Heart Rate below Pacer Low Rate

I had my pm and leads replaced 3-7-12 with Medtronic Revo. Initially, I had problems with sinus tach and low BP. Florinef fixed that. Now I have lots of PAC's with both brady and tachy rhythms, plus three episodes of near syncope in one week. Pacer was checked last week and say nothing shows up. Still waiting for holter results. PCP ran EKG on Monday and said stuff is showing up there--PAC's, long pauses between beats. Low rate is supposed to be 60, but I am finding rates in the high 40's and low 50's during symptoms. Do the new pacers pace beat to beat?? How can I have a rate that low? I am not pm dependent. I have sick sinus syndrome, and also rates affected by intracranial pressure--high pressure = low heart rate, high BP, and bad headache deep in the back of the head.

4 Comments

has your doctor checked you for pseudotumor cerebri

by kathykat11 - 2012-04-21 01:04:35

with the kind of head ache you are experiencing I would think that would be something to look at. from the electrical stand point I will flat out say I do not understand how it works... I am only glad that it doesand put it in the mental box with other things I have no explantion for labeled MAGIC. There are some things I have to understand and I make an effort to do so but this is one I can do nothing about myself so I dont bother.

Something does not sound right.

by Heidiglassmeyer - 2012-04-21 05:04:04

Hey Pace Cat,
Did you tell your physician ALL of your symptoms at the last visit or did they just start? I am assuming you have a dual lead PM. I'm certainly not an expert but...your HR should not be running that much lower than your set rate if everything is working properly. Are you sure it's set at 60 and your monitor is working correctly? If I was feeling pressure in my head and my BP was high with the symptoms you're having I would be on the phone with my doctor. I am dependent and was told if I ever drop significantly below my low thresh hold to head immediately to the ER. Something does not sound right.

Take care,
Heidi

HR below pacing threshold - same problem

by Lancashire Lass - 2012-04-22 02:04:10

Hi Pace Cat
We seem to have a similar couple of things going on here.
Dual chamber pacemaker for almost 2 yrs now. DDIR mode. Had tweaking a few times but was OK June to December last year, HR was set to 50bpm last June to minimise ventricular pacing which I was extremely aware of and made things very uncomfortable. Had check of pacemaker early December, told them been having my usual prem beats but runs again of paroxysmal VT. Told nothing showed on the trace. In January becan to have slow, thudding beats, shortness of breath, couldn't even stand up when these attacks were happening. Would get a heart beat which seemed to ricochet around the chest rather like the situation when you see a bullet fired in a cartoon which ricochets to various parts of the room.
Headaches and inability to walk far. Saw EP urgently and scheduled for stress echo and 48hr Holter, but ended in ER early Feb as one night symptoms so bad husband got me to ER. Kept in three days and of course nothing happened!!! Two days before stress echo I noticed my HR was only 46bpm, taken at the pulse in mt wrist, also a BP and HR monitor. SometimesHR dropped to 36bpm so rang the clinic and told that couldn't be happening, I had obviously got the number of beats wrong! Fast forward 2 says for stress echo, they downloaded my pacemaker and came in and said "guess what, you were right your HR is too low", reasonable report on the echo, Holter justthe head technician said, just prem beats and the pacemaker isn't recognising them. I felt this was not the answer but I am seeing the EP in a couple of weeks so hope to ask him the questions and see what answers I get. By the ay had Xray of chest in case something else was going on to disturb heart rate, hiatus hernia possibly. Nothing showed up but my CTR last year was 43% and now 47%, I have read that if CTR reaches 50% that is classed as heart failure. I would be interested to know what they tell you about your low rate.
Take care
Maureen

The Answer to the Riddle

by PaceCat - 2012-04-22 07:04:25

Well, my heart continued to beat slow and irregularly, until I felt it take off. I grabbed the stethescope, listened the very fast, chaotic rate, and called the doc. The doc on call listened and said I could go to the ER or wait until Monday morning to be seen in the pm clinic. I went to the ER, since the nurses in the pm clinic have NOT been very nice through all this. While I was in the lobby, hr took off again. Back in a room on monitors, it did do it enough for dx. Slower speed A-fib. Pm showed the higher speed a-fib (atrial rate 280) that had prompted me to get help. So the slow pulse was due to the atrial rate being faster than the ventricular rate. The cool thing is my Metronic Revo is capable of trying to pace me out of atrial fast rates. So that is now turned on. I am to follow up with my cardio in the next couple of days to see if additional meds are needed. I don't do well with them, so the EP who happened to be on call yesterday and has seen me before decided to hold off on the meds and see if this works.
Sorry for the misunderstanding on my first post...my brain does not like to work so well during this. My pacer was put in for sick sinus syndrome and I have also had episodes in the past of bradycardia with the headaches. The pacer keeps the high ICP brady from going into the thirties, thus keeping the blood pressure out of the 200's mostly when it happens. But I am not having that right now. I have shunt corrected hydro and slit ventricle syndrome. So my head pressure is jacked up a bit right now to reopen the ventricles and relieve the spinal type headaches, but is not the current cause of the problems.
Thanks, L

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