Pacer Adjustments at 1st Appointment

Howdy!

I just had a dual chamber pacemaker implanted on 10/5/15. All is feeling well. A bit of my background and then a question.

31yr old male with severe afib refractory to all meds. Ablation in 2009 and no problems at all with any SVT or afib. Had sudden syncopal episodes starting in 2014 and everything checked out (e.g. - tilt table, echo, angiography and anything else that could explain syncopal episodes). Loop recorder implanted last year, but was set to only start recording when rate dropped below 20bpm. Long story short, I manually activated the loop recorder after syncopal episodes and rate was in low 40s and was junctional. Also, some AV block, but reason for implant was diagnosis of symptomatic junctional bradycardia.

The rate was set at 60. I am wondering if this is the standard setting for a patient with a bradyarrhythmia? I know everyone's different. I have been paced several times since implant as far as I know because my pulse was exactly 60.

Is the point of the first visit to just interrogate the device or do they also increase or decrease pacer parameters? I have felt amazing and full of energy after procedure and am worried they are going to decrease settings to pace at 50bpm instead of 60. Anything particular I should expect at my post-op appointment? Questions I should be asking?

Cheers,
Douglas

4 Comments

60 BPM

by Artist - 2015-10-11 08:10:16

My PM is set at 60 BPM. That was my resting heart rate until I got older and developed Bradycardia and rhythm problems. It works very well for me. My 102 year old mother is on her 3rd PM and that has always been set at 60 BPM. I think it is a pretty standard setting and unless there are problems with low energy etc. that setting is usually used. I always fear that someone will mess with the settings that are working very well for me and during doctors appointments, need to remember to say that I don't want any setting changes unless they are first discussed with me. I agree with Donr, tell them to leave your settings alone!

Easy answer Douglas

by IAN MC - 2015-10-11 08:10:40

Tell them " I feel great. Don't change ANYTHING "

Cheers

Ian

settings

by Tracey_E - 2015-10-11 11:10:42

They will make some adjustments at the first check regardless because they always start it turned up higher than it needs to be. Once the leads settle into place and the heart gets used to being paced, they cut it back to the smallest amount of juice it takes to get the heart to beat. They may make some other small tweaks to make the battery last longer. However, as the others said, be sure to stress to them that you feel great so they don't mess with your limits or rate response. Glad to hear you are feeling good!

Bradycardia just means your heart rate was below 60 bpm, whatever the cause. Junctional means the ventricles were beating on their own rather than in response to the atria. By definition, this is the type of beats you'll get when you are in block because the signal isn't going from the atria to the ventricles, so the ventricles beat at random. You'll find that most of us have a combination of electrical problems, and each problem has more than one name. Go to ten doctors, you might just get ten different diagnoses written in your chart, but they basically all mean the same thing.

Thanks

by PacedProfessor - 2015-10-12 05:10:58

Thanks, folks. I will go in and make sure I am crystal clear about how I'm feeling and expect they may make some tweaks here and there, but that I can at least be very clear that what we're doing now is working. Thanks for the advice.

And thanks, Tracey, for the explanation on different wordings and diagnoses.

Cheers to a great week,
Douglas

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