Pacemaker adjustments

I am not really sure what I am asking but here goes. I have been having trouble ever since I got my pacemaker 6 weeks ago with diaphragm stimulation. I have had it adjusted 5 times. The last time (Friday) the technician adjusted the atrial lead to 0.5 to keep it from stimulating my diaphragm and turned off the auto checking. My EP wants to replace and reposition both leads this week. Each time they adjust it I feel worse. Should I be able to feel the difference as much as I have? I have tried to find any information on setting and adjustments to know what is normal but am having no such luck. If anyone knows where to find any information please let me know. Thanks, Misty

7 Comments

Ddiaphragm Stimulation

by SMITTY - 2010-09-13 01:09:02

Hello Misty,

Six weeks and you have already been through more problems than you should have in the entire time you have a pacemaker. But, based on what you are saying, I think our greatest need is to find someone that fully understands the complexity of making the correct pacemaker settings for an individual. It just seems to that for you to get that you will need to try for another opinion. If that is not feasible then ask to have a manufacturers rep take a look at your pacemaker.

As for your finding the information you need, I don't really think that is possible. You, like all of us with pacemakers, are at the mercy of the doctor and their assistants when it comes to getting the benefit of a pacemaker without side effects.

I have had a pacemaker since 2000 and have been through the problem with diaphragm stimulation and the futile efforts to correct the problem. After many, many settings changes did not help I chose to have the phrenic nerve deadened to stop the diaphragm stimulation. It worked , but that brought with it more problems such a one side of my diaphragm being paralyzed and that brings with it an entirely new set of problems. So I suggest to you and any one with a problem of diaphragm stimulating by a pacemaker accept the nerve deadening procedure as an absolute last resort.

I've also had many other problems over the years and the nurse/technicians doing the checking/changing my settings are experienced if nothing else. One has 30+ years experience and when it comes to problem solving she is very little better than a 1st years rookie. My greatest help came from a manufacturer's rep. I know for a fact they are better trained than most doctors and their assistants.

Before I give up an this, I do not mean to say or imply that lead relocation not an answer to your problem. I just think it should be the next to last effort when it comes to problems like yours. My feeling when that was offered to me to solve my problem was "how do I know that relocating it will solve the problem if you didn't know not to put it there in the first place?"

I wish you the best,

Smitty

Stimulating Diaphragm

by ElectricFrank - 2010-09-13 01:09:48

It sounds like your EP is on to the problem. The most common cause for muscle stimulation is a defective lead. Normally the electrical current that paces the chambers of your heart returns through the sheath of the leads. This is called bipolar pacing. If the sheath circuit is broken the current has to return to the pacer through body tissue which will stimulate any muscle type tissue in the path.

Often they will try to turn down the pacing voltage in hopes that it won't stimulate the muscles, but still be high enough to pace the heart. While this may work it isn't a good solution. Over time your heart may require higher voltage for reliable pacing and the twitching will return. It is much easier to replace the leads before become scared into the blood vessels so I would take them up on the offer. The fact that the EP has recommended it is a confirmation of the problem.

best wishes,

frank

Search may be helpful

by Heidiglassmeyer - 2010-09-13 12:09:58

Hi Misty,
Have you searched diaphragm on this site? I remember seeing a post not long ago about this topic. I do not have an issue with diaphragm stimulation but I did search it and found a few postings that may be helpful. I can't imagine the discomfort! Good luck to you!

Heidi

I have the problem,too.

by cruz - 2010-09-14 11:09:12

I've had the problem and I've had the settings adjusted 3 times. I knew right after the procedure that they weren't able to get the "ideal" placement of one of the leads. The doctor has told me that in no way does it indicate a fractured lead. He said the lead is touching a nerve and setting off the "hiccups." I saw a tech, in fact, within hours of the surgery for the problem. Next visit to the office, I saw a different tech, explained that it's re-occuring on occasion and he adjusted it and it seemed to work most of the time, but still an occasional problem. Next visit a different tech asked me if my settings had been adjusted on my last visit...duh, you should be able to know that. He adjusted it but said they have to keep it at a certain setting for it to do the work it's there for. The EP has explained that there is a 20 minute procedure where they go into your back to do the lead in a better position when they continue to have problems. I haven't gotten to this point at the present time. I've found it most often occurs after a meal (?), and when in bed, shifting for a good position to sleep. If I keep shifting positions, eventually, I find a spot where it stops and I just freeze in that spot.

Diaphram Stim. After Adjustsment

by Alaskan - 2011-01-22 01:01:59

I went into A-Fib and while I was at the hospital getting cardioverted they checked out my pacemaker and adjusted it. For the next 3 or 4 days I thought I was having spasms of some kind in my lower left side under my ribs. Come to find out it was from the adjustment at the hospital. I called my cardiologist office and they had me come in. 10 minutes later I was adjusted and back on the street with no problems. I was told it was a fairly common thing.

diaphragm spasms

by beckiej - 2012-10-20 12:10:05

I have a medtronic pacemaker that was inserted in 2004. In 2008, my diaphragm started spasming, like 18 spasms in less than 2 minutes, almost continuously. They had me come in and adjusted it, eliminating the spasms. In July of this year, I started having them again, but only occasionally. I had my regular interrogation in September, at which time they tried to see if they could get it to spasm by changing the settings (it didn't spasm ONCE while I was there...but started up again within a few days. Now I have them many times a day, although not as often as back in 2004. I still have about 2 years of battery life left. Why would my pacemaker start causing my diaphragm to spasm after so many years? Is this something I should see the Dr. for? I live in Taiwan, so communication is challenging...
Thanks for any advice...Beckie in Taiwan

diaphragm spasms

by beckiej - 2012-10-20 12:10:14

I forgot to comment that the spasms are fairly violent (you can see it, and it interferes with talking and breathing momentarily (like if it does it while I'm talking, you can tell).
Beckie

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