Studies: Single vs Dual pacing - New PM implant and Subsequent adjustments

Hi – First time posting.  I had my PM implanted on 9/1/16. I am being paced in the Atrium only, although my PM is capable of dual pacing.  I am an active runner, running 4 - 8 miles every other day.  I had the implant to correct missing heart beats and breathlessness (and some light headedness) which came on fairly suddenly.  This first became evident when climbing stairs, then to a lesser degree in less stressful circumstances.  The problem was more annoying that life threating. The PM corrected the missing beats right off.  However I was stilling feeling short of breath when climbing stairs.

At my one week check, my Dr. turned on the Rate Response feature.  We also discussed dual pacing.  I thought this might be a solution to my problem.  The Dr. stated that the European studies show that dual pacing can have a long term effect on the heart.  The Rate Response feature seems to have generally solved the breathlessness problem.  I say generally because I still feel out of sorts at times, but I seem to be moving more towards 100% every day.

I wonder if others would like to comment on how either the heart seems to be adjusting to the PM or how the brain is doing the adjustment and helping me cope?  Also does anyone know of studies that discuss single vs dual pacing risks?  I have seen a few studies which I have interpreted as saying that dual pacing may be better, contrary to what my Dr. stated.

3 Comments

Dual Pacing

by Good Dog - 2016-09-18 17:31:07

I can speak from 30 years experience. I have had a dual lead PM implanted in January 1987. I was paced primarily in the Atrium while in my late 30's and through my 40's. Very little ventricle pacing until I got older. As I got older my ventricle was paced a greater percentage of the time. In my later 60's now my ventricle is being paced about 75% to 85% of the time. Early-on when I was maxing-out my pulse the PM wasn't even necessary. The PM functioned primarily to keep my pulse above 50 bpm when not active and also paced my ventricle to keep my heart in sync during these times. Pacing the ventricle really helped as I got older during times of greater activity. I could not have worked-out to the max as I aged without my ventricle being paced. So I would say that the answer to pace the ventricle or not is really based upon how you feel when exercising. If your heart isn't beating in sync during exercise you'll really need to have your ventricle paced so that you feel good enough to push yourself. Also, the activity monitor may also be necessary if your HR doesn't pickup sufficiently on its own.

The only down-side to ventricular pacing that I am aware of is that as we age, the more our ventricle is paced, the greater chance we have of developing heart failure. It isn't a huge risk, but nevertheless, it is a risk. I have kept my minimum rate down around 50 and have not had my activity monitor turned-on for that very reason. Of course, that is only possible, because I feel fine and don't "need" my activity monitor turned-on. The PM tech has said on many occasions that she would turn it on for me, but I have refused. I asked my Doc and he said that if I don't feel that I need it, then I am doing the right thing by leaving it off. 

I may not have been too helpful here, but that has been my experience.

Sincerely,

David

Rate response and activity monitor

by jimterribak - 2016-09-19 00:16:01

3 months from PM implant and still researching and learning.   I have a dual lead for pauses causing almost fainting.   So far it's doing its job but have had problems with feeling pacing.  Have made a few adjustments that have helped with what I think is nerve stimulation causing hard spasms or jerks in my diaphragm.   Learning to live with the uncomfortable pacing feelings that seem to come with PVC's that my cardiologist says are not dangerous.  Please explain to me what rate response and activity monitor is that the above posters referred to.   I will also ask my EP how that applies to me or not.   Thanks.

Activity monitor

by Good Dog - 2016-09-19 20:07:11

I think that the rate response and activity monitor are the same thing. Just different names (I think, I didn't use the term rate response). The activity monitor simply monitors your activity and adjusts your heart rate accordingly. It is used when you heart rate doesn't increase as it should during times of significant activity such as working-out or running. It usually requires some initial adjustments to optimize the settings.

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