Pacemaker fullav block and beta blockers

My wife has a pacemaker, which is in theory is due to complete av node block

I say in theory as nearly a year later and another emergency room visit, we were told, something different, maybe not complete block, just weak signal. And sometimes pacemaker picks up a signal and says it does not need to pace. They reset pacemaker to beat faster, 70 bps vs 60 pbs

we are told complete block, How would pacemaker get an override? And then let the pace drop?

Now to our new situation 9 months later. The doctor is now saying they need to add a beta blocker, and do an echocardiogram. (which I am glad they are doing echocardiogram.)


Starting in october, my wife is still experiencing moments of dizziness, lightheadedness, rapid heart rate. She was recently given a 24 hr heart monitor to wear, in january to record episodes when they happen. She has received 4 different monitors in less then 8 weeks,because the monitors ERRORED out and stopped working. Faulty equipment!

Now doctor is recommending beta blockers and echocardiogram

Anyone have experience, having a pacemaker and needing more diagnosis?

I am really worried the pacemaker my wife has is not adequate for her needs.


1 Comments

diagnosis

by Tracey_E - 2015-02-26 05:02:43

I have a pm for av block and also am on a beta blocker for fast beats. Sounds crazy but it works. I explain it that I have the pm to make the ventricles beat faster, I take the bb to make the atria beat more slowly.

It's possible when we have "complete" block to have periods when we either beat normally or are in 2nd degree block which means some of the signals get through rather than none. They like to slap a label on it, but the reality is it's more fluid and it's not at all uncommon to go back and forth.

I was born with 3rd degree block and pace nearly every beat. Once when I was getting ready for a replacement, they turned the pm off for a few seconds to see how low my rate was. I'm usually in the 20's without pacing and they do the replacement a little differently if it's too low. The tech did a double take, I was doing 60 all by myself. I got a brief vision of healing and not needing pacing so I eagerly asked if I was pacing less. She said yep, I went from 99.9 to 99.6 LOL. So yeah, I guess I still need it. Next time we checked, it was back to my usual pokey underlying rate and pacing every beat. The reality is it doesn't really matter how much we pace. If we need it every beat or only occasionally, if we are always in 3rd degree or move back and forth between 2nd and 3rd, the fix is the same and we need it.

AV block is the signal between the atria and the ventricles. The pm fixes it by making sure the ventricles beat whenever the atria does,it paces ventricle whenever the atria beats but the ventricles don't keep up. This doesn't mean we can't have a second problem with the atria. If the heart goes to fast on its own, the pm can only sit back and watch, it can't prevent the heart from doing its thing. She's probably still pacing ventricle during these episodes, what the atria is doing is unrelated to when the ventricular lead kicks in. If it's going too fast, beta blockers will help.

60 to 70 is an atrial setting. I have no idea why they'd do that. Theoretically with av block we don't pace atria because our sinus rate is normal. If our resting rate is between 60 and 70, changing the lower limit will cause atrial pacing. That doesn't make much sense to me but I'm no cardiologist. Maybe they thought it would help with the dizziness by giving her a faster resting rate?

Ask if her rate response is turned on. It's a feature that helps when our atrial rate doesn't up appropriately on exertion. It senses movement and raises our rate for us. With av block, we rarely need this because our sinus node works like it should but sometimes they leave it on just in case. However, it can sometimes compete with our natural atrial rate and cause problems. They can turn it off.

Did the monitors fail or did the person reading it not know what to do with a paced reading? We can be a little tricky to the untrained eye. You'd think they'd be trained in a cardiologists office, but it's something to ask since the odds of 4 sets of faulty equipment are even more rare.

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