Pacing rate & leads

I wish to know why my EP didn't want to set the pacemaker to pace at rate 60? He wants it on 70. I have a terrible pacemaker syndrome. I've begged him for a year then he sets it down to 65.

I would like to learn or know why the pacemaker has to pace the Atria and ventricle sequentially?

If Sick Sinus Symptom or A-Fib happen, why can't just pace the Atria and leave the ventricle alone?

If the AV node not function, why can't just pace the ventricle and leave the Atria alone?

6 Comments

Sequential Answer

by pete - 2008-07-11 02:07:46

Sequentially because first the atriums beat to fill the ventricles and when they are full of blood the ventricles contract (beat) to send blood around your body and to your lungs. Sick Sinus Syndrome means you hearts natural pacemaker is not functioning as it should. I am sure they will have done the best for you. Setting your lower pulse rate at 70bpm is the most common setting.
You did not explain the nature of your "terrible pacemaker syndrome" as you put it. Cheers pete

Pacing rate & leads

by SMITTY - 2008-07-11 09:07:57

Hello Piika,

Your EP takes many things into consideration when deciding the best rate for your pacemaker. For example, your daily activity could influence his decision, or your ejection fraction could influence his decision, etc.

I've had a PM for 8 years and during that time the low setting has been, not in this order but at one time or the other, 30, 40, 45, 60, 70 and 80. For the least two years it has been 70. My suggestion is don't fret over what the high or low settings of your PM are and leave that decision to your doctor.

As for your other questions, may I suggest that you go to Google, or some other web site, and input "How Does A heart Work" and after you study that look up "How Does A Pacemaker Work?"

Please understand that I mean no disrespect by my suggestions. But you have asked some questions that make me think you probably need to brush up on some of the basics to get the full benefit from any answers you will receive.

Good luck,

Smitty

I got a pathway so not a PM dependent

by Pika - 2008-07-11 10:07:54

Thanks for the comments.

As I know many of you went to my profile and found I got a His bundle ablation. Yes, I had a His bundle ablation but I'm NOT a pacemaker dependent.

I got wpw, some how after the his bundle ablation, a new pathway started to connect from my Atrial to the ventricle (anterograde) during my heart block. My EP told me that I don't need the pacer but would like the pacer sits there for an insurance.

Reason for AV sequential pacing...

by Angie_O_Plasty - 2008-07-11 12:07:00

The type of pacing depends on what the electrical problem is but the idea is to have the heart functioning the way it would with a normal electrical system as far as this is possible. This means with the atria contracting, then the ventricles. Atrial contraction contributes significantly to cardiac output (I think it's about 20%) so it is important to have that "atrial kick" if possible. In the case of AV block, ventricular pacing is always needed but atrial pacing may not be--if the sinus node is working fine, the pm can essentially wait for the sinus impulse and then pace the ventricles a fraction of a second after it, basically taking over the function of the AV node that isn't working. With sick sinus syndrome, it is indeed possible to just pace the atria and leave the ventricles alone as long as the AV node conduction is intact; in fact, this is preferable in the interest of avoiding unnecessary right ventricular pacing (which can in some cases weaken the heart b/c the ventricles are contracting out of sync). A-fib is a different situation--it's not possible to pace something that is fibrillating; it's too chaotic for it to work. So in that case one is left with just ventricular pacing which isn't optimal but neither is being in a-fib :-) As far as yoru rate question, you'll have to talk to your doctor about that one as I don't know your situation and am not a dr. (I'm a nurse with an interest in cardiology). Hope I didn't confuse you too much!!

Musketeer

by Musketeer - 2008-07-15 02:07:25

What's pacemaker syndrome. My cardio tried to explain it. Mine speeds up for no reason. They adjusted and if that doesn't work they are talking different meds. He did change the rate at the time of admustment.

Pacemaker syndrome

by Pika - 2008-07-19 11:07:12

Mine one like an express train once I opened my eyes in the morning while I was still in the bed. Day time, it's like a metropolitan train, stopped all stations. Some time it's like a garbage truck, loading tons and tons of rubbish in my chest. Now he set from 170 to 220, my chest like someone is playing a table tennis. Now it is like an elephant sitting on my chest. All food is stucked in my chest and throat. ER doc told me, it is all called "Pacemaker Syndrome".

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