now according to pm readings 4000/year a few seconds each, and maybe once a month one symptomatic lasting 5-12 houra. In addition to that these two nasty flutters oct and dec2015. As said earlier my PM was changed afew years ago. Maybe this more modern PM is different or propafenone differs from flecainide OR it is just taking longer time to develope problems. I take also bisoprolol 1,25 mg in the Evening and Mg 300mg daily.

And yoga of course. All healthy life style news are most interesting.

But for now I'm going to learn more of pacing and consequencies.

Thank you once more for taking time for me.