Pulse rate over time

Depends on what's going on in your heart

by crustyg - 2020-04-20 18:23:24

I don't think one can necessarily generalise, as it depends on what disease process caused you to need a PM.

I'm still classed as an endurance athlete (sounds great, but I'm no iron-man): a couple of years ago my resting HR was about 48bpm, at the time of my PM it was about 45bpm, last Dec my resting HR was about 43bpm and when I had my PM switched off at the end of March for an MRI (yes, I know, not the smartest choice that the PM tech and I could have made - could still walk around and lie down for 30min and then stand up and walk out of the imaging suite) it was around 30bpm - too slow for their pulseox.

In my case my SA node has failed completely, so without pacing I depend on a junctional initiation, and clearly that's still going down.  It seems likely that I will eventually become PM dependent, we'll have to see.

For athletic types with SA node damage and chronotropic incompetence, it seems likely that there's a fibrosis process going on, and this type of process can sometimes be progressive (as it can in the liver and lungs).

If you have a cardiomyopathy that's affected your resting HR that may well progress.

*BUT* for you it may be different.  The EP techs check this at every interrogation session (usual warning something like 'this may make you feel a little dizzy - my lot always insist on me being seated which makes good sense) and then they stop the PM pacing and see what rate is achieved unaided.

If your question is really 'Will I die if my PM stops working' then you'll know at your next interrogation.  Actually, patients who suddenly acquire complete heart block (usually a large anterior infarct), which can often produce a vent rate of 20-30bpm, can survive some hours lying down until someone can insert a temporary pacing wire, with (in the olden days) isoprenaline IV until the HR is driven up by the external, temporary PM.  There are lots of folk here who are absolutely, totally dependent on their PMs to stay alive - and much more so the ICD folk.  AFAIK almost all of them just get on with living their lives as the worry is almost entirely theoretical (PM failure).

HTH.

impossible to predict

by Tracey_E - 2020-04-20 20:58:27

My rate was 44 most of my life, didn't go up or down. It tanked and was low 20's the day I had emergency surgery to get the pacer. Since then, when we've tested it's been anywhere from 20 to 60, no rhyme or reason to it.  One thing I can tell you, in 26 years of being 100% paced, the pacer has never once stopped pacing except those few times we turned it off on purpose for a few seconds. They are extremely dependable computers, way more dependable than our wonky hearts.

When we have it replaced, if we have a low underlying rate they'll use a temporary pacer to keep us going as needed while they switch it out to the new one. 

crusty

by Tracey_E - 2020-04-20 21:10:12

Smiling at your comment about surviving several hours lying down with a rate 20-30. The day my rate tanked, my fingernails turned purple and I thought it was funny. My cardiologist returned a call about scheduling some tests (to get the pacer) while I was in the grocery store. When I mentioned the purple nails, he said forget the tests, get to the hospital NOW. So I finished my grocery shopping, took the stuff home and put it away, packed a book and my toothbrush, drove myself to the hospital. It was like being drunk, never once crossed my mind I was in any danger or that driving might not have been smart. I have one seriously kick a$$ guardian angel. Once admitted, oddly enough they wouldn't let me get out of bed again until surgery. 

Thanks for sharing

by crustyg - 2020-04-21 03:43:52

Thanks for sharing Tracey.  Your experience made *me* smile - I only ever saw old patients with ischaemic heart disease with serious bradycardia, and many of our surgical patients had various malignancies, so often looked terrible immediately post-op.  I recall my astonishment when I saw my nurse GF sitting up in bed the next day after major abdominal surgery looking fit and well.  Suddenly I realised why surgery could be interesting and rewarding.

Spending 30min in the MRI with a HR of about 29bpm was perfectly fine, but when I chatted to the EP tech afterwards as he was restoring my usual settings we quickly agreed that it would have been a *lot* smarter to have just set me to 50bpm (normal LRL for me) and have done with it.  Walking around the suite etc. was just idiotic macho posturing on my part. It would also have saved them having to use an amazing non-metallic (mostly) MRI-safe portable ECG monitor while I was in the machine.  Not so much Iron-Man as iron-head. Doh!

Hindsight!  A wonderful gift.  But we didn't know...

It may differ

by saniarehman - 2020-04-21 08:45:25

Your pulse rate may be disturbed but it will not be around like you have Between 31 to 44. I was also facing the same problem especially when I had to constantly work, as I am an owner of powerpoint presentation agency so, I have to look after each and everything. That was the time when my pacemaker had also stop working and the pulse rate was disturbed.  

My experience

by Buzbuz9 - 2020-04-21 15:01:04

So I can't say anything about the technical stuff and I'm sure everyone's condition is very different on this website but for me having a pacemaker actually improved my underlying rhythm.

I have had a pacemaker since I was 7 months old and as a kid my underlying rhythm was about 20 bpm.  I have a dual wire pacemaker system and when I was in kindergarten I broke my atrial wire effectively stopping my pacemaker from working. I don't remember much but apparently it knocked me out, and I woke up with a bloody nose in the nurses office after someone found me lying unconscious on the floor.

At first my parents didn't know what was going on and we waited a full day before they figured out that it was my pacemaker. By that time my condition  was very severe I could not hold down any food or even water because my organs started to shut down.  I couldn't keep my eyes open for more than a few minutes at a time. 

 They got me into emergency surgery and I was fine and recovered quickly and there's no lasting issues from that. And the only reason my wire got broken was because I was a kid and I had grown a lot since my last pacemaker change(when i was 2), so don't worry wire break are rare.  Over the next 20 years of my life up to now my cardiologist always measures my underlying  rhythm and as of my last appointment my underlying rhythm has improved from the 20s up to 34. So it could help. But this is just what happened to me and by no means what will happen to you we have very different pacemaker journeys.

But the community is here for you :)

-Abi

Improvement

by AgentX86 - 2020-04-21 19:17:09

Interesting Buz.  Do you have CHB?  That is, is your rate the junctional escape rate rather than the atrial rate?  It would make some sense that the junctional rate would change but it's not good to rely in it (AV dyssynchrony at such a low rate isn't good).  It's not much of a change, either.  Not enough to trade in your PM for a good used car, anyway.  ;-)

After nine years

by Gotrhythm - 2020-04-22 16:54:22

Early on in my pacemaker journey, I had the same questions--like you, not because I was paricularly worried, but because I like to think about "what if" questions.

I don't know about your situation but here's what I concluded. Initially, I was only paced 34% in the atrium and less than 2% in the ventricle. To me that meant 66% of my heartbeats were instigated by my heart's sinus node. So even if my pacemaker did quit, I likely wouldn't keel over dead. I would feel terrible, i.e. like I felt before pacemaker. But there would be plenty of time to get help.

I would get help that is, if I had the mental accuity to realize I was in trouble. Before my pacemaker when my heartrate was dipping into the low 30's and pausing, my fingernails didn't turn purple, but I did drive myself 4 1/2 hours at 80 MPH (leagally) to the beach just two weeks before I got the pacemaker...and maveled that the trip was so easy.  I mean, it felt like I got in the car, and the next thing I remember, I was there! It didn't occur to me there was something wrong with that picture.

Nine years later, the pacemaker is chugging away and has never failed. The same cannot be said of my heart. Very gradually over the years I was paced more and more. I am now paced 100% in the atrium and am termed "pacemaker dependent." meaning, that the sinus doesn't function atl all and when tested, my heart no "escape" rhythm.

So while I can't speak for you, I can tell you, although I had no "vascular heart disease" in the beginning and still don't, the pacemaker didn't keep my "pulse" from getting worse. I can also tell you that at no point ever has my pacemaker failed, nor after 9 years does it even occur to me that it might.

Turns out, that in my experience--how I feel day to to--there is no difference between being paced 34% and 100%.