New Pace Maker

Hi...I will be getting a new dual chamber pace maker Wednesday.  What changes should I expect immediately ?  Hopefully more energy, less shortness of breath??   My current heart rate  is 48 to 51 average... Holter showed range of 39 to 100..Am I expecting too much??


11 Comments

expectations

by Tracey_E - 2019-07-28 09:28:13

I don't think that's too much to expect! If the only thing causing your symptoms is a low heart rate,  you should notice improvement immediately because low heart rate is fixed the second they turn on the pacer. I could feel the difference as soon as I woke up, like flipping a switch. Some people bounce back from the surgery more quickly than others, pain meds and anesthesia can slow us down, it can take some time to get the settings fine tuned, so it may be a few weeks to a few months until you feel as good as you're going to get, but feeling the difference in heart rate is immediate.  

Rate setting

by Bill99 - 2019-07-28 10:59:11

Thanks Tracey, your information is very helpful.  If you don't mind my asking, what rate did they first set your PM at and if they had had to adjust it later where did it end up? Thanks

 

Pacemaker Expectations

by Marybird - 2019-07-28 14:22:33

I was also diagnosed with SSS- tachy-brady in my case, with the heart rate going into the 30's- 40s often, but not 100% of the time. I assumed the brady was caused by the metoprolol I took to control the atrial tachycardia, but over time they determined the drug just unmasked the bradycardia issues that were becoming worse over the last couple years when it became symptomatic. The drugs make the bradycardia worse, but without them the tachycardia goes out of control. 

I had doubts about whether I really needed a pacemaker, but things weren't getting any better, and I had a dual chamber St. Jude implanted on June 12 of this year. 

I noticed I felt better, with improvement in the light-headedness, mild shortness of breath and confusion the next day, and generally felt much better after I got over the effects of the surgery. The default settings were in place at that time with  a lower pacing limit of 60, upper limit of 130, and it was determined I was atrial pacing 83% of the time with the check they did in the EP's office the day after the surgery. Ventricular pacing was less than 1% but that was just where they wanted it.

When I went for the five week post-op pacer interrogation and visit with the EP,  they determined that I was atrial pacing at 84% but were surprised to see that the rate response (that's for increases in pacing rate due to sensed activity) was turned off. I'd wondered about that since I didn't see all that much of an increase in HR when I exercised, but I'm such a newbie at this I thought it must be me.

In any case, they turned on the rate response, and it really makes a difference, I feel even better. The EP also decreased the minimum pacing rate from 60 to 55, he said so I wouldn't pace unnecessarily to 60 while I was sleeping. We'll see how much that effects the pacing

percentage rate, kind of sounded as though the EP expects it will increase some with the rate response turned on. But in any case I'm finding it easier to exercise with the rate response on. 

There's an atrial tachycardia/a-fib moniter-alert feature on this pacemaker ( it's a St. Jude Assurity MRI pacer), and the EP lowered the threshold setting on that from 180 to 140 BPM, and lowered the upper pacing threshhold from 140 to 120. 

All this for somebody who figured I really didn't even need a pacemaker, and having one implanted would probably mean just a hunk of metal hanging out in my chest. 

Good luck with yours and I hope all goes well.

Mary

Thanks for the info

by Bill99 - 2019-07-28 14:34:25

Thank you so much Mary for the infomation.  This is all very new to me.  My cardiologist will not be doing the surgery so I have not even met the Dr. that will be doing this.  Therefore I have very little information to go on.  Did you have to stay in the hospital when you had yours installed?

 

settings

by Tracey_E - 2019-07-28 16:15:01

Why are you getting it? I have av block. Mine is set to a minimum of 60 but with av block that's irrelevant because my sinus node works normally, I just need the pacer to make sure the ventricles beat when the atria does. The pacer is playing follow the leader, not setting the pace. If you have sinus dysfunction, then your lower limit is more important. They usually start it at 60 unless there's a reason to have it higher. 

Most doctors keep us overnight. 

Valuable Information

by Bill99 - 2019-07-29 19:05:45

Thanks a million for  all of the terrific information.  You all have been very helpful. Kind of sounds like I will probably be staying overnight. Was hoping to avoid that but guess it really doesn't matter that much. You all take care and I will let you know how it goes Wednesday.  Tomorrow is  pre-op day.

 

how are you doing?

by Tracey_E - 2019-08-04 11:21:15

Checking in to see how it went! 

Doing well

by Bill99 - 2019-08-04 11:43:06

Hi Tracey, how very thoughtful for you to check on me.  It has been a very interesting experience but I think we are doing well.  I had  the first pace maker surgery  Wednesday morning.   and had he normal expected discomfort during the night and was anticipating going home the next day. but about 11:00 the next morning, they advised me that  the ventrical lead had dislodged and they were bringing in another surgeon to do a revision.  That afternoon They opened it all back up and did the revision so I went throuth the second  night of discomfort but this time I decided not to be superman and accepted the pain meds when they were offered and it made it much better.  Again anticipated going home the following day.  About 6 am they came back in and said it did not appear to be working correctly  and if the pacce maker rep  ageed, they would have to take everything out  and start from scratch.   Later that morning Boston Scientific confirmed that it was pacing ok on their side so after  more xrays, ekgs etc they decided it was ok.   the lead was a little shorther than they would have preferred but they think it has enough extra length to be ok.   So I am home Still kind of sore after  the extra proceedures.   They advised it is  very common to have to do a revision and not really a big deal.  My lesson learned is to take the pain medicine when it is available.  It makes the experience much more comfortable. Overall, I actually enjoyed all the excitement  and seeing new stuff.  And it is not often you have a whole staff of people treating you like a King. !!   For those having this coming up...do not dread it....just go with the flow, they keep you very comfortable and it is really an adventure !!! 

wow

by Tracey_E - 2019-08-04 12:21:36

Glad all is well now! Sometimes our anatomy makes it hard to get the leads just right or the heart wall gets cranky. It's great that your surgeon was quick to call in a second set of eyes.  Can you feel the difference with the higher rate? 

I hate taking any meds also, but it's a lot easier to stay on top of the pain then let it get bad and chase it. Ice is good for staying on top of the pain, also, that's mostly what I used after I got home.

Higher Rate

by Bill99 - 2019-08-04 12:30:24

Hi Tracey,   i m not really sure what I feel yet.  I also have emphysema and prior to the PM was having sharp pains in direct center of chest.  We never could really determine if it was from cardiac issues or pulmonary.  I still have that sensation but it seems like it pulses more, if that makes sense,  I have been being pretty lazy so really havent got over the 60 range it was set   They wanted me to take it easy until they determine if the lead is going to stay connected.  I go back Thursday.  Till then I guess I will take advantage of a good excuse to do nothing.

WOW Again

by Marybird - 2019-08-05 21:40:34

Bill99, sounds like you went through the wringer in getting that pacemaker, hopefully you are on the mend now and your pacemaker will tick along just fine from here on out.

It sounds as though people most often stay overnight at the hospital after a pacemaker implant-and that's if everything goes as planned and leads stay in place, no complications  and all that. I guess I was the exception to that, as I was able to go home the same day, although it was after 10PM when I left. I had the pacer put in around 1:30PM, was sent to a room for obervation for 6 hours, x-rays, labs, telimetry and some meds (including IV antibiotics), and after the doc reviewed everything and pronounced all well, I went home. 

The doc had me go to his office the next day to check on the wound, and do a device check at the pacer clinic to make sure all was well with the pacemaker-this in lieu of the wound check and interrogation of the pacemaker by the manufacturer rep prior to discharge from the hospital after an overnight stay. At this time the pacing clinic manager also explained the processes of remote monitoring they do for their patients with ICDs, pacers, and answered my questions. 

Hope things go well for you and your pacemaker and its associated parts stay put and do their jobs! You seem to have a great attitude about it all. You've earned some do nothing take it easy time, so enjoy it, and I'd probably have been taking those pain meds too in your shoes, especially after the second and third go rounds at getting the pacer implanted and staying put.  Good luck and hopefully good news Thursday.

Mary

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