Bossing

this is the 9th month after my pacemaker was installed.
I must say i dont have much problem and doing fine.
I went for a recent checkup.
I was informed that my pacemaker is being used 86% now and it was around 20% 3 months ago during my last visit.
The technician also told me that this is normal and nothing to be afraid of.
He said they call it bossing, which means the pacemaker kinds of take up the whole responsibility of pacing after a certain amount of time.
Is this normal or has any medical validation?
I have also taken the report to the doctor and he says its ok.

Another problem which prompted me to get the settings checked in the first place is "shortness of breath".
I have had a slight history of asthma. But kind of feel short of breath after not so tiring work.
It goes away though. My pulse is constant , so that is not a problem
Is it that i am being hypersensitive or this happens??

3 Comments

bossing

by Tracey_E - 2012-11-28 09:11:13

I never heard the term bossing before, but it sounds like the pm taking over, which could be good or bad. The actual number is irrelevant, there is no "good" or "bad" percentage to be pacing, we're all different in what we need. If you feel good, then it's a good thing. If you don't feel great, and it sounds like you don't, then perhaps the settings should be tweaked to let your heart have more of a chance to beat on its own before the pacer takes over. How did you feel before the last visit, better or worse than now?

bossing

by sdgupta - 2012-11-28 09:11:18

actually i feel quite the same. but yes, the shortness of breath set in sometime in between. other than that everything seems fine.

Diagnosis?

by golden_snitch - 2012-11-29 03:11:36

Hi!

May I ask what your diagnosis is?

The "bossing" does not need to be! A well programmed pacemaker will let the electrical conduction system of the heart do its job as good as it can; a not so well programmed pacer will "boss around" and not give the natural conduction system enough time to get the job done on its own.

If you have permanent third degree heart block then the pacer needs to take over the job 100%. Same is true, if your sinus node is always too slow. But there are lots of patients who have intermittent heart blocks every now and then, or only have a too low heart rate at rest, or it's ok at rest, but does not increase enough with exercise - all these patients do not need the pacer 24/7.

So, it depends a bit on your diagnosis. My first guess when I hear that someone's pacing percentage has increased as much as yours is not that your natural pacemaker fails more than before, but rather that the pacemaker settings have not been optimized.

Good or bad also depends on where you're paced, atriums or/and ventricles. Ventricular pacing in patients with intermittent heart blocks should always be reduced to a minimum. Google "unnecessary right ventricular pacing", and you'll know why. Studies indicate that right ventricular pacing can lead to heart failure and occurence of atrial fibrillation. The evidence is strong, so that many pacemaker manufacturers are working on special features to reduce ventricular pacing. This is not to scare you; even if that risk did not exist, it would always be better to let your natural pacemaker do as much work as possible on its own.

Best wishes
Inga

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