Something new happening?

Hi, folks!  I've been a member here for quite a while, but not active.  Well, recent developments may bring me back on board.

I have a Boston Scientific Altrua S603, implanted after aortic valve replacement in Feb. 2011.  For the past 5 years I have told people "Unless I look in a mirror with my shirt off, I just don't know I have it."  Maybe not so any more. . .

I typically check my BP and heart rate early in the AM, before I am too active and before I take all of my morning meds.  Typically my BP is in the "high-normal" range around 145/90 (cardio is fine with that) and resting heart rate is around 80-82 bpm.  Starting this past Monday, I've noted that although my BP is around my normal range, my resting heart rate is now showing more like 45-50 bpm.  This is about where it was before my valve surgery and PM implant.  My cardio says I had undiagnosed bradycardis.  My PM is set for a "minimum" of 60 bpm.

 

I have used two different rate monitors - one is part of my wristband BP cuff, and the other is a Mio Alpha (uses infrared sensors to "see" blood flow in wrist veins).  Both agree that my heart rate is low.  When my rate is this low, I feel lousy - no strength, almost but not quite light-headed, just "not right."

Since I am not pacer-dependent, as soon as I get up and start moving, my heart rate goes back up to a normal range.  Of course, I do not know if my A-V delay is being managed by my pacer, or if it is relying on my native pacing, which we know to be a bit delayed and irregular.

 

I've moved up my mid-year interrogation to tomorrow morning, but does anyone have any idea of what I should listen for when talking with my favorite PM tech?  Any ideas what can cause this sort of behavior in a 5-year old pacer?  As of my last interrogation (5 months ago) I had 1.6 years of battery life remaining - right on track with all of the previous readings over the years.  Also, the adjustments and interrogations over the past 5 years have been uneventful - no issues, just normal tweaking to get performance where I needed it to be.

 

Any help will be appreciated.

SteveE

2 Comments

Don't know, but....

by Good Dog - 2016-06-16 16:18:13

I don't know what is going-on, but something doesn't sound quite right. First, a resting heart rate of 80-82 seems pretty darn high. Second, you need to take your pulse manually. You just can't always count on monitors no matter how accurate you think they are. 

I certainly can't explain why you don't feel "right" when you are at rest, but if it just started happening it could be an indication that something has changed (no shit, huh). In any case, I don't think it would be a problem with the battery, because it is designed to hold a steady rate when it is at elective replacement. I don't know if you have the activity monitor turned-on and/or when you had your last pacer check (in case your tech changed something). I gotta believe that if something is wrong an interrogation will reveal the problem. I would think that if you tell the tech exactly what you wrote here, you should get some answers. If not, I would ask to see the doc.

I wish you the best.................

 

David 

Well, we know something. . .

by SteveE - 2016-06-17 19:23:26

Thanks, David.  I saw the pacemaker clinic tech today, and even had the Boston Scientific field rep come take a look.  It appears that I was losing pacing intermittantly, and that it now takes higher voltage to pace my ventricle than it used to take.  We don't know if it is due to scar formation at the lead attachment in my heart or if the lead itself is failing.  What we do know is that I'm probably going to have to have the lead replaced sooner rather than later. 

The tech made some adjustments to the pacing voltage and things are OK for now, but I'm not at all sure if this is going to go downhill fast or hang where it is for a while.  I see my EP doc next Thursday for a conference, and will probably know more after that.  It is possible that if she feels the lead needs to be changed soon, she may opt to replace my generator soon, as it now has only about 1 year of battery life remaining, and they might want to do it all at once.

 

This is not really a high anxiety thing for me so far.  I know that my "escape rhythm" will keep me at a minimum of 45-50 bpm, and that I do not suffer syncope at that rate.  I just feel lousy.  Also, I have a few other medical things going on, and don't know which will need to take precedence.  I'll have to see all the docs and then make some plans.  For this one, the only part that disappoints me is that I'll have to follow the "new lead" discipline for some time after replacement.  Can anyone refresh my memory - how long before I can drive after a new lead is implanted?

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