Palpitation after implant

hi, I am on my third PM which I got implanted 5-6 weeks ago. To be honest I had my 2nd PM for 12 years so cant really remember how I long I took to adjust to it. I had an AV node ablation prior to my first device 20 years ago which makes me pacemaker dependant. Just after this implant I had crippling palpitations (not fast but thumping in my chest) which eased a little but are still bothersome. I can have episodes which last for 3 days and then get peace for a couple of days but they come back again.They are more troublesome at night but thats to be expected as you are more aware of the unusual feelings. Someone remarked in an earlier post that this happened to them and the best thing the dr could come up with was trauma due to the surgery. Has anyone else experienced these symptoms and how long did they take to lessen. I'm 60 years of age now and was extremely anxious about this latest surgery so dont know if it is all psychological or a genuine concern.

5 Comments

have done that already

by lizzie - 2013-07-21 03:07:13

i honestly dont think it is the settings as the palpitations change from day to day. it doesnt necessarily change with movement. i can be completely normal for a few days and then they start up even when im at rest. my cardio technician is the same one ive had since my first pm implant years ago and she knows what settings im comfortable with so i was going more with the trauma suggestion or my dr thinks im just over anxious which might well be a factor as well. just have to hope things even out a bit.

Palpitations

by CardiacTechnician - 2013-07-21 03:07:50

Palpitations is an umbrella term that people use for a whole variety of sensations seemingly coming from your heart. Without knowing what type of pacemaker device you have it makes it harder to speculate as to whether your pacemaker could be to blame. You should contact your pacemaker centre and organise a check and document the time of your symptoms too. Primarily because pacemakers have recording facilities that could shed light on your symptoms but also as there are a few pacemaker 'issues' that could cause these symptoms.
Some pacemakers have auto threshold checks which usually occur at night, these are used to minimise the voltage output and to save battery (these checks are very safe but in some instances can be felt and can be switched off).
There is also a possibility of Diaphragmatic pacing or something similar which is essentially the lead stimulating a nerve/muscle causing a twitch (this can be resolved in a lot of instances by reprogramming the lead polarity)
Another possibility is something called pacemaker syndrome which although sounds dramatic is a collection of symptoms caused by a dyssynchrony in the contraction of your heart which can occur in Single chamber pacemakers or pacemakers in a single chamber mode such as (DDI).
All of these 'Issues' are addressable and not too much cause for concern.
My advice is to get your pacemaker checked and ask about these possibilities whilst seeing what the pacemaker has recorded. If the technician is unable to resolve or shed light on your 'palpitations' then they will either refer you to your cardiologist or back to your GP. Either way you will have more information for your GP to investigate further.

NB the previous comment is discussing something called rate response which for them was a little too sensitive. A rate response issue would potentially increase your heart rate causing faster palpitations due to movement or a closed loop impedance system, in English I dont think a rate response algorithm would explain your symptoms... but then again who knows :)
BEST OF LUCK!

palpitation -

by lizzie - 2013-07-21 04:07:09

i didnt notice the comment made by Cardiac Technician and the above comment by myself was made in response to Bostonstrong. My pacemaker is a medronic Res01(VVIR) and i asked my technician if it could be my lead and she didnt think so. Would the 24 hr holter monitor show up any of the symptoms you suggested. As i said my symptoms are manageable for a few days at a time and i would have thought any of the above would be felt all the time.

Cardiac Monitor

by CardiacTechnician - 2013-07-21 04:07:39

Ok so in a VVIR pacemaker diaphragmatic pacing (hiccough like twitch) is almost unheard of but potentially a pectoral or muscular twitch could occur if your lead was set Unipolar. So that could sneak under the radar.
As a quick interlude a bipolar lead uses an electrical impulse based at the bottom of the lead to stimulate a contraction. A unipolar lead uses an electrical pulse that travels from the tip of the lead to the pacemaker device itself to stimulate a cardiac contraction. This is why pectoral stimulation or something can occur in a unipolar configuration.

The auto threshold checks could also occur in these pacemakers.
Also Pacemaker syndrome is unlikely as I am assuming (from your previous posts) that you have a chronic atrial arrhythmia? Permanent AF or a flutter and in these cases Pacemaker syndrome is unlikely. Though in rare cases could be explained by a patient going in and and of normal atrial activity (PAF - Paroxysmal Atrial Fibrillation).
This brings me nicely round to your suggestion of a 24 Hour heart Monitor. These are very useful still for two reasons in your case! During your symptoms your pacemaker recording facility will have no idea what is going on in the top chambers of your heart (Atria) but also because pacemakers are excellent at recording things that they have been told are abnormal... they will not record and document anything going on which they consider normal behaviour. A heart monitor records it all just hope you have your symptoms whilst you are wearing one.
I am skeptical that the pacemaker is to blame but these things are worth checking out, like any technology a pacemaker comes with out of the box settings and with the best will in the world when trying to program a pacemaker to mimic exactly the previous device, a setting may be overlooked.

As a side note a 'stronger' heart beast in all hearts even those without pacemakers can be associated with an Ectopic Beat or an Extrasystole, although these occur in everybody and are usually benign, the burden of these ectopics is of interest and may be medicated. A 24 hour holter monitor will show the burden of any ectopics and help your cardiologist make future treatment decisions. Decreasing caffeine intake and alcohol are always a simple and easy method to try and reduce ectopics.

Get your pacemaker checked and ask the technician to have a look at the PVC count this is a data collection of your Ectopic Beats and I am pretty sure that the Medtronic Sensia SR has this algorithm.

If you were a member of my family I would want you to have a further pacemaker check, and a holter monitor to get to the bottom of your symptoms. If these all come back saying everything is fine then you will have peace of mind! Which is what we all ultimately strive towards.

Simply ask if the device was set up exactly as before, including the lead configurations and whether the lead impedance's are within normal parameters, if they are then ask nicely if you may be fitted with a monitor for your peace of mind as much as anything else.

You are correct in that the autochecks would occur at the same point each day, but pectoral stimulation, ectopics, pacemaker syndrome or a problem with the lead could seemingly come and go as it pleased.

I hope this helped, but ultimately I am not a Doctor I am simply explaining possibilities. Palpitations should be investigated so an appointment with your GP is always advisable.

Palpitations

by Bostonstrong - 2013-07-21 12:07:19

This is a genuine concern and can be fixed with adjusting your settings. I got a pm 3 weeks ago and didn't have them initially but did after having settings changed to increase sensitivity for running. They changed the slope from 9-12 and told me it might be too much. After 2 days of a rate if 150 whenever I moved I had it adjusted again. The slope is at 11 and upper limit is 140 now. I am being paced at 60 so the rate is not fast but each beat feels like my chest is being slammed hard. Tell your EP what's happening and ask to be reprogrammed. Best of luck!

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