Pacemaker confused

[Nomis21]

Hi, just been for a cpex exercise test due to having health issues since pace and ablate 20 months ago, I have total heart block hence the pacemaker, I get really tired, out of breath, struggle doing anything strenuous and get dizzy, lightheaded and recently been diagnosed with heart failure (left ventricular systolic dysfunction)I have a two lead pacemaker pacing right hand side of heart.

The cpex exercise bike test left me worn out, out of breath with weakness especially in the legs (had to stop) and it was stated by the consultant that my heart rate didn't increase and go above 70bpm and they were writing to the EP who I'm under the care of.

So I was at the pacemaker clinic about 7 months ago and was paced at 70bpm, I thought it meant my heart rate wouldn't go below 70bpm but it seems it doesn't go above. I also attend cardiac rehabilitation and when I exercise I have noticed the heart rate monitors on the exercise machines shows my heart rate never goes above 70bpm.

Would I be wrong in thinking that a pacemaker should allow for the need of a faster heart rate during exercise? how does it work?

I always thought that a pacemaker would have upper limits and lower limits and the parameters can be changed on the advice of the EP at the pacing clinic to suit the individual? So the settings could be say 120bpm upper and 65bpm lower and the heart rate would stay in that range?

Thinking if my heart rate won't go above 70bpm how does the rest of the body get the additional oxygenated blood when carrying out exercise if the heart rate isn't pumping it?

Also if the right hand side is paced at 70bpm and doesn't go higher (as it's been proven today) would the left hand side be put under extra stress to get the blood out?

Appreciate some advice please

[Deejay62]

I think these questions you should be asking the device clinic or even your cardiologist.

I last visited my cardiologist and my breathing was even worse than usual. He did his usual tests using his stethoscope. I am paced at 70 bpm and always thought my heart rate would remain that way but in his report he said I was 75 bpm and in atrial fibrillation, which I can’t feel, although I’m in persistent. I’ve actually given up trying to understand how my heart is working and just trying to take each day when it comes. But that’s just me. I feel I know enough regarding my condition.

[Nomis21 in reply to Deejay62]

Hi yes, I will be asking the clinic or cardiology when I get the chance, just thought some could enlighten me in the meantime?

[Deejay62 in reply to Nomis21]

Hopefully others might come on who might be able to do so. All the best.

[Nomis21 in reply to Deejay62]

Thank you

[PinkKizzie]

Hi Nomis21, I have an EF of 25% and LV imparement , I was tired and breathless and a pacemaker (3 lead) was attempted, however the third lead pierced my heart and emergency OHS was performed. It was so traumatic I can't get myself back into theatre to try again for a pacemaker implant and now I take lots of brilliant meds, I didn't realise until coming on this forum that EF can be improved thru keeping fit , good diet etc., I still get tired and breathless from time to time, but I keep active, I just do what I can, gardening etc., I'm passed overthinking things, take each day as it comes. I have a brilliant cardiac nurse and contact her rather than a GP for advice. Seek professional advice if you are worried. Take care and keep well.

[Nomis21 in reply to PinkKizzie]

Thank you pink, like you i do keep active and I don't overthink things, just get on with it, I have the similar symptoms and manage what I can, can't do.Just started on meds and my bed is getting some use at the minute but not complaining

[Circular]

I experienced exactly the same problem. (73 year old male)

Similar background of heart block and pacemaker fitted.

No matter how hard I tried my heart rate would not go above 70. Thankfully, A simple adjustment carried out by the pacemaker clinic solved the problem. It was like magic- I immediately felt more energetic and became far more active within days.

So, don’t despair. Hopefully your problem will be solved.

[Golfing2022]

morning I also have had P&A in Feb 2022, 3 lead pacemaker the first Month I was paced at I believe 80. I was also very breathless then they turned on what I believe was called rate adjuster, I noticed big difference immediately. I went in once a month for 3 months for adjustment and I’m now paced at 130 - 60 which works well for me. We are all different but I would definitely talk to your EP. Hope this helps best of luck - Les

[helenium75]

I had a total heart block in April 2022 and was fitted with a pacemaker to replace the AV Node (which just stopped working!). It was set at 60 -130 from the start, so for the majority of the time my heart just beats as it did before the block, following the signal from the SA node.