Feeling pacing

Is it possible to go from feeling pacing to not feeling pacing? I ask because I have intermittent heart block and my settings were set to allow my own heart to work as much as it can. 7'months Ago I started feeling thumping and chest pain off and on all day. Which caused me to have an achy chest. Pacing? It would come and go. Some weeks nothing and some weeks all the time. My EP thinks my ventricle lead is in a bad spot and needs to be moved. At first my doctor made my settings looser to limit pacing. His thought was, if it paces less, you will feel less pacing and better overall. It made it worse. So we changed it back. By December, it was coming on more frequently. In January, I had had enough and asked to have my settings tighter. Felt great for 6 days. Didn't feel pacing much at all. The thumping went away. Great. Didn't realize how crappy I felt. Then it came back. So we adjusted settings 2 more times. Now I can't feel pacing at all. My pacing increased from 40-78%. I feel like a new person. I use to always feel pacing and now I don't. Even with activities I know I should feel pacing, I don't. My doctor won't give me a straight answer if it's a lead issue still or we are just covering it up by pacing me more. He had advised against making any more AV delay adjustments to "fix" this issue and was only offering surgery. He's been flexible with me in the past with coming in for adjustments went I wanted. So I kept going in. I have intermittent 2;1 rate related block. So higher rates I go into block. But I seem to be blocking at rates lower than 70.  
 

Is it possible to cover up a lead issue by pacing more? If it's a bad no settings changed will work He's told me since the beginning I shouldn't feel pacing which I have since implant but this is different. I just want to know but he's convinced it's a lead issue. I'm thinking my settings were too loose. If you understand Av delays. I was at 80-280ms for a long time when this started. Now I'm at 100-200ms and I feel great. 
 

Hope someone can help. It's been bothering me since my pacing has gone up so much. 
 

T


3 Comments

Hope this helps

by Gemita - 2020-02-22 10:32:05

You ask if it is possible to cover up a lead issue by pacing more?  I am not a pacemaker technician Pacedmyruns, but I would imagine if a lead was not placed in the optimum position, the signals would be weaker and therefore your doctors may need to turn up the power/increase the sensitivity and pace more to keep your symptoms under control.  Of course with increased pacing, the battery will drain more quickly.  

If your EP has had to increase your pacing because of poor lead positioning, then the only solution would seem to be to reposition the lead which obviously wouldn’t be so straightforward.  It sounds to me as though the picture is far from clear and that you are not altogether satisfied or reassured with the explanations coming from your clinic.  Have you considered getting a second opinion and a new perspective on all this ??

As to your questions.  Is it possible to go from feeling paced to not feeling paced ?   Well I would say yes, when my heart is beating in rhythm and regularly at the set rate of 70 bpm, I do not feel paced at all, but when my heart slips out of normal sinus rhythm into one of my arrhythmias and either goes soaring to high heart rates (or a feeling that it is dropping to lower than the 70 bpm minimum heart rate) I can certainly feel my pacemaker kicking in, if that is what you mean ?  My pacemaker was implanted for syncope, bradycardia and pausing.  Do you have any arrhythmias?  They can certainly cause thumping and chest pain off and on all day (and a good deal else like breathlessness, fatigue and instability).  I would ask for some additional monitoring to try to capture what is happening or ask your clinic to interrogate your downloads more frequently, or you could do an instant download when you are most symptomatic.

it is important that we try to keep right ventricular pacing to a minimum.  For some unfortunate patients, pacing in the right ventricle alone (or to a higher degree) may lead to heart failure symptoms because of dyssynchrony between the right and left ventricle.  This might then require an additional lead to the left ventricle to support heart function.  I have a dual chamber (right atrium to right ventricle) and my pacing is almost totally in the right atrium, with perhaps a maximum around 6% in the right ventricle.  During an arrhythmia,  “mode switching” occurs and stops tracking my tachy arrhythmias in the atrium and paces my right ventricle instead.  However, I do not like being paced in the ventricle at all and  cannot wait for normal sinus rhythm to return and mode switch to switch back to pacing the right atrium

Thank you Gemita

by Pacedmyruns - 2020-02-25 01:29:50

Hi. Thank you for all that info. I don't have any arrhythmia's. I have just intermittent 2;1 block with exercise that has seemed to progress. My settings were originally set to pace intermittently and allow my own heart to work. Then 7 mos ago I started having blocking at lower rates. After making adjustments, I pace more and feel nothing. Went from being miserable at 40% paced to 80% feeling very minimal. My doc wants to move the lead but I think I just wasn't pacing on time. So I'm curious if you can pace more with someone that was uncomfortable with pacing at one point 

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by Pop - 2020-02-25 04:51:28

Sorry to hear you are having problems, I too are having same problems, keep being told this is normal,  eight weeks implant (November 20917) I had consumed seven and half years of battery power. keep getting heart pauses, chest pains, dizzy spels and out of breath. Keep being told I have lead displacment, then no Idont have lead displacment. Now written to head Cardilogist asking for a honest answre. Alan (UK)

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