First Pacemaker Checkup

Pre-post info: I had a Dual Chamber Medtronic pacemaker implanted for CCHB 3 weeks ago.

Hi all, I'm 3 weeks post op and feel almost completely recovered. I have my first consultation since implant on the 2nd of January and I was just wondering what sort of things happen in this consultation? Is it as simple as checking the leads haven't dislodged and what percentage you're pacing at and sending you on your way? Also how do they check that the leads are working correctly as I've been reading some stories that lead dislodgment can go un-noticed, is this completely false? Any suggestions as to what sort of questions should i ask in this appointment?

Thanks a lot.


Mostly boring electrophysiology stuff

by crustyg - 2019-12-17 12:03:24

Hi Tommy:

Glad it's going so well for you now.  First check-up is mostly about checking lead function, making sure that the PM has a good electrical connection to your heart muscle and that it's not having to use too much battery power to stimulate the heart muscle to contract.  They will be checking to make sure that your PM says it has 7-15years before it needs to be replaced.

Lead being dislodged: should be impossible to miss, if they look at the intial settings from the day of implantation and compare with now.  Even if a lead has moved and made contact with a new area of heart muscle, the impedance and sensitivity should have changed enough to make them wonder and order a CXR.  This is your anxiety coming through again!  I empathise - I've been there too with pocket pain that I thought was from my heart.  Doh!

This is the time to start negotiating for the sort of PM settings that will allow you to live your life to the full - your chosen exercises etc., and still sleep at night.  You should be asking about the maximum tracking rate that your box will allow (detecting SA impulses and conveying them down to your ventricles), reminding them about the sort of lifestyle that you lead etc.

Take a USB memory stick (thumb drive) with you and ask to have *ALL* of your PM reports copied on to it.  Then when you want to ask questions you'll have good data with which to begin.


by dwelch - 2019-12-21 12:18:35

I have CCHB as some others here do as well.  First pacer at 19, I am 32 years into this now.  You will be like myself and Tracey_E and some others with CCHB (or other conditions) with a lifetime of pacers.

Whether it really has an impact for those of us starting young they like to try to do extra tweaking on the settings, just a wee bit less juice and this pacer may last a wee bit longer and you have a wee bit fewer pacers. (you cant tune the settings to gain 10+ years worth of saved time, just silly) but no need to bother telling them that, most of them know this as well.

First checkup is as mentioned above, is it in place, working, incision looks good, healing.  Some settings tweaks in case it is way off.  The few month checkup ideally the leads have formed scar tissue their resistance is settling in and they can make longer term adjustments on the settings. 

From there on out yes it is just a quick-ish test of each lead, and they will likely turn off the device to see that your underlying rythm is still there.  If they showed you what heart block looks like before the pacer, this is what will be on the chart, the A and V pulses will not be lined up in anyway, running to their own rythm, fighting each other more than working together. 

Being so new to this you are not used to the pacer yet, but as time passes, even by the few month checkup and likely by the one the year after that when they do each test you will feel it it is perfectly fine.  one feels like someone is sitting on your chest another they crank you up and you are racing, need to breath harder, etc.  good techs will warn you others wont, resist the desire to punch or kick them, "hey, how about a warning before you do that",  it wont help you in the long run.  

Always ask for your copy of the report.  You have the whole rest of your life to study your heart condition, pacemakers and what they do and these settings.  But it is your data you should have a copy of it, and with that data you can ask questions here or go look things up if that is the kind of person you are, etc.

Ignore the battery life estimate, until the units on that estimate say weeks, dont bother, it is wrong and sometimes VERY wrong, like years wrong.  So ignore it.  ignore it...ignore it...even if they read it to you, you have 7.5 years left thats good...ignore it, ignore it.

Its like buying cars, every so often you get a new or new to you one, every so often it is pacemaker time and you get another, days to a month of discomfort, and same old same old for a number of years.

if you stay in the same place you will very likely retire your doctor if not a few, your lifetime with pacers is like two whole careers of a professional.  You will be the youngest paitent in the waiting room and often the doctors youngest patient, even 30 years from now.

Not to worry about these things, but instead, understand it aint no thing.  The checkups aint no thing, these boxes you take home save from having checkups more often and save from having the phone box at home which also was no big deal a few minute phone call every so many months depending on the doctors office/insurance.  I still have one or two of my old ones as they didnt want them back.

This thing will be like a belly button or big toe you know you have it but forget its there until you stub it then you remember, then you go back to forgetting it was there.

Take your pulse if you are concerned.  A full minute no cheating. If the A lead dislodged then how would it know to drive the V lead likewise force your lower rate so if your rate is below your setting (you know your setting from being told and/or from the printout), call them.  If the a lead is working but the v lead isnt then the heavy beat you feel in your pulse is the ventricles yes?  they would be doing their own thing and may not be at the minimum.  I believe they would have known by now if there was an issue.  As mentioned above you should be able to feel it if it turned off, the sitting on your chest test is the turn off the pacer test, you would feel that, you would feel it being strange. You can call them at any time, talk to a nurse, see if you can get an appointment if they feel it is warannted.  They might put you on a 24 hour holter to record stuff, and then from that see if they see anything strange. 

This is all perfectly normal, and part of the transition into your newer and better life.






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Pacemakers are very reliable devices.