Low heart rate after Pacemaker implant

[BrackenBT]

Three weeks ago I had a Pacemaker implant to improve low heart rate. The implant was set at 50 bpm and by following my heart rate on a Garmin watch I can see that I have a very stable heart rate overnight, however in the morning when sitting at the breakfast table my heart rate drops to 35-40 bpm and stays that way for some time. Throughout the day this will happen quite often when I relax yet overnight is stable at 50+.

Historically I had an Aortic valve replacement in 2021 and have a frequent ectopic heart beat.

Has anyone else experienced anomalies like this after a Pacemaker procedure?

[Rosie1066]

Hi, if you have any concerns then I would contact your Pacemaker Clinic.

[BrackenBT in reply to Rosie1066]

Yes, I have done that today and am now awaiting a reply. Also contacted Cardiologist about my medications and again waiting for a reply.

[L8Again]

ignore your smart watch. My wife has a pacemaker for bradycardiac- related syncope set at 60bpm. Her Apple Watch often shows a heart rate well below her pacemaker setting. Her pacing team said that this is normal with smart devices on the wrist. Her pacing check confirmed that the pacemaker is maintaining the preset rate.

[Ticker26 in reply to L8Again]

I recently saw my GP as my Apple Watch was notifying me that my heart rate was dropping below 40bpm for over 10 mins. My GP was very sceptical about the watch being accurate. I was fitted with a 24 hr heart monitor which showed that my heart rate went down to 36bpm. I personally feel GPs are too quick to dismiss smart watch data, probably because it causes them more work. Mine was certainly quiet when the heart monitor results came back then she asked if I wanted a cardiology referral - acting as if she was doing me a big favour by doing so.

[L8Again in reply to Ticker26]

Unless a pacemaker is malfunctioning or a lead has become disconnected, the heart rate should not fall below the pacemaker baseline beats/minute setting. This is checked about 3 months after pacemaker implantation and for most yearly thereafter.

The US FDA approves some smart devices for heart monitoring (eg; for AF) but not for initial diagnosis.

My wife’s Apple Watch and 6 lead KardiaAlive detected silent AF 18 months ago. ECGs and a 3 day holter monitor results were normal. Her GP looked at the KardiaAlive traces and said that it was not AF. A 14 day holter monitor detected one brief episode of AF but not the cause of her infrequent TLoC episodes. This required an ILR. Two months later she was fitted with a pacemaker.

FWiW, my wife’s cardiologist looked at the very short period of AF in the 14 day holter monitor trace and said that it was definitely AF but not a ECG presentation that would most GPs would recognise.

[bee2]

Your garmin watch probably won't count count the ectopic beats which will make your heart rate look lower?

[BrackenBT in reply to bee2]

That is a very good point about the Ectopic heart beats not being counted and strangely the frequency of Ectopic beats seems to have increased since the implant.

[resistancewasfutile in reply to BrackenBT]

Ectopic heart beats can be associated with bradycardia. If your pacemaker base rate is set to 50bpm, that's probably too low. Normal sinus rates are between 60-100bpm and vary from person to person and women need a higher rate than men.

Be a squeaky wheel at your pacing clinic to get the right pulse rate for you.

Your heart needs a rate that restores homeostasis at rest so it can do its job. If the new artificial resting heart rate is too slow, your heart will be trying to do work from a base rate that puts the heart muscle under duress. Over time, this can create problems like thickening of the heart muscle and reduced valve function.

[MDROGER]

Personally I had a pacemaker fitted a year ago and my Apple Watch shows exactly what my resting heart rate was set at after the insertion. I do know that the watch cannot be relied on for everything but it provides me with an indication of what is going on.

Resting heart rate as shown on my watch