pacemaker replacement

No reason to be nervous

by CyborgMike - 2020-06-05 14:47:28

The heart is an amazing organ. It seems like it is all muscle and just a big pump, but it has built into it four intrinsic (internal) pacers. If you cut a live heart out it would keep beating on its own for a while, since the signals are coming from within the heart (sorry for the gory example). 

The "top" pacer is the SA Node (the second S (sino/sinus) in SSS). It has the full range and keeps everything going at 50-180 bpm. But, if the SA node isn't working there is a back-up called the AV node. The AV node will pace the heart if the SA node doesn't fire, but it isn't as good. It only fires around 50-100 bpm. You also have internal pacing in each ventricle as a back-up to the back-up and they only fire at around 40 bpm.

So, if you (like I) have SSS and are pacing 100% of the time it means your SA node is shot. If you turn off your pacemaker your AV node and/or ventricles will still pace, albeit slower. So, it is likely fine if you turn off your pacemaker while at rest, but it would be a real shock to the system to turn it off while exercising. My HR drops to about 45 when I turn mine off, hence the reason it paces at nearly 100%.

In other cases, where someone is 100% dependent for SA pacing and V-pacing (top and bottom) the docs can still provide external pacing when replacing the pacemaker. 

No reason to be nervous.

And they don't just change the batteries

by LondonAndy - 2020-06-05 15:55:11

In case not aware, they replace the whole device.

I am 100% dependent too, owing to surgical complication when they fitted a mechanical aoritc valve.  As this complication is a small-but-known risk, they automatically give patients an external pacemaker when they do the surgery.  So in my case I went from just an external to just an internal, so I as CyborgMike says: you will be temporarily paced by the external one.  It's all completely routine to the surgeons - as I started to wake up towards the end of my surgery, I heard the surgeon and the anaesthatist chatting about a business idea!  

Dependent

by AgentX86 - 2020-06-05 23:43:51

Yeah, I'm dependent too, and have been since I got it (AV/His ablation).  The difference is that I have no AV node or bundle of His.  I also have SSS but that's no longer an issue since I'm paced VVIR.  Because I have no AV node or bundle of His, I also have no junctional rhythm and also no other detecteble ectopics.  If my pacemaker goes out I may be royally screwed.  Fortunately, it's exceedingly rare that they go bad without warning. 

As Andy says above, they'll put you on an external pacemaker for the duration of the surgery, until they're certain that the new device is working properly.

I was chatting/joking with the EP implanting the PM all during the surgery (as my EP was manipulating the catheters in my groin).  They do loads of these things and it's not a big deal in 99.9% of the cases.  I'm sure you'll be in good hands.

ask the doc

by dwelch - 2020-06-07 01:36:47

First and foremost, this isnt their first pacer replacement, you are not breaking new ground, they are not going to make it as risky as possible and fiddle about.   They know what they are doing they have procedures and experience at replacements for the various conditions.

Second, just ask.  This will not be the first time the doc has answered this, a good percentage of the folks once told "dependent" or "100%" have the same concern and question.  The doc will hopefully walk you through the procedure, we do this, we do that.

Note not all EP's are surgeons.  Mine isnt, my EP takes care of the pacer, the practice has a surgeon that takes care of putting in and taking out pacers and leads.  I like it that way but have also had other docs that were both.  It is more of a case of find a doc you trust and trust the doc you find.  

Its not your job to worry about the surgery, its your job to just show up and lay down, they take care of the rest.  Not your job to pick the device nor brand.  Find a doc you trust, trust the doc you find.  Putting you at risk benefits them in no way.  They arent going to gamble.  Usually if not always AFAIK there is also a person from the pacemaker company with a box of goodies, your new device plus leads and other stuff, plus experience.  Your surgeon is not flying solo.

In my case on the last one, since I was out of it when the surgeon showed up two devices ago.  We had a meeting/appointment and i got to meet him and ask questions (even though this was my fifth one, we were switching to a three lead and there were concerns about space on the one side).  I got my questions answered, got to meet him face to face, felt good about the whole situation.

Just call the office and ask the question they may have the nurse answer, since it is not an uncommon question, but either way they will have an answer, you are not the first dependent patient and you are not the first dependent patient to ask.

My second icd

by SheilaG57 - 2020-06-09 00:08:41

On my second icd now. I think mine has a year and a half left. I just read a big article about how it paces you. As needed. 
You'll get a complete new device when that ones about finished. 

Timing to change batteries

by Tony Stark - 2020-06-14 16:07:09

I will be ready for a battery/pacemaker change in 1.5 years. When do the insurance (including ssi) allow for surgery. 6 months battery life remaing?  3 months?, can anyone shed light on this for me. I live in Manila Philippines since I had ICD implanted and will travel home to U.S. for procedure. B.T.W The cost here to have my unit read and reviewed at Makati medical Ctr.: ..... $37.50   Xeralto here: $.38   yes: cents.