Mobitz II & PVC

I had a PM installed a little over a week ago to handle Mobitz Type II block. I find out afterwards I also am subject to PVC and PAC - I am told a PM does not deal with them. Now I think the missed/skipped beats may have been due to PVCs?

Yesterday I had an "episode" - feel light headed, about to faint (only happened once), the HR drops significantly when cycling, etc. I stop to recover and continue on.

Supposedly (according to the doctors) these episodes are caused by a Mobitz long pause between heart beats. I have records dating back 10 years of these episodes, average 4 to 6 a year, almost all (until recently) occurred while cycling.

The PM was installed to prevent these. I am very disappointed.

I called the PM tech (not in and left a message) and wondered if she could download recordings from my PM when the episode took place to see what was going on. Is it possible to do this?

6 Comments

2 Chamber PM

by BillH - 2016-02-21 01:02:21

For the Mobitz II your 2 chamber PM should "fix" it.

In Mobitz 2 the atria pulses as normal, but not all of them get through the ventricles, the main heart chambers.

If working normally the PM, and adjusted correctly, should detect this and fire the ventricles in synch with the atria.

One common mistake the is made that PM is not setup for active persons. The set the max tracking rate too low so that when HR rises with exercise that it thinks that the heart is beating too fast and will pulse the ventricle as a lower rate.

But it does not do anything for the PVC and PAC's.

A long string of PVC's can reduce the output of the heart so that might be the problem.

The PM does have record a lot of information. So keep after the tech.

Adjusting the PM and communications

by oldearthworm - 2016-02-21 01:02:44

I think the PM has to be adjusted ..and the patient should have been told about this ..Several adjustments may be necessary.
These episodes (fainting / near fainting) are very serious , IMO . I am not sure how well any PM can handle PVC/PAC ..
The question, I'd think that this is possible in todays computerized world , but, we do have other "concerns" ... fear and privacy ...

block vs pac/pvc

by Tracey_E - 2016-02-21 02:02:18

They are two totally different things, the pacer can only fix the block. Block is not skipped beats, is when the signal isn't getting from the atria to the ventricles so the atria is beating regularly but the ventricles aren't keeping up. It watches. When the atria beats but the ventricles don't, it kicks in with ventricular pacing so the heart stays in sync.

When we are in block (not paced), the ventricles beat at random rather than following the atria.

Pac's are premature atrial contractions, pvc's are premature ventricular contractions. Both are little half beats between the full beats. The pacer can't stop the heart from beating, all it can do is add extra beats when needed.

Tell them what you are feeling and when it happens. They can often tell what was going on by looking at the pacer's report from that time. it's not at all uncommon to need to tweak the settings to get them just right for us. We're each different with different needs, so they start with a good guess then fine tune as needed. Have a little patience. It takes some time for the heart to get used to being paced after a long time out of sync, it takes time for us to heal and adjust, and it takes time to get the settings fine tuned.

What may be happening when you cycle (and this is an easy fix) is your upper limit is too low. The pacer has an upper limit, often around 120-130 to start because that's adequate most patients. Your atrial rate is normal, so you cycled and your atrial rate went up as normal. However, the pacer will only pace the ventricles up to the upper limit. So let's say it's set at 130 but your atria kept going to 160. The ventricles maxed out at 130 so your heart rate didn't go higher and the heart was out of sync. That does not feel good! That's the first half of the problem.

After that, the pacer sees the atria going much faster than the upper limit and it has no idea you are on the bike so it thinks you are in afib. With afib, our rate can get too high, so the pacer jumps in to be helpful and keep you safe by putting you in an artificial 2:1 block, only pacing one ventricular beat to 2 atrial beats, so if you are at 160, it'll drop your pulse to 80. If you are working out, this can easily make you feel like you are going to pass out, btdt. This feature can be turned off if you have no history of afib. With me, they turned off the afib thing and raised my upper limit to 170, no more problems. Sometimes the plummet was all me, not the pacer thinking it's afib, so they turned on another feature that prevents sudden drops, kicks in with pacing if the rate drops too fast.

Sometimes we have things going on we don't know about, like my sudden drops, being in block masked the atrial issues. And the settings we start with are just a good guess, with active patients it's normal to need fine tuned. Call and tell them what happened, give them the date and time, should be an easy fix!

Most everyone has at least some pac's and pvc's, that's normal and they're harmless and if we didn't have a handy dandy pacer recording everything, we'd never even know about them. Hopefully once the other things get ironed out, you won't feel them as much.

Confused Tech

by BillH - 2016-02-22 01:02:31

"She also disabled the RR feature so my heart can now go as high as it needs to without the governor effect of the PM increasing the upper limit based on activity during cycling."

Rate response does not limit the max rate at which the heart can beat. Nor does it limit the max rate at which the PM can track (that i a different setting).

All the rate response feature does it generate a faster when the SA node (the hearts natural pacemaker) can keep up when active.

But if you only have Mobitz II then you don't need it.

Also in some PM there are some options that are not available with RR is on, and others that only work with RR.

So ask a lot of questions.

block vs pac/pvc

by zazen_1 - 2016-02-22 03:02:25

Thanks for the comments - supposed to go to the PM tech in the morning - hopefully for a data dump during the episode?

During my first visit three days ago the PM tech said all was good. She lowered the limit to 50 from 60 bpm since my resting pulse rate has been 50± for years. She also disabled the RR feature so my heart can now go as high as it needs to without the governor effect of the PM increasing the upper limit based on activity during cycling.

Also after 4+ hours of meditation (zazen) today I was aware of thumping missed heart beats (presumably PVCs) whenever my respiration rate was reduced as I tried to relax and focus on my practice. I learned for the most part these could be reduced or eliminated by ignoring them and focusing on my practice. It was though I could make them happen if I wanted to?

From what I read on Wikipedia regarding PVCs they can be alleviated by eliminating caffein and taking a magnesium supplement. Has anyone had success with any treatment for PVCs?

pacing checks

by Tracey_E - 2016-02-22 11:02:59

Yes, they will get all the data from the last check when they do a new check. When they say all is well, that means the pacer is functioning as expected, the leads are in good position and working. That doesn't necessarily mean the settings are right where they need to be. It sounds like your tech is on the ball and responsive so continue to tell her when things aren't right. This is a process.

Some are more sensitive to caffeine than others. It causes all sorts of problems for me, even hours after just one cup, so I avoid it. Cut it out, see if it helps.

\Magnesium can't hurt but the only evidence it works is anecdotal, not scientific research. Ask your doc before taking new supplements.

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