Feel "Some" pacing and not others

I have had a new ICD implanted about 12months ago.  When l had a checkup, they told me the device is pacing me about 16% of the time which l believe is due to my heart rate being quite slow of a night given the medications l am on to forcefully slow my heart rate.  If my heart goes at <=50bpm, it will pace me to keep me at a minimum of 50bpm.

With that said, i DO NOT feel this pacing.


Now, occasionally, l do fee some pacing, it is like a slight tens machine under my left breast tissue.  This I most definitely CAN feel.. I have asked specialist, ICD clinic etc and they tell me some people do and some do not feel the pacing.


Again, the regular pacing ll DO NOT feel at all.  If l have the ICD checkup doctors inflict pacing up to around 90bpm, l do feel a little light-headed when they do this test but certainly do NOT feel and flicking in or under my left breast.


I had an arythmia a few months back and l assume the device tried to pace me out of the arhythmia, l felt the pacing in the form of the flicking sensation on my LHD breast.  It sone this for about 30second or so on and off the WHAM!!! off went the defib with a huge shoch, luckily it got to me before l went uncontions and shocked me out of the arhythmia.


My question is... Why do l not feel some or meost all pacing but do "sometimes" feel the flicking typ epacing.


Are there two different types of pacing?  I have seen something around CRT (Cardiac Resynchronization Therapy) and was thinking that maybe l do not feel the standard pacing but l DO feel the CRT pacing.


If anyone can enlighten me on this as no one has been able to give me any information that may help.


I am very on edge after the last ICD SHOCK as l did feel the twitching/pacing just before it went off and am trying to distinguish if there is something odd going on here or are there two types of pacing one of which goes by transparently and the other l can feel (possibly CRT)?


I hope all of this makes sense but l am wanting to know what is possibly going on as now, whenever l do feel the pacing twitching me, l panic and think that is a precursor to the device being about to Shock me with a defib shock (they hurt).


Thanks all and look forward to a possibly simple explanation to what may be happening.




symptomatic pacing

by Gemita - 2020-08-16 10:02:23

Everything you say makes perfect sense to me.  I can only try to answer your question from a patient perspective BIGDAD555 with some experience dealing with arrhythmias.  

You clearly say that you do not feel your pacing or TENS machine sensation on the whole except when you are aware of having an arrhythmia.  This might indicate that when you are out of normal sinus rhythm and your ICD is trying to flip you back into normal rhythm, pace you out of a dangerous arrhythmia or stop a high heart rate, you will be more likely to feel this type of pacing and be more “symptomatic” than if you were being paced by your own natural pacemaker.

Before I get an arrhythmia I often feel a strong warning sensation, vibration, whatever you want to call it in my mid central chest/diaphragm area.  It feels as though the pacing is coming momentarily from my stomach/diaphragm (which it could well be) and then I feel the arrhythmia kick in.  I do not have an ICD nor CRT pacing, but a dual chamber pacemaker (lead to right atrium/lead to right ventricle).  I certainly feel the difference between when my heart is pacing naturally in the right upper chamber (right atrium) during normal sinus rhythm and when my pacemaker switches to pacing in the right lower chamber (right ventricle) during an arrhythmia.  Perhaps this is what you are feeling and like me, it affects you and causes symptoms ?

Sometimes when we lose synchrony (let us call it harmony) between the upper and lower chambers it can cause adverse symptoms.  It certainly does for me.  Likewise if the left and right ventricles are not in harmony we may also get worsening symptoms.  Some of us however are not so sensitive and may not experience any symptoms at all.

I see you have an ICD.  Do you have three leads, one to right atrium, where your natural pacemaker is located, and one to each ventricle ?   Could it be that you do not feel symptoms when your heart’s natural pacemaker in the right atrium is gently pacing you, but as soon as you start pacing in the ventricles, you feel the difference?  Maybe this explains your symptoms.  What to do about it is another matter.  Are you having any treatment for your arrhythmias apart from pacing and ICD support when needed ?  If we can get our arrhythmias under better control, we may have less symptomatic pacing but that it not always easy or possible depending on our particular health problem.  It is certainly worth speaking to your doctors about though and to let them know just how symptomatic you are during your arrhythmias and your understandable concern not to receive another shock in the near future.




Diaphragm pacing?

by AgentX86 - 2020-08-16 18:19:23

It's possible that your leads are occaisionally moving in contact with your diaphragm.  It's not unheard of to have some leakage from the leads and have it "pace" the diaphragm.  It's exactly what a TENS unit does, except to an internal muscle.  From what we've been told here, it's often intermittend and not pleasant.

Time for a test

by Gotrhythm - 2020-08-17 16:25:57

I am 100% paced in the atrium which I don't feel at all. Never did, even when I was being paced less.

I also have intermittant heartblock and am paced around 16% in the ventricle. And whoa! do I feel it, when the artrium is paced. It feels like the granddaddy of all PVCs. Like I've been kicked in the heart--from the inside.

Your anxiety lest the feeling be a harbinger of being shocked is completely understandable.But here's the thing. We can speculate all day about what might be causing the sensation you have but the only way to know is to talk to your doctor. It may be that a Holter monitor or similar test is in order. You press the button everytime you feel the "tens unit feeling." And the monitor tells you doctor exactly what your heart (and ICD) were doing at the time.

Thank you

by BigDad555 - 2020-08-17 21:01:04

Thanks for all your help guys, always good to know l am not alone.  Yes, it really does seem that there are TWO types of pacing l am experience, one which goes by completely unknown and the others l do feel, while nothing like the defib going off but a twitch to say the least.  I guess now l understand what l am feeling and can certainly feel it as a precursor should it try and pace me out of anything "Before" the big one.

You know you're wired when...

You fondly named your implanted buddy.

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