Does a having a pacemaker damage the heart?

being paced

by Tracey_E - 2016-10-30 15:29:23

We are paced because our hearts weren't doing the job on their own.  It's extremely rare to reach a point where we don't need it, that would mean the reason we got it healing itself. There are almost no conditions that lead to a pacer that would get better naturally. Some eventually use it more with time. Did the heart deteriorate on its own or due to pacing? Who knows, but we need it just the same so it doesn't really matter. You can pace 1% or 100% or somewhere in the middle, you still need it.  You can go from 40% to 60%, you still need it. Does that makes sense? The pacer is there to do whatever we need, however often we need it. 

The heart is a muscle. After the leads are put in, it heals just like any other injured muscle. 

The signal the pacer puts out is very minimal, mimicking what our heart should have been doing on its own so it does not damage the heart. I know sometimes people get a mental image of the heart getting shocked with every beat but that's not the way it happens.  

The pacer is usually reactive, which means it gives the heart a fraction of a second to work on its own before stepping in with pacing. If you are having odd beats, ask about it. Tell them when it happens so they can check the pacing reports, possibly tweak the settings. Sometimes that helps. Sometimes we are simply more aware of our heart beat after getting a pacer so it's not really doing anything it didn't do before, we just didn't notice it before because we didn't have a reason to pay attention. Sometimes our hearts deteriorate, which would have happened with or without the pacer. 

Fact is, we need it. They try to minimize how much we use it and the impact it has on our heart, but the benefits far outweight any potential negative. 

pacing

by christy99 - 2016-10-30 17:55:34

Last year at my checkup I was told I was only using my pacemaker 12% as my battery was running low I asked if I could have the pacemaker removed instead of having a new one put in. It was decided to turn it down to 30bpm from 50bpm to see how I got on, this was carried out and I left the clinic feeling fine, however by the time I got to the car park I started to feel unwell, a bit light headed but decided I was imagining it and carried on home. Once home I still didn't feel to good but tried to ignore it, to cut a long story short 3 days later my heart started racing 140bpm I ended up in A&E  drugs were used to try and bring my rate down but no success, they were talking about electric shock treatment when the pacemaker technician came in hooked me up to the machine and tried to reset my pacemaker back to 50bpm  luckily for me on the third attempt I was back in sinus rhythm 50bpm.....I was told my heart had gone into shock after having my pacemaker turned down so even though I was only using it 12% of the time it seems my heart still needs it because it is used to it now.

TraceyE

by DampDog - 2016-10-31 06:41:55

Thanks for taking the time to reply.

I understand that for the majority of recipients, the support and function that the ICD is intended to perform is essential and intended to be the “best-fix” to improve heart function for many years.

I am simply curious as to whether the procedure itself actually causes damage. If damaged heart muscle did not affect the way heart functions we wouldn’t have 1000’s of folk being implanted each year. The heart may well be a muscle but even small areas of damage can be catastrophic, depending where in the heart that area is, when its internal conduction pathways are damaged. The way the heart heals and how the scars form has an effect on how efficiently it pumps and even on whether its efficiency will continue to diminish years from now.

I simply wondered if screwing an electrode into a patch of cells within an already failing sinus-node actually causes more damage? It may be that the correct functioning of the device masks the damage for most of us. As you say the benefits outweigh the risks. Likewise I think most of us go through a phase in our recovery where we are more aware of our own heart beats to begin with.

As I think I’ve mentioned the additional ectopics I’ve been feeling have been averaging 80-100 an hour. (as measured by the device) Now I didn’t get them prior to having the device, I’ve had numerous ambulatory 48h tapes. Of course it could be my heart as deteriorated and they were going to manifest anyway. But seems odd they started within days of having the device implanted.

I'm 6 months in and thought I would have reached a point where I feel "At-one" with my device. Unfortunately that day has not arrived yet, maybe it will, maybe it won't.

damage

by Tracey_E - 2016-10-31 10:03:05

The sinus node isn't one spot, it's more like a network, so no, putting in the lead won't damage it further. Over time, scar tissue can build up around the leads. It doesn't usually cause problems, tho if it were to, it would be more structural than electrical and generally only becomes an issue if the leads have to come out. Even then, it's rare that it's a problem. 

Ectopics are by definition little extra beats the heart does on its own so theoretically the pacer can't cause them, but I can see why the timing is suspicious on yours! Sometimes the heart gets agitated from the surgery so it can take a few months to settle down. I assume they have tweaked the settings? Sometimes they can adjust the timing to make them less noticeable. 

settings

by DampDog - 2016-10-31 10:23:11

Up to yet I have only really had one face-to-face device interrogation. (1 outside the hospital ward) They supplied me with a remote monitor so the last one was done remotely. Prior to that, I had one done in hospital and one as an outpatient.

If I’m honest it was too early in the process for me to know what the devices are capable of, or what questions to ask. As far as I know the only ‘changes’ made following implant were to disable an Opti-Vol, alarm. Other than that, my only real question has been “am I getting more odd beats” and the answer was “Yes.” At worst I was getting up to 100 additional beats an hour. At that point they swapped me from Ramipril to Entresto in the hope that may help, however other than dropping my blood pressure (90/60) it has not really helped.

I guess I’m just a little frustrated at the moment. I didn’t expect on feeling better, but didn’t bargain on getting new symptoms.

settings

by Tracey_E - 2016-10-31 13:30:59

New symptoms was not part of the deal, you are entitled to be frustrated! 

The home monitor only reports, they can't change settings remotely. After 4-6 weeks, they will usually make some changes. They start it off with the pacer equivalent of factory standards. The voltage will be on the high side until the leads settle in and the heart gets used to pacing. At the first check a few weeks later, they'll turn it down to the minimum necessary to get the heart to beat and they'll make some other tweaks to meet your needs while trying to conserve battery life. If you are at all active, it will take more than this one attempt to get it right. No two of us are alike and they like to do it in small increments, so if you are still not feeling well, don't be shy about asking to be seen again.

New meds can take a minimum of 4-6 weeks to be fully effective. Extra beats are generally not helped with meds, tho it's always worth a try. 

6 months is early days.

by DampDog - 2016-10-31 15:06:02

I guess time will tell, the bridge has been crossed now so it’s about learning to live with it and adjusting to things.  Home monitoring has its advantages; I imagine it must save hundreds of hours’ worth of clinic time. Granted they can’t make any adjustments but if anything were to go badly wrong it should give them a heads up. I do wish they would talk to you a little more about the various setting, while I appreciate much of what they are capable of may go way above my head. It would be nice to learn a little more about some of the settings and configurations.  In the UK we tend to have our adjustments made by pacing technicians working with the consultants.

I am becoming more active so that may well change things, hopefully for the better. Some are chatty, others, not so much.

home monitor

by Tracey_E - 2016-10-31 16:57:24

I didn't have one with my first 4, but they gave me one when I got #5 earlier this year. I'll admit I hated it at first, didn't want the reminder in my face every morning that my heart is a mess, felt like an invasion of privacy. I wrapped it in a towel and put it under the bed, out of sight, out of mind. I've used the button on it twice now, once saved a trip to the office, the other time made the trip to the ER a lot faster. I'm a convert now. 

I see a tech from SJM at my doctor's office.  They don't usually talk much, but when they know we are interested, many of them will open up and explain things. I like to know how things work! That's a big part of acceptance for me, if I have a good understanding what's going on then I can deal with it.  

Fifth?!!!

by DampDog - 2016-11-01 07:24:20

Fifth device! How many years have you needed a device, if you don’t mind me asking? Bizarrely I have my Medtronic Care-Link on a table by the bed but also cover it with a small towel so it doesn’t remind me how broken I am… LOL.  Also because it has a small LED on the side, that is quite bright in a darkened bedroom.

One thing that I am guilty of is not taking a list of questions I intend to ask with me. Last time I wrote the list but forgot to pick it up as I left the house. It is so annoying walking down the corridor post-appointment, only to realise you still have questions in your head that never got asked.

100 events per hour?

by donr - 2016-11-01 10:19:55

At the average HR while moderately active, the heart beats roughly 80X80 =6400 times in an  hour.  100 events per hour is about 1 every 64 beats, on average.  Usually an ectopic beat is a Premature Ventricular Contraction (PVC) & can really catch your attention.  Way back when - about 10 yrs ago, I started having them & fealt every single one of them.  It took several months to better than a year of listening to my Cardio tell me that they would not kill me & to stop worrying about them.  I have now gone for years w/o sensing them when they occur as singles.  I still sense them when they occur as "runs," but the run has to be 5 or 6 in a row.

Donr

yes five :)

by Tracey_E - 2016-11-01 10:30:53

I'm congenital, got my first one at age 27. I'm 50 now. I had a lead go bad which drained the battery so one of them only lasted a little over two years. 

They told me the box would work as long as it was within 10' of me. Under the bed is less than 10'. I don't hate it anymore, but it's still not allowed out from under the bed! lol

I've left my list at home also! 

I'm impressed

by DampDog - 2016-11-01 13:55:02

I’ve not done the maths, one reason being it occupies more of my thoughts than I’m comfortable with anyway, but off the top of my head I’d say 3-4 erroneous beats each minute and likewise the odd little run of a few in a row. It also waxes and wanes of its own accord. The past couple of weeks it’s much more settled, the beats feel less vigorous and less frequent. I have noticed they become worse when I’m tired or stressed. Also following exercise when I was quiet they would drive me crazy, but again that does appeared to have eased. I’ll count my blessing for the moment and hope they continue to subside.

“I'm congenital, got my first one at age 27. I'm 50 now. I had a lead go bad which drained the battery so one of them only lasted a little over two years.”

Wow, that’s pretty impressive length of time!! All the people I've actually met since having my device have had their devices for a relatively short period of time; months to a few years. Have the devices improved over the years? Are they smaller now, or last longer? 

old timers

by Tracey_E - 2016-11-01 16:28:32

We have quite a few members here who have been paced as long as me, a handful 30 or more years.  Kinda cool, I spent most of my life being the only one I knew like me but thanks to the internet we are able to find each other. 

My first one was a little bigger than my current one but not by much. Leads are smaller now and connect in a way that's easier on the heart, screw vs hook. They told me up to 10 years battery life in the past, but I've never had one last more than 7. Supposedly this new one will be good for 10-12 years, but I'll believe it when I see it lol. I don't really care, replacements are really easy and I feel great so whatever it takes.

As for improvements, most of the technological advances have been in rate response, which I didn't use until recently. This last one is the first that's felt different to me. The other 4 were all the same from my pov. I have av block so sometimes I used to get my atrial rate higher than the pacer could pace the ventricles (180) when I worked out so I was on beta blockers to keep my rate down under the pacer's limit. This new one goes to 220 so I was able to get off the meds, and now my rate goes higher so my stamina is a lot better. Yay, technology! 

Do CIEDs “damage” the heart; PVCs

by Hoosier Daddy - 2017-11-23 07:18:58

Yes, the initial anchoring of the leads can result in a temporary rise in serum troponin levels but it is clinically irrelevant. Consider that when one receives an intramuscular (as opposed to a subcutaneous) injection, your muscle is “damaged” and a brief rise in serum CK level can be measured, but likewise this is entirely clinically irrelevant.

Have your PVCs settled down? The phenomenon of transmural dispersion of repolarization (TDR) has been used to explain the very rarely seen occurrence of LV lead induced VT/VF, but even in the very small number of patients in whom this is seen, it almost always either manifests within 72 hours of implant or it does not happen at all. I suppose PVCs could be explained by altered TDR as well, but I imagine it would similarly be a temporary phenomenon.

By the way, RA leads are not (intentionally) anchored in the SA node. They are typically placed in the RA appendage (RAA), although there is a debate among EPs about whether this practice is suboptimal compared to simply anchoring the atrial lead into the body of the RA. Remember, the RA lead has to be able to sense as well as to pace, programming depending. There are also the matters of patients who’ve previously had open heart surgery (bypass cannula are often placed in the RAA) and the time and technical effort required to map where the SA node is.

Next, ‘does being paced damage the heart’s own electrical system’ ? No. Not the electrical or conduction system. However, more and more data are supporting that the mechanics - the muscle - of the heart can truly be negatively impacted by some kinds of artificial electrical activation (i.e., pacing). Long term pacing of the RV, especially with the typical RV apical lead, is well known (albeit rarely) to cause atrial fibrillation and heart failure. How ironic for patients like you and me who have CRT devices specifically to TREAT heart failure. 

Additionally, “unnecessary” RA pacing is associated with right atrial dysrhythmias, reduced LEFT atrial filling times and atrial dyssynchrony, both of which can reduce cardiac output, and a reduction in battery life. 

But (1) I have been very active with my EP docs to exploit my device’s algorithms to reduce RV pacing to next to nothing, and (2) these theoretical pacing “side effects” have to be weighed against the consequences of not being paced. I don’t know about you, but for me that would mean a 100% likelihood of my CHF symptoms worsening.

By the way, it’s Thanksgiving over here in “The Colonies” today. Do you celebrate any such similar holiday across the pond?

Thanks. Happy ThanksGiving.

by DampDog - 2017-11-23 13:19:18

Thanks for the interesting and in-depth reply, it’s a tad over a year ago since posted my initial question and things have been up and down for myself.  The past 18 months or so since I had the implant have been somewhat varied.  The ectopic beats that I thought I was getting have been evident when I have had my device interrogated. On two occasions I had been averaging in excess of 100+ extra beats an hour but with no “runs” of beats as such. Then at my last but one interrogation my device had logged 4 runs of VT in the region of 220+bpm, with the longest lasting 8 seconds or so. My device had actually gone into something I think he called “pre-charge” and was getting ready to deliver a shock. Fortunately my device had terminated the rhythm with therapeutic pacing.

I had been feeling generally worn out and exhausted for a couple of weeks prior to being seen but I had only felt one run of beats, not the 4 or so that had been logged. Upshot is they made some adjustments to my device that slightly delays my device delivering a shock, and also the number of cycles of therapeutic pacing it delivers before it delivers a shock.

I was seen by a consultant on the day (not my usual chap) and they mentioned changing my medication. It wasn’t until I went to collect it that it was Amiodarone. After a couple of weeks!!! Sitting thinking about whether it was really a path I wanted to go down I decided that it was not a drug I really wanted take. All drugs have side effects, some we learn to live with, but from what little I read Amiodarone appears worse than most with some damaging and irreversible effects. My view right or wrong, is what is the point in damaging other parts of my body, for the sake of a possible benefit to my heart?

Anyway long story-short, I’ve now seen my own consultant who has referred me to an Electrophysiologist, with a view to seeing if I’m a suitable candidate for ablation therapy. That will be shortly after Xmas.

Odd thing is after being dogged by ectopics and runs of VT, the last 3 months or so I feel like they are 95% better! So go figure????

Again thanks for the post, it was an interesting read. You are obviously way more knowledgeable than myself.  

We don’t do “Thanksgiving” as such over here in the UK. Though we do now have the “Black-Friday” sales though I don’t think most people know it is the first Friday following Thanksgiving. Anyway I hope you enjoy the holiday…