Ventricular pacing while sleeping

Hey all!  I have had my pm since 12/19. Had some ups and downs during that time, mostly problems with shortness of breath and feeling exhaustion and palpitations when doing resistance work, especially when it is hot out... no heat tolerance at all... but the reason for my message.....I had a 24 hour holter a few weeks which showed that my ventricle was pacing during sleep where it had been only pacing at 0.4% in my prior interrogation. I am going for a sleep study but I had one done about 3 years ago and had no sleep apnea, just told not to sleep on my back...I do have excessive vivid dreams all night and don't seem to get much deep sleep...  So my md is concerned as to why this is only happening at night... have any of you had a similar issue and gotten any answers? 



by arentas80 - 2020-07-15 23:45:37

I just showed my fiancé this message as I JUST talked to her about this at lunch today. I noticed that a lot of my SOB and palpitations seem to happen around V-Pacing. The odd part is I'm not supposed to V-Pace much. I wake up with shortness of breath almost every night but it goes away as soon as I move around. I'm starting to think it's related to the PM and not a problem with my actual heart. I like you have VIVID WILD dreams nightly. I don't get much deep sleep either. However I have severe sleep apnea. I use my CPAP religiously every night and they say it's helping tremendously. I as of late cannot tolerate heat. I get prickly all over and my body sort of goes into a state of stress. It's like a lack of cardiac output. I'm thinking I need some more settings adjusted. It's so nice to read that someone else knows what I'm talking about. I don't have the answer for you but if I ever get it I'll be sure to let you know. If you find out please message me as well. I wish you nothing but the best. God bless you!


Ventricular pacing while sleeping

by Gemita - 2020-07-16 08:29:19

Hello Soulshine,

Firstly, may I ask what your current % of ventricular pacing is ?  I attach a link about pacemaker algorithms for minimising ventricular pacing in case this is of interest.

A sleep study gave my doctors a lot more information about what was happening during sleep which answered many of my questions.  The vivid dreams can be related to our medication, like beta blockers which can affect quality of sleep and cause all manner of sleep disorders, so ask your sleep consultant about helping with this with sleep aids like melatonin or maybe changing medication dosing times or switching to alternative meds.

I see you have several health conditions including hypothyroidism and resistant hypertension and the latter has been difficult to treat resulting in mild pulmonary hypertension and aortic regurgitation according to your history.  Hopefully these conditions are now controlled since both can be a leading cause for palpitations and other problems.

Yes maybe try to sleep on your side in case you do have sleep apnea because back sleeping makes it more likely for your tongue and soft tissues to obstruct your airway.  Look online for special pillows to keep you on your side or try the tennis ball trick stitched into your pyjamas to stop you rolling onto your back. Try raising the head of your bed also a few inches which might help you to breathe better at night and prevent breathlessness. 

I have mainly central sleep apnea.  From my sleep study + implant monitor, I was finding that ventricular pacing was occurring mostly during the night when I needed support with pacing as my heart rate naturally fell, triggering “palpitations”.  It was the Medtronic pacemaker “mode switching" (mode conversion) programme from pacing in the right atrium to pacing in the right ventricle which tended to cause problems for me.  My lower heart rate is now set at 70 bpm (from 60 bpm at night) and with this higher right atrial rate, my right ventricular pacing has almost been eliminated at night along with my palpitations so my sleep has greatly improved.

I am not with certainty able to answer why higher rate pacing is so helpful for me.  It certainly doesn’t help everyone and I even recall my doctor mentioning that “nocturnal atrial overdrive pacing”, if I have got that right, “could actually cause unnecessary right ventricle pacing in some individuals”.  My last pacemaker check though showed less than 1% ventricular pacing overall, down from 5%+ last year so this is reassuring.  

I think they can programme the AVD (Atrio Ventricular Delay) to prevent unnecessary right ventricle pacing but hopefully someone here can help to explain this because I cannot, although I did find a very good description about AVD on an old Pacemaker Club posting:   (AVD . . . ?) under general posting 2013-09-26 which might be worth a read.

All I can say is that I do not like being ventricular paced at all and feel most symptomatic when my pacemaker switches from pacing me in the right atrium to pacing me in the right ventricle.  Of course having palpitations (arrhythmias) can often trigger “mode switch” and having sleep apnea, hypertension and hypothyroidism are all going to be potential triggers for your palpitations which may require pacing in the ventricles to avoid tracking what is happening in the atria during fast arrhythmias.  Did your holter monitor detect any significant arrhythmias at night by chance?  My sleep study and implant monitor both confirmed significant arrhythmias during the night triggered by falling heart rates.

I do hope for the very best for you.



Ventricular pacing when sleeping

by Sisterwash65 - 2020-07-16 22:11:03

I read these comments with interest because 6 weeks in with my PM I have very few twinges and certainly no pain anywhere. I’m pacing 93% AV apex and only 6% Atrial and I can’t feel a thing. Should I feel something ? My blood pressure is good and my HR as well. All that being said, I am feeling great overall and I’m trying to be grateful for every day..However I admit I am very concerned about the high rate of pacing on the AV and trying not to stress over it since I have zero control ! I’ve been slowly getting getting back to my regular activities and going, doing and enjoying myself. Living in the south though means dealing with the heat and humidity this time of year. So I’ve had to get creative with some exercise routines - Happy to say I’ve had no problems there either. I won’t see my EP until January but in October my Medtronic Azure will send data to my clinic ( if I understand this correctly ) and a nurse there will let me know what it says. Hoping for good results then.

Feel something

by AgentX86 - 2020-07-17 00:12:02

What do you expect to feel?  V-pacing?  One shouldn't feel it as long as there is the pacemaker isn't pacing V-only.  In the case of heart block, all the pacemaker is doing is bypassing the AV node.  Since you're pacing 6% A-pacing, one would assume there is something slightly wonky there, too.  But perhaps not.  That 6% may be in special circumstances (e.g. RR on, fighting with the SI node).

BTW, I'm v-paced only 100% of the time.  I don't feel anything unusual but my PM isn't mode changing, either.


by Gemita - 2020-07-17 03:46:18

Since you feel so well with your pacemaker, try not to be over concerned and make yourself ill from the stress of thinking about the time you are paced in the right ventricle (RV).  You clearly need this support, while I do not.  Instead I am now almost 100% paced in the right atrium (albeit at 70 bpm!!) which suits me well. 

I would say as long as your EP looks after you properly and you continue to get echocardiograms to watch your ejection fraction and they watch for any adverse signs from high RV pacing and step in early to correct if need be, you should live your life and be happy.  Life is too short to worry about something that may never happen.  If on the other hand you do not feel safe with your present set up, then I would speak to your EP about this so that he is aware of your concerns and will do everything he can to protect you.  

By the way, feeling nothing is a very good sign !  It means everything is working close to what nature intended.  

Ventricular pacing when sleeping

by Sisterwash65 - 2020-07-17 16:09:40

What I was curious about is that some of the posts are saying they can “tell” when they are ventricular pacing, which I take to mean they feel a certain way.  I’ve not felt anything. I’m pretty sure that’s what the EP was aiming for. And I do have faith in my EP that he knows what he’s doing. So far, so good ! I just need to stop reading all these articles about the prevalence of HF with ventricular pacing ! Since the “ lockdown “ with the virus my usual activities have been curtailed and I’ve probably had too much screen time lately. 


Thanks for the input !

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