New at this (3rd Degree AV block)

Hi everyone! I'm new to this. I don't have a PM yet but my cardiologist says that my pacemaker will be done as an "Elective Procedure." What does that mean, elective?


I'm 25 and I found out about my Third degree AV block when I was 19. I was well aware that my heart rate was in the 40s but I didn't do anything about it since I thought that I was handling it well. I just had occasional difficulty of breathing and feeling sleepy all the time but it was manageable for years. Never passed out. Though I think my recent poor concentration may be due to this AV block. It was the first time last Thursday that I felt dizzy along with being dyspneic and had chest tightness. I was rushed to the ER and told them I had been diagnosed with Complete Heart Block but no workups were done. They did a trial Atropine but my HR just went up to 52 from 47 bpm.

I got admitted at the ICU because my heart rate was still in the 40s. Friends who visited me said that my heart rate was in the 30s sometimes when I was sleeping. Tests were done which revealed normal results. My EF is even fantastic at 68%! My BP was around 110-120/80. The doctor told my father that my heart was healthy, it's just that the pumping is weak. The doctor is also considering that my condition might be Congenital Complete Heart Block.

For the whole 2 days that I was in the hospital, I didn't feel anything (no dyspnea, no dizziness). So I think nothing's wrong. :/

Today, It was the first time that my heart rate was 37-39 beats per minute for more than an hour.

Thoughts please? Can anyone help me out? :)

9 Comments

necessary or not

by Tracey_E - 2015-09-19 01:09:23

Elective means you are choosing to have the surgery and it's not necessary. I think of cosmetic surgery when I think "elective", not fixing your heart! In this case, it's more likely the dr doesn't want to do the surgery on someone so young, so he's hedging. It's not 100% necessary but you definitely meet the guidelines and would benefit from pacing.

I, too, have 3rd degree congenital av block. They found it when I was 5, I got my first pacer at 27. That was more than 20 years ago. I waited until it was an emergency because my rate had dropped so low (20's). In hindsight, I wish I'd done it much earlier. Yes, I got by without it, but I wasn't thriving. My energy level skyrocketed after. My mind was more clear, no more dizziness, I could be active like never before, and it was just plain easier to get through the day. Our bodies need a certain amount of oxygen. When we're young, we can get by with a lower rate. The older we get, the more our bodies pay the price and the harder it is to function with the low rate. Why drag it out when there is a fix? JMHO.

More thoughts...
passing out is NOT a good yardstick. What if the first time you pass out you are driving or standing at the top of the stairs? We've had members seriously hurt that way. I never passed out either. My rate was 22, I was on the verge of cardiac arrest, my fingernails were purple and I had impaired judgment, saw no reason not to drive myself to the hospital because I thought everyone was overreacting, but I did not pass out.

There are no meds that will raise your heart rate. And what you need isn't just a faster rate, you want your heart in sync so the ventricles beat when the atria does. The only thing that will do that is a pm.

Most of us with electrical problems have perfectly normal hearts otherwise. Our electrical system is messed up but the plumbing and architecture are fine. BP is unrelated also. What we have is an electrical disconnect, a short circuit. If no one has given you a good explanation, St Judes has some great animations that explain both block and how the pacer fixes it.
http://health.sjm.com/arrhythmia-answers/videos-and-animations

Under 60 is considered bradycardia, tho people often do fine with an average rate in the 50's. Once you get to the 40's, you really aren't even borderline anymore. Also, your rate probably isn't going up on exertion. Every time you do something physical and your body wants more oxygen, your atrial rate goes up normally but the ventricles still plod along at their own pace. This is hard on the body. The older we get, the more our bodies suffer for it, whether we have overt symptoms or not.

I'm not a dr, just someone who has been in your shoes and dealt with this for the last 40+ years. Don't put it off. It's easy to procrastinate, to tell ourselves we are fine. And we may well be, but we could be so much better! In my case, and I would be willing to bet it's the same for you, we deteriorate so gradually that we get used to compensating and have no idea how bad we really felt until suddenly we have a normal heart rate again. I was astounded at the difference it made in my life. I could feel a profound difference literally from the moment I woke up in recovery. Twenty years later, I'm still healthy and active and have never regretted it once.

mri compatible

by Tracey_E - 2015-09-19 01:09:49

mri compatible is nice, but there aren't many to choose from. If you go this route, ask what the maximum tracking rate is. One of them only goes up to 150, which means your heart rate will not go above 150, no matter what your atria is doing. This can keep you from exercising and being active. Most pm's go up to 180, there is one that goes to 220. And more and more places are able to safely do an mri on a standard pacer, so having the mri-compatible device is less important than it was a few years ago.

Other considerations

by Theknotguy - 2015-09-19 02:09:36

You are young. That's great. And your body can respond quickly. Some other thoughts about things the doctors may not notice or find immediately.

I passed out on the trail. They didn't get to me until after my heart rate was in the 20's and probably down for about 20 minutes. While I was in the hospital the doctors kept asking how I was responding. After I woke up they kept asking me the same questions over and over. Testing for possible brain damage.

After getting out of the hospital, they found out I had permanent damage to my right eye because of the lack of oxygen. My mental calendar and clock were gone. It took me months to get those two functions back. They told me in the hospital I would be diabetic when I got out because of what had happened and damage to my internal organs. I am now diabetic. No one else in my family is diabetic. So I have to attribute that to what happened.

Every time your heart rate goes down you receive less oxygen to your internal organs. You run the chance of doing damage that may not show up immediately. It may not show up for years.

While this is an "elective" procedure, I would suggest you seriously consider it. You have a long life ahead of you and with a pacemaker you have very good odds of having that long life.

I wish you the best results for the future.

Elective Surgery

by IAN MC - 2015-09-19 07:09:43

There are only 2 types of surgery :-

-- Emergency Surgery and
-- Elective Surgery

Just because elective surgery isn't done immediately does NOT mean that it is not necessary . Elective surgery can be life -saving as in the case of installing a pacemaker.

Elective surgery is done at an agreed date rather than emergency surgery which isn't !

Hip joint replacements, gall bladder removal , rupture repairs, removal of cancerous tumours, even kidney transplants in some parts of the world may all be done "electively ". If you have to make an appointment for any surgery then it is " elective ":

Best of luck

Ian

Elective procedures

by Pacemum - 2015-09-19 11:09:15

My understanding of an elective procedure is something that you choose to do to improve the quality of your life. It means that although you are not in an immediate danger your condition is affecting the quality of life and the procedure that you elect to undergo is one which should improve or bring benefits to the quality of your life.



Suggestion

by Good Dog - 2015-09-19 11:09:18

I am sure your doctors office has already checked, because they want to get paid. So they'll not likely proceed without the approval of the insurance company. However, insurance companies will sometimes balk at paying claims for elective procedures. If it is medically necessary there is no doubt that they will pay.
So just be sure!

trailerboats

by zawodniak2 - 2015-09-19 12:09:43

It sounds like your issue will not go away or improve without some help. My EP told me when I had a similar situation that I would need a PM as time went on.; so I went for the "Elective" procedure and had the PM put in before a serious emergency situation arose. My PM has kept my heart rate at 60 or above for 8 years now an I no longer get the symptoms we both have shared. I know, 25 is a young age, but look at it from a positive point of view, that you want to have very many quality years ahead of you. With heart rates as low as you are experiencing, you will continue to experience your symptoms. Be grateful you are in the "elective" situation rather than a dire situation which you should avoid. Personally, knowing what I have experienced and what I now know, I would advise you to go for it and I would demand getting an MRI compatible PM and leads.

Rodger

I'm young and I have a pacemaker

by gertrude - 2015-09-20 05:09:45

Hello! I'm just a bit older than you but still consider myself young. I just had my first pacemaker last month. I wasn't in complete heart block (Yet!) but had persistent symptomatic bradycardia and shared many of your symptoms. Dizziness, poor concentration, fatigue, near syncope... I kept telling myself I didn't need the device because I wasn't actually passing out. Don't wait until you get to that point. As someone else said, it's unpredictable and you could pass out behind the wheel of a vehicle and seriously injure yourself or someone else. I posted about my story and answered some long standing questions I had before my implant. Bottom line... I feel MUCH better and most of my symptoms have vanished.

Click on my name to visit my profile and find my post about my story.

Thank you :)

by trailerboats - 2015-09-22 01:09:19

Thank you for all your replies! I took to heart every single advise you guys gave. It is very much appreciated.

My pacemaker procedure got moved this week instead of next month. My parents got worried and decided it get inserted at at earlier time. I'm a bit nervous and excited at the same time!

You know you're wired when...

You forecast electrical storms better than the weather network.

Member Quotes

The pacer systems are really very reliable. The main problem is the incompetent programming of them. If yours is working well for you, get on with life and enjoy it. You probably are more at risk of problems with a valve job than the pacer.