EOL PM Experience

• by JoeAthlete
• 2015-02-04 05:02:09
• Exercise & Sports
• 1605 views
• 3 comments

Pacemaker Low Battery by Joe Chirco 1/2/15
I am an athlete. I have a pacemaker to correct a birth defect of a blockage from my SA node to my A/V node. I have no cardiovascular disease. I was given a pacemaker to correct this problem over 8 years ago. During the last 2 months the pacemaker battery was at its end of life voltage.
I was monitoring the voltage at the Clinic on a monthly basis. We watched the voltage declining but it had not reached its ERI. I cycle as an athlete. I cycle to the gym and teach spin classes. Spinning is intense cardio. Actually riding to the gym is intense too as I ride at speeds close to 20 MPH.
I know my body and my fitness level and what shape I am in. As the battery continued to decline, I noticed one day a sudden change. I began to experience shortness of breath and fatiguing at a point in my workout where I normally do not fatigue. I powered through this fatiguing. I explained this to my Doctors and requested a monitored stress test to determine what was happening. My Doctors did not understand. I was denied a stress test. They followed protocols for cardiovascular disease testing. It is interesting that at this same time I experienced PACs or Premature Atrial Contractions, which feels like palpitations. The Doctors noticed this on an EKG. They quickly assumed this was the problem. IT was not the problem!
After some persuasive arguments I was able to get a Holter Monitor. I wore this during my workout and paid attention to the time stamping of how I felt during the workout. The data from the Holter Monitor was surprising. It showed that in the middle of my intense cardio spinning class my heart rate was 68! At the peak of intensity it went to 83! My heartrate should have been 110 to 140. When shown to the Doctors their explanation was the time-stamp must be off. Well it turns out the time-stamps were 100% accurate. It took a while for me to diagnose what was happening. I applied my engineering knowledge to the problem. I am an electrical engineer with a Master’s Degree in Science.
Here is what was happening. Batteries decay at a very slow rate until their end of life. At which point they rapidly decay. When I first noticed the shortness of breath and fatiguing it was time to immediately replace the pacemaker. However, testing did not show that the battery had reached its ERI Threshold. What was happening and I got confirmation of this from the pacemaker’s manufacturer’s technician, is that when my body during my workout called for more energy from the pacemaker battery, the battery’s voltage dropped. The pacemaker did not quit but it went into a safety mode that kept my heart beating but not at the demanded workout rate. After my workout the battery voltage crept back up and showed that it had not reached the ERI Threshold when in fact during my workout it was causing severe stress on my heart.
This severe stress on my heart caused the PACs which led to Atrial Tachycardia episodes which are dangerous.

Summary
As I was working out the battery voltage dropped below the ERI threshold. When I had the battery tested it had time to recover and showed a test result above the ERI! The only way to know this is through either a monitored stress test or the results of a Holter Monitor during an intense cardiovascular workout.
The process for determining ERI for athletes with a pacemaker is different than for other patients. The best way to determine what is happening is a monitored stress test or a holter monitor. The Data speaks for itself! I should have had the pacemaker replaced 8 weeks earlier and during this 8 week period I was unnecessarily at risk. I write this paper to help doctors to be aware of this problem. So that other patients will not be put at risk.
If you are reading this and have a pacemaker whose battery is close to end of life and you are an athlete. I strongly suggest you take action and get data on the performance of the pacemaker during your intense workouts. This needs to override the ERI threshold. The ERI Threshold is the voltage at which insurance pays. I do believe that in circumstances Doctors can override this and get the insurance to pay.