Fatigue

I'm new and looking for guidance. I have sinus bradycardia (upper 30s at night, mid 40s day) with no other major heart problems, plus I have obstructive sleep apnea treated by CPAP. I often have severe fatigue which seems to be worsening in conjunction with my heart rate gradually slowing over the last few years. My cardiologists have said it is my option to get a pacemaker. (I'm considering a Medtronic Advisa if I do.) However, they will give me no assurance or even a meaningful probability estimate that a pacemaker may provide relief. I've scoured the internet and found some who say it helps, and others who say it makes no difference or worsens their fatigue.

6 Comments

Bradycadia

by donb - 2014-10-07 04:10:47

HI, I have lived with similar sleep problems with low HR along with Vegal attacks since early 1980's. It was my choice in 1992 to get my 1st Medtronic pacemaker which turned my life around. I have also learned in the past without a pacemaker for 30 days where my heart rate would gradually drop back to it's old habits at night.
Just a year ago, I again was without a pacemaker for 30 days with erosion & infection. My heart rate would drop to 30's or less at night. Now with my 6th pacemaker I'm back to normal and very fortunate at age 82 to have good control of my Heart Rate both at night and also have lots of energy to do whatever I want to do.
donb

Bradycadia

by donb - 2014-10-07 04:10:47

HI, I have lived with similar sleep problems with low HR along with Vegal attacks since early 1980's. It was my choice in 1992 to get my 1st Medtronic pacemaker which turned my life around. I have also learned in the past without a pacemaker for 30 days where my heart rate would gradually drop back to it's old habits at night.
Just a year ago, I again was without a pacemaker for 30 days with erosion & infection. My heart rate would drop to 30's or less at night. Now with my 6th pacemaker I'm back to normal and very fortunate at age 82 to have good control of my Heart Rate both at night and also have lots of energy to do whatever I want to do.
donb

Bradycardia

by lauram65 - 2014-10-07 06:10:33

RK, I had exactly the same thing. My pulse was dropping into the low 30's at night. I had a heart monitor for a month. It was VERY helpful. It convinced me I needed the PM. Yes, I was tired for a few weeks after the insertion, but now I walk 6 miles a day, and enjoy many activities. It saved my life. Oh, I also have a CPAP That helped me a LOT. (Not with the low heart rate, but I do sleep much better)

I am struck by what you said about your doctor: that is YOUR decision. Well, it is, but he should tell you all the pros and cons. Are you having sinus pauses at night? You aren't feeling so good now. I can't tell you to "go for it" but it has certainly helped. me. Bet of luck.

Thanks for feedback

by RK - 2014-10-07 08:10:43

Thanks for all of the on the mark feedback comments. I have indeed had a problem with advice from several cardiologists. None has said yea or nay. It has always been "your option" with no guidance pro or con. In their defense, I must say that all of my research for a case like mine pretty much yields the same conclusion: it is entirely my option with no strong assurances either way.

On many days, though, I am so tired that I don't want to get out of my chair. It is starting to affect my work, too. On some days I teach college classes for three hours straight, and afterwards I'm pretty much shot for several hours. Almost all other causes have been ruled out, so a pacemaker may be my last recourse. But, I don't want one if it won't help my fatigue.

glass half full or half empty?

by Gotrhythm - 2014-10-08 11:10:12

No reputable physician is going to guarantee a cure. I myself was very reluctant to get a PM, even though my HR was in the 30's, with long pauses at night. I know how it might seem like a step you'd rather do without if it won't offer improvement.

But I think you are seeing the glass half-empty. If the PM doesn't help, you won't be any worse off.

I see the glass as half-full. Here is what I can promise you: if the PM does improve your quality of life, it will seem like a miracle. You won't just have more energy, the fun of living will come back. You'll be able to look forward to pleasurable activities rather than dreading having to leave your chair to participate.

You are aware that the bradycardia is getting worse, and you are feeling worse and worse as a result. You know how your future lies without a PM. And you know there is little chance it will improve by itself.

On the other hand, although there are no guarantees, there is a chance that by having a PM speed up your heart to something closer to normal, you could feel better than you have felt in a long time.

All of the above is just my opinion. Good luck with whatever you decide.


glass half full

by RK - 2014-10-08 12:10:22

Good points, Gotrhythm, worthy of consideration.

I guess I'm concerned that if it doesn't help, I will have assumed some new risks (granted apparently small) by having the implant. Another problem I've had with the docs (and I understand the lack of guarantees) is they have provided almost no input whatsoever regarding outcomes and potential future problems with an implant.

I am leaning in the direction of your suggestion, though.

Thanks.

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A properly implanted and adjusted pacemaker will not even be noticeable after you get over the surgery.