diaphram pacing

I had a pacemaker placed two weeks ago and I've been feeling a strong beat under my left breast. My cardiologist told me this morning that the pacemaker is set too strong and it is pacing my diaphram as well as my heart. I will be having my pacemaker interrogated later today for adjustment. Have any of you had this problem?

2 Comments

Yes, two times

by girl dreamer - 2012-11-21 01:11:28

Before my second lead revision ( which was last Tuesday), I came in to the E.R. with severe diaphragmatic stimulation leading me to breathe like a fish basically. For the most part, the impulses decided when I was to breathe. I had macro-dislodgment of my atrial lead and it was stimulating my phrenic nerve. That was last Monday and was in the operating room the following day.

Unfortunately, just a few days after that 2nd lead revision , the diaphragmatic stimulation came back. I went to the cardiologist the day after it came back and it happened during the EKG. He observed it and had Medtronic evaluate me right away. They finally turned off my atrial lead completely since it was decided it was a malfunctioning lead.

Amplitude

by golden_snitch - 2012-11-21 12:11:42

Hi!

Yes, have had it, and it's an easy one to solve (in most cases). All the cardio will do is to turn the amplitude (voltage) down a bit. This setting is usually set relatively high for the first couple of weeks or months, because while the leads heal in, the site is a little bit inflammed and the heart tissue not that easy to stimulate effectively. So, a stronger electrical impulse is needed.
While you usually set the amplitude two or three times as high as the threshold (lowest voltage needed to stimulate effectively), doctors often program it even four or five times as high as the threshold in the beginning, just as a precaution. Now, if that is too strong for you and leads to diaphragmatic pacing, then it should be no problem to change the amplitude, so that it's only twice or three times as high as the threshold. You're still on the safe side with that, but hopefully the diaphragmatic pacing will be gone.

In some cases lowering the amplitude does not help, because the ventricular pacemaker lead is placed somewhere so close to the phrenic nerve (that stimulates the diaphragm) that every impulse from the pacemaker irritates the nerve. In that case one would have to go in again, and find a better spot for the lead. However, this is a rather rare complication, and as I explained above, in most cases it helps to just turn the voltage down a bit.

Best wishes
Inga

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