Resons for a PM questioned

Hi everyone, this is my first posting and the questions I am asking will be discussed with my cardiologist when I see him but just wanted to know if anyone had similiar questions.

I was told I needed a PM because when I would self-convert out of atrial fibrillation, (the heart stops and resets itself) I would get dizzy but not to the point of passsing out, before returning to a normal sinus rhythm. The PM keeps the heart from stopping preventing the possiblity of passing out. My first question is: Can the PM impede the outcome of a cardioversion. I have had two cardio's this month for a slow atrial flutter problem and both failed.

Also, I was told that a PM is used to keep the heart pacing at a rate that will keep a person feeling good and active. However, I have noticed that even though my rate is set at a lower rate of 75 bpm, up from 40 bpm, I am having episodes where my heart rate drops to 63 bpm with pemature ventricle contractions (PVC) that the PM counts them as a beat and doesn't fire. This causes me to become fatigued and worn out.
Has anyone else experienced this and if so what was done to correct it.

Thanks
notattoos

5 Comments

rates

by Tracey_E - 2013-09-25 02:09:01

How are you counting 63? Monitors are notoriously inaccurate with us so always count by hand. Even counting by hand,if you have afib and/or pvc's, it can be difficult to get an accurate count. It's more likely that you are missing beats when you count than the pm is actually letting you get down as low as 63. Tell them what is happening and if you can, a day and time so they can see what the pm was doing at that time. Sometimes adjusting the lower rate can help you feel better, but the pm can't really stop a pvc.

Do you have one of the new ones that paces you out of afib? I don't know much about them but some of our other members do and that will be the first thing they ask. A pm cannot guarantee you will never pass out or need a cardioversion, but it can help.

VA timing

by PacerRep - 2013-09-25 03:09:52

You have a pacemaker that uses VA timing vs. AA timing. Depending on your model ask the tech to switch it if it is possible. You want your heart rate driven off of your atrial beats not your ventricular beats since you have PVC's. But I'm surprised your feeling that drop, it would only go to that rate for 1 beat even with VA timing.

PM will not impede a CV. Your heart takes a second to restart because of a phenomenon known as SNRT (pronounced snert). Google it if your interested, Sinus Node Recovery Time.

Questions

by gleesue - 2013-09-25 04:09:44

A PM does not inhibit a cardioversion. I was cardioverted in May. One thing I did notice is that they used more joules, 250. In the past I have been cardioverted using anywhere from 35 to 250 joules. I have also had times where they have had to zap me as many as three time before I went into sinus.

Also a PM won’t prevent a heart from going into an arrhythmia, but will eliminate the situation where the heart may go into Bradycardia then spike up and cause the heart to go into an arrhythmia. I went 6 months after my PM implantation before I went into another arrhythmia that required cardioversion. My doc. thought that was pretty good. A quick zap twice a year I can live with.

Jerry

PVC's & PM's

by donr - 2013-09-25 10:09:27

No: I'm the King of PVC's - have an average of 100,000 per month. Also have a PM. Dot't choke on the number of PVC's - that works out to only be 2 every three seconds - no big deal, I assure you.

I assume that you measure your HR yourself, since the PM will NOT let your HR go below the lower limit. Counting HR w/ PVC involved is difficult. If you are doing it w/ a finger to the wrist & a second hand on a clock, you have to be experienced enough to recognize the wimpy beat that is premature. First time my wife did it for me, she got a HR of about 36 - it was in reality somewhere in the 60's. She just did not recognize the wimpy ones. If you are using a montor of some kind, they are notorious for missing PVC's. That's the main reason I doubt that your HR was 63 while the PM is set at 75.

I have a bunch of runs every month, also, & the PM just paces merrily along. IF there is a voltage above the sensitivity level, the PM ignores it & continues to sense. That counts as a beat. Maybe it's wimpy & weak, but it's there. The problem w/ the PVC is that its natural heart signal is early, hence the PM can do nothing to pace you out of trouble. After the beat is started, the PM continues to sense electrical activity, so it inhibits itself from generating pacing pulses. It's the sensing function that the PM counts & determines that a PVC has occurred - it compares the time of the PVC wimpy QRS wave w/ the values stored in its memory & puts a hash mark on the blackboard tally for another PVC.

I started this comment before PacerRep wrote his & finished it much later, w/o reading all that transpired in between. I think I read your description of events different from him, hence a different conclusion. I did not see a name & model for your PM, so cannot even conjecture on that effect. My comment is based on my experience w/ my Medtronic.PM & lotsa PVC's. I look at my HR histograms in every download report, & never see any HR's reported less than my lower rate of 75 (actually the gram shows an interval of 70-75).

Don

A-Fib control

by Roys - 2013-09-25 10:09:40

I have a Medtronic PM Model A5DR01 with overdrive pacing, designed to manage early recurrence of AF. Also mineral supplements can stop the heart going into A-Fib, the doctors don't tell you about that.
Cheers Roy

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