pm problem?

just had a pm fitted couple of days ago, set at 60 beats, having some short bursts of af (expected) but concerned that pacing leads faulty as getting missed beats and an occasional pulse at wrist of 42 beats ? is this normal

3 Comments

Yeah, it's normal

by Theknotguy - 2014-01-31 09:01:06

Gotta give your body time to settle into the new routine. I had a lot of trauma so my body was ringing like a bell. Beats would take off, then quit, PM would kick in, BP up, then down, all over the place.

Even though it feels like it, the PM doesn't quit. It may sit there and watch your a-fib but it will try to kick in and start a normal heartbeat. If your a-fib takes off, going from 60 BPM up to 130 BPM the PM will sit there and not do anything. Mine is set to pace up to 130 BPM but if it's an a-fib session it won't jump in and pace at that rate.

It sounds like your doctor has you set the same as me. If they don't treat my a-fib it will spiral out of control and kill me. If they treat it, my heart goes slower and slower until it kills me. So what they've done is to give me meds to keep my heart from going into a-fib and then use the PM to bring the heart rate up fast enough to keep me alive. It's called rate control.

Since I'm on rate control and not rhythm control, PM settings that will regulate a-fib are turned off. The doctor will accept a little a-fib as long as the rate doesn't spiral out of control. That sounds good on paper but doesn't feel good when you're in a-fib.

Missed beats that you feel may be PAC's or PVC's. Those are Premature Atrial/Ventral Contractions that feel like missed beats but really aren't. If you're using your fingers to get a wrist pulse it will feel like a missed beat. If you can get a Pulse/Ox meter that will give you a more accurate count on your heart beats. In the US they're sold over the counter at drug stores and are battery driven. Not that expensive either.

When I first got my PM I could feel when it kicked in. So my heart would beat, then take it's own sweet time about starting the next beat. The PM would be watching and give the heart a whack to beat at the appropriate time. I'd get coughing spells when that happened. So you don't have to worry about the PM not working. The PM computer and algorithm that watches your heart doesn't sleep, take a vacation, or wander off on its own. It will patiently watch and kick in when it's needed.

The other is true too. If you can get to a location that can show your PM and heart beat, it will sometimes show the PM working when it really isn't. I'm in cardiac rehab and have to wear a monitor while exercising. The monitor would show the PM working but it was really making sure my heart beat was happening with a regular rhythm. I'm actually pacing only about 23/24 percent of the time. Talking with your Cardiologist, your EP person, and the PM tech will answer a lot of questions.

I had a reading of my PM and got a printout of the settings. They have Atrial Pacing turned off. Reason for that being - atrial pacing may actually help my a-fib go faster and faster when the doctor wants the exact opposite. Again, his goal is to not let my heart spiral out of control. Since I'm not anxious to attend my own funeral, I tend to agree with him.

Before the first 90 days they may have the voltage on your PM set up to a higher level. Around 90 days they may reduce the voltage to "save the battery". They do reduce the voltage but if your heart will kick off at 1.2 volts they'll set the PM to 1.5 or 1.75 volts. I was watching the monitor when the PM tech cut the voltage and never felt a thing. I did notice when I went to bed that night that my heart didn't pound as much and I got better sleep.

Hope this helps.

Hang in there. You've got a lot of living to do.

Theknotguy

pacing

by Tracey_E - 2014-01-31 10:01:28

When in doubt, ask them to interrogate the pm. They can tell right away if a lead has moved. As theknotguy said, PAC and PVC can mess up the count, little beats are there but we aren't counting them. That's more likely than a lead out of place. Make a note of the day/time you counted the lower rate, they can look it up on the report. Go ahead and call, put your mind at rest.

asfasf

by boxxed - 2014-02-01 12:02:52

In addition to the PAC/PVC's that knotguy talked about...

If you have a Medtronic PM, their MVP algorithm allows one or two dropped beats here and there in an attempt to let you beat intrinsically as much as you can. It's probably one the bigger reasons why device rep's get dragged into an ER @ 2AM to check a perfectly normal pacemaker. Because someone at the hospital that isn't (understandably) intimately familiar with devices saw a missed beat and thinks the PM isn't capturing.

Sorin works the same way. SJM's version of MVP's algorithm doesn't allow dropped beats.

But like Tracy said, it never hurts to ask for an interrogation. Better to be safe than sorry.

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