Feel block

Just curious if anyone had had the same experience as me. I'm 40 and have second degree heart block type 1. I would basically start dropping beats around 99bpm and would land on 2:1 block pretty quickly. I got a Medtronic PM Jan 2, 2020 and I can now exercise more due to the higher rate. For some reason I can feel when my heart goes into block still. my symptoms which I describe as my heart just not feeling like it's pumping in sync like a loss of pressure or maybe like I'm having a half palpitation every heart beat. I also get just slightly winded during this feeling. This feeling happens the moment I would have gone into 2:1 block prior to my PM. On good days the feeling only lasts till I'm paced up to around 110bpm and then I'm good until I get back down to 99bpm and start feeling it again. I had a 24 hour heart monitor and he said I was switching from intrinsic regular heart rate to a sensed atrial ventricle paced rhythm when I would feel the feeling. I'm going in next Tuesday to talk to my EP again about this. They tried changing my sensed AV delay from 150ms to 120ms and maybe that made a slight improvement Im not sure, but certainly didn't make the feeling go away when I got around 99bpm. My adaptive AV delay is set to start at 80bpm and end at 130bpm and the minimum is  av delay 110ms. They have never touched that adaptive adaptive AV delay setting and it might be a default setting. I don't know if maybe they would set the adaptive AV delay to start around 70bpm and make the minimum something like 90ms if that would help the PM take over sooner so I wouldn't feel it or if I'm just feeling pacing in general and I should just get over it and this is how life is now. 

does anyone else notice when they switch from their own normal heart rate to a paced heart rate? Usually it's just atrial sense and ventricle pace unless I'm sleeping my low rate is 50bpm. My max tracking rate is 150bpm and I reach that quickly when running so I hope he increases that. My heart starts skipping when I hit 150bpm, which is by design)

I sure welcome any advise. 



Not at all likely it's a heart block

by AgentX86 - 2020-02-27 08:25:31

These are classical symptoms of  PVCs. You "heart rate" feels lower than it is because the PVC (premature ventricular contraction) doesn't allow complete filling of the ventricle before the ventricle contracts. This is felt as a skipped beat, however your PM sees the electrical signal to the ventricle and starts its timer over. The result is that your perceived heart rate is reduced by the ratio of PVCs to normal heart beats. Since the ventricles aren't completely filling during this short beat, it does reduce the oxygen to the body and if there are enough of the PVCs, you may feel lightheaded.

The reason I believe that there is a 99% chance (but remember, we're not doctors) that the cause of your symptoms are PVCs is because when your heart rate increases,  the PVCs go away. What's happening is that your PM is now beating faster than the PVCs and suppresses them.

My "Lessons Leaned" about PVC's (never befor 3rd degree heart block, almost never any more)

by MartyP - 2020-02-27 12:28:50

3rd Degree Heart Block, May 23, 2017 - PM (Sparky) in and working !!  But about PVC's

PVC’s - Premature Ventricular Contractions - wow, no one told me about these. For me they felt like my heart was pounding and if I check my pulse it feels like a skipped beat, but it’s actually a PVC. I remember “Tom” saying that he had them for ten years and his doctor said “they won’t kill you”, but for a newbie they are uncomfortable and scary. For me, before I knew what they were, I thought something was very wrong and at 1:00 AM my wife took me to the emergency room - 5 hours later, nothing found. ------ So the lesson learned … Either before or after your PM, talk to your doctor and ask lots of questions about what you could / should expect and what you may feel … your heart won’t stop, but it will be different”.  What I think I found a little later on, at least for me, when I’m not doing much and my heart rate gets into the high 50’s or low 60’s; again my lower rate is set to 55) I tend to get more PVC’s sometime 2 a minutes - they are scary until you know what they are. I do take Magnesium with Taurate (I get it from Amazon) and I think it keeps the PVC’s in check for me. 

Caffeine - I used to drink “Black Magic” coffee and caffeine diet soda, PVC’s here they come. ------ So lesson learned, some drinks and maybe some foods (high sodium and high sugar content foods) will have to go, do some testing to figure out what may give you trouble and cross them off your list. More recently I’ve started to add back some caffeinated coffee, but they do tend to kick off one or 2 PVC’s. 

Stress and PVC’s - for me it’s like oil and vinegar, they don’t mix. One morning was particularly stressful, nothing special just rushing to get a few things done before I had to go out. The PVC’s started right in and lasted on and off for a few hours. ------- So lesson learned - try hard to reduce stress as much as you can, but if your heart starts to pound at least you know what may have caused it.

You shouldn't feel your heart being paced.

by Graham M - 2020-02-27 20:23:33

You shouldn't feel your heart being paced, as your PM will only pace ventricular beats that don't occur within a given time of an atrial beat.

I have been getting what I now know to be PVC's since before my PM implantation and still have them occasionally.  They feel like a skipped beat followed by an extra strong one that gives a thumping feeling in the chest. They are distressing, but, hopefully, harmless.

I have a Type 2 AV block so was also getting missed beats, but the pacemaker has taken care of those.

As always, if you have any concerns, you should talk to your cardiologist.

I hope this makes sense.


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