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British Heart Foundation
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Sick Sinus Syndrome with slow heart rate: How long to wait before pacemaker insertion?

My 85 year old mother has sick-sinus-syndrome. Initially she had occasional heart rates of 20+, 30+ beats at night during sleep. Four years later, slow rates of 40+, 30+ and on occasion 20+ beats, are happening during in the day.

The EP is of the view of no pacemaker till she faints. This sounds extreme to us especially for an elderly person.

Her symptoms now are persistent pallor, drowsiness, nodding off /knocking out and sudden waking, very low BP(increasing instances), intermittent panting or breathlessness especially when stressed, greatly reduced exercise / physical activity tolerance.

Just 6 months ago she was still able to do 1 hour walks. Adequate nutrition and hydration mean she has managed to maintain muscle mass and mental agility. Her recent detailed blood test results done as prep for an angiogram, show all levels for minerals, etc, to be in range.

But now she has appeared to age overnight as her heart condition drags her down physically.

Our question is - is now the right time for her to get that pacemaker?

Thank you

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I know I am going to get the their degree for this post but I knew someone a similar age to your mum who had a pacemaker and regretted it badly.

Part of the EP advice maybe age. I feel very sorry for you to be in the position of having to see your mum go down hill like that and probably have everything she enjoyed in part taken away. However, it is important to remember that a Pacemaker is a long term commitment. Ultimately, there is a very reasonable probability that five years from now that pacemaker may be keeping your mother alive against her wishes. The person I referred to in the opening of my post received a pacemaker in their 80's. Then two years later received a terminal diagnosis. The support given by the pacemaker prolong this life but he was in such pain he spent most of the added time requesting for the pace maker to be removed. The pacemaker was the one decision he completely regretted.

I am not saying you can/should make a decision on what if. Absolutely not. However, I am suggesting you should give consideration to what might be to come when viewing how badly she needs the pacemaker.

Back to your initial question: I think if you are in a situation where you are concerned for her safety or she has lost the ability to live independently as a result of the condition that you should stress this in your conversations with the EP. Only an EP is the right person to answer your question. Remember - you an always ask them "What is the reason we have to wait until she faints?" It may be he has a good answer to this. I can think of a number of very good reasons why the EP would be holding off (not what I wrote above).

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Thank you very much for taking the time to write. Thank you also for your understanding.

We are not completely new to pacemakers. My father had one and it served him well. His circumstances for insertion were vastly different from my mom's.

We have had those conversations with the EP. The reason for waiting, according to her, is that a pacemaker, inserted before it is required, will do damage instead of good. We should be asking more details about this now. We last saw the EP about 2.5 months ago, and my mother's deterioration since has quickened significantly.

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Hello ling - Like you say I think it's time for your Mother to have a complete review including full blood checks. She may also have some heart failure which could be helped with medication. Best wishes

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Thanks Nathan, for your reply.

Heart failure? How did u come to that conclusion?

Thank you

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Sorry ling I didn't want to add to your concerns. The symptoms you describe reminded me of my Mother's symptoms. She had coronary heart disease which started in her 60's and which was well managed by medication. In her 80's she developed extreme tiredness, pale and breathless. She was diagnosed with right sided heart failure but on medication of nicorandil and furosemide improved a lot. She also had but b12 deficiency anaemia and vitD deficiency which were corrected with pills and 3 monthly injections. I have just noticed your Mother had recent blood tests maybe just make sure the above bloods were done. I should add my mother lived a good life until age 93 with the foresight of a good GP

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A good doctor! We should all be so lucky : )

Thank you very much Nathan. We are keeping an eye out for heart failure. My dad had HF so we have some experience with that. My mother did have her heart function checked some time back. We probably need to have it checked again given the recent quick progression of her low heart rate. Thanks for pointing the HF out.

The blood test was pretty comprehensive given it was done to determine physical fitness for the angiogram. No anemia. She been on Vit D as part of her calcium regimen. B12 I cannot remember that one, will check out. Thanks!

Thank you very much for taking the time to write. God bless you : )

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