Another "not bad, but different" question

This may be a long story, but please stay with me – I need to set the stage for my current questions.

My pacemaker (Boston Scientific S603, DDDR) was implanted 3 ½ years ago when I went into complete heart block following aortic valve replacement. At time of implant, I was 100% paced. Over then next couple of years, my intrinsic pacing grew stronger and more dependable, so my EP began carefully lengthening my A-V delay step-by-step to allow for whatever underlying intrinsic pacing I might have. At his last adjustment, atrial pacing was down to less than 25% of the time, ventricular was about 35%, and feeling fine. This was great, but I live about 20 miles of city traffic away from the EP’s office, and had to take half a day off work each time I went there.

About a year ago, at my “local” cardio’s recommendation, I moved my semi-annual PM interrogation to their local EP, rather than the big downtown clinic I had been going to. At the first interrogation at the local clinic, the EP and tech made some setting changes – supposedly turning on something like “auto-voltage sensing” to try to improve battery life. About an hour later I concluded that I felt just terrible. I made it through the night but went to the emergency room first thing the next morning, demanding that they bring in a Boston Scientific rep to “put everything back just the way it was.” As soon as the tech adjusted the PM, I immediately felt “back to normal.” I crossed this EP off my list.

Fast forward 6 months to my next interrogation at the downtown clinic. Interrogation was fine, I felt fine, but was surprised to find that although my atrial pacing rate was still about 15%, I was being paced over 90% in my ventricle. Since I felt fine, we went with it.

Now, after another 6 months, I have had another interrogation downtown. This time I got the “Alpha Tech.” She is Device Coordinator for the entire clinic; she really knows this stuff. She asked if I knew why they had my A-V delay set so short when my intrinsic pacing was strong and regular. I had no idea, nor did she. She lengthened my A-V delay about 30 msec to allow for intrinsic pacing. She said that I would not feel or notice anything due to this minimal change, but that my battery life should show improvement at the next interrogation. She said very clearly “You are NOT pacemaker dependent. As we speak, your heart is pacing naturally and the PM is just there in case of missed pulses or slow rate (I had bradycardia prior to valve surgery).”

Since this last adjustment, I feel fine, just as normal as I have ever been since having valve surgery, BUT I occasionally feel short periods of “hard” or “pounding” heartbeats, especially after exertion like climbing a couple of flights of stairs. I do fine in the gym, but occasionally have these episodes. No light-headedness or fainting, etc. Just “bump-bump-bump.”

So (finally) these are my questions:
1. Any ideas what could be causing this “pounding?” As far as I know, the A-V delay is the only adjustment made.
2. Is this likely to subside? Will I (or my heart) just “get used to it” and stop noticing it?
3. Should I worry about it and/or demand a re-check?

I feel normal (for me), so I’m just looking for some reassurance, but since I don’t know what the cause might be, I’m anxious.


3 Comments

pounding

by Alma Annie - 2014-08-05 07:08:53

Hi SteveE,
I often experience pounding heartbeats, usually for no reason, and at anytime, not just when exercising. But all is well according to EP, don't worry. So if all has been checked out with you and all ok then don't worry. Just make sure though that everything HAS been checked.
Alma Annie

Settling down. . . maybe?

by SteveE - 2014-08-06 09:08:47

Thanks, Alma Annie,

Since posting yesterday, I have had really no episodes of this weird heartbeat. I'm still not sure what it is/was, but if it subsides, I will just chalk it up to experience.

It also could be, I guess, that my heart was used to a certain strength of electrical pulse when my ventricle was being paced, and now my natural pulse may not be as strong. It could be something related to getting used to the natural pulse as opposed to the electronic pulse.

But that's just me, grasping at straws to try to explain what I felt and why it may be settling down. I guess I shouldn't over-think it and just go along with it. As long as I now feel well with the current settings, and I'm being paced less at that, it all should be good.

pounding for me

by skaggsoak - 2014-08-12 01:08:49

Your pounding you explained and when it happened is what I've experienced for some time. Was just on exertion but then got to where it happened daily. My pacemaker was 2 wire on right side of my heart. Not long ago started happening at rest. Run a diagnostic and nothing show up at first. Then I specifically told them a day and time they looked back and there it was my natural heartbeat from my av node was going chaotic for a few seconds and my pacemaker was trying to correct it. When they got to investigating my heartbeat was going up to 200 and at one time hit almost 300 beats per minute. These did not last long enough to pick up on diagnostic totals. But the effect it was having on me was slamming my bodily system. They said usually could be corrected with another ablation but mine could not. Tried every medication available for rhythm but got worse. Last Thursday August 7 went in and had to have av node ablation to kill all natural heartbeat. Then a crt device was implanted with a 3 rd wire to beat for me. Big decision and big step. But at the moment I'm glad I did it. Since surgery my heart has been as smooth as silk. I have a Medtronic crt 100%paced. I tried to walk little today and couldn't go very far. Don't know if it may need adjusting or maybe it's still just me needing more recovery from a 6 hr heart surgery. Dont know if this is anything you want to hear but there are answers for everything that's going on inside our body. Just may have to take down precise times this happens and make them look at a printout of that time. Good luck. Feel free to ask anymore questions.

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