Pulse "stuck" at 70 after one year with PM

HI folks, I'm writing this on behalf of my father who had his PM installed about 12 months ago. It's a St Jude's PM2210. According to my Dad, the PM was set for a range of 60 to 130 and he was feeling grand for the year that followed.

Some time in the past month, my Dad started feeling bad (low energy, shortness of breath with mild exercise, etc.) and realized that his pulse never varied from 70 bpm. A local doc had him do some brisk exercise (jogging in place) and after several minutes of this, his pulse never varied from 70!

The phrase "Atrial Fibrillation" was tossed into the conversation and I've been busy researching that. I just don't understand how his heart could stay locked in at 70 in the presence of a "variable" PM.

My question for you good folks: does this sound like a PM that somehow lost its programming, or perhaps is there some other condition that could explain the steady-state pulse of 70?

Obviously, my Dad is having trouble doing anything other than basically sitting around. His heart rate just doesn't go up and he's a pretty active guy. I'm just trying to get educated so I can help him advocate for himself.

Thanks!
Tom

8 Comments

Should be easily fixed !

by IAN MC - 2013-03-12 02:03:18

Hello foothilltom . It is fairly common for pacemaker patients to be " chronotropically incompetent" which simply means that their heart doesn't respond to exercise by beating faster.

Maybe your father has developed this as his heart condition has worsened. As Smitty says , turning on the Rate Responsiveness function on his pacemaker should solve the problem. There are various sensitivity settings which determine how quickly, and by how much his heart rate will increase. It may take a few adjustments to get the settings right.

Best of luck to your father

Ian

Father's Low Heart Rate

by SMITTY - 2013-03-12 02:03:40

Hello,

If your father was having episodes of A-Fib his heart rate would most definitely go above 70 during those episodes.

My guess it the rate response on his PM has not been activated or it is like you say, "the PM has somehow lost its programing."

I'm inclined to think the rate response has not been activated. If the dr he saw couldn't tell him what was going on I suggest that you find another cardiologist.

By the way my heart rate would be "stuck" on 80 if I didn't have the rate response activated.

Good luck to your Dad.

Smitty

Stuck.

by MsJanet - 2013-03-12 04:03:18

After my first PM surgery last Nov. my heart rate would not get above 60. Then bottom lead had become misplaced and I had to have a second surgery. The lead was turned off first and my heart rate immediatly went up and varied. After the second surgery, it also varies. I'm not an expert on A-Fib or even a PM., but he needs to see his/ a cardiologist and the PM tech or even the surgeon if it's someone other than the cardiologist, as soon as possible for a checkup. Please don't wait around. Even if it's just adjustments needed, they are needed now.
Hope your father feels better. Good Luck.
Janet

How about going into low battery mode?

by ElectricFrank - 2013-03-13 03:03:47

It's a bit soon, but batteries have been known to fail. When a low battery is sensed the pacer shuts all the options down and goes to a fixed rate.

In any case it's time to see whoever does your checkups.

frank

Heart rate stuck

by golden_snitch - 2013-03-13 04:03:29

Hi!

Atrial fibrillation doesn't lead to fast heart rates in every patient. Some remain in the normal range, some even go into bradycardia (there are Afib patients who got a pacemaker because of this). However, Afib is always characterized by an irregular heart beat. It can be somewhere around 70bpm, but it will most likely not get stuck at exactly 70bpm; it will vary. When the doctor has mentioned Afib as a possible cause, maybe he did see something in your father's ECG? After all, sometimes right ventricular pacing leads to an onset of atrial fibrillation, and I guess your father is also in the typical age for Afib.

What Janet suggested about a lead having become displaced also makes sense, and that's something that can happen at any time. That the rate response is not switched on, and that your father all of a sudden developed chronotopic incompetence after having done so well for a year, is, in my opinion, rather unlikely. What was his original diagnosis? If it was (sinus) bradycardia, then the rate response should be on. I think the only patients who usually don't get it switched on are the heart block patients who have no sinus node issues.

Hope your father gets this figured out soon.

Inga

Let us know the outcome

by IAN MC - 2013-03-13 05:03:37

foothilltom .... as you will have read , there are lots of possible explanations :-

-- is it your dad's heart causing it, or is it a PM settings issue, or a PM malfunction ?? . He needs to see his pacemaker/cardiology guru a.s.a.p. to get him back to normal.

For the sake of all of our ongoing education please let us know the outcome.

Ian

( Inga, just for the record , I only have sinus node issues yet I don't need RR on ; it seems that your sinus node may not function properly in terms of bradycardia developing but you can still be chronotropically competent ..... any explanations for that ? .... ian )

My dad has exactly the same problems

by leoncino - 2013-03-13 07:03:06

HI
My dad has exactly the same issues he has Afib and Bradycardia..he has always been fit and active but is forced to just sit down most of the day. He explains that he walks like a zombie due to lack of energy in his legs.

Been to 2 cardiologists but they wont adjust his settings they have him on Rate response and his PM is set at 60. We have nowhere else to turn we have been to every leg doctor and had his meds checked out. He feels very down that no doc will help him.Cant understand why they won't change his PM settings. We are in Australia and has a medtronic single chamber
Good luck with your dad.....hope you find a solution keep us posted.Isobel

Ian

by golden_snitch - 2013-03-13 12:03:43

Hi Ian!

I have a friend with severe sinus bradycardia at rest, too, but as soon as she starts to exercise, her sinus node works perfectly fine. I have no explanation for that. It's interesting, though. Maybe it has to do with some of the hormones that are released when you exercise, Cortisol and endorphins for instance. Could be that they kind of wake the sinus node cells up :) But that's just a guess.

Hope all is well in the UK!

Inga

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