Still having symptoms

I've had my PM for almost a year to treat bradycardia.  At my 3-month check-up, they adjusted my pacer to a slightly higher threshold for day time because I still felt syncope symptoms coming on (dejavu feeling, tingling in arms, nausea).  My doctor suggested putting me on beta-blockers as well, depsite the fact that the drug slows heart rates - this made me nervous so I declined and decided to see how the PM adjustment would go.  Well, I'm still having symptoms, even waking up at night with them.  I have a call out to my doctor now but was wondering if anyone has/is going through the same thing?



by Tracey_E - 2020-09-02 11:42:29

Yes a beta blocker can slow your heart rate, but you have the pacer to make sure it doesn't get too slow. The meds can't overrule the pacer so your heart won't get too slow regardless of any meds you are on.

Could the symptoms be coming from blood pressure rather than heart rate?

May I ask why your doctor suggested a beta blocker ?

by Gemita - 2020-09-02 13:17:07

Hello Nicole,

Not sure why your doctor suggested putting you on a beta blocker unless you have a problem with a high heart rate or high blood pressure or, perhaps, you have an arrhythmia that your doctor wants to try to treat ?  Do you feel better during the day now that your heart rate has been increased ?

I also suffered from bradycardia prior to my pacemaker.  A minimum set heart rate of 70 bpm works for me fine and I am no longer prone to getting dizziness, pre syncope/syncope spells.   You could ask what your heart rate is set at and whether a higher rate might help prevent your continuing symptoms.  

I would also ask whether your pacemaker is detecting any arrhythmias which might be causing your symptoms because clearly it is not normal to keep coming over faint.  

Also as Tracey_E suggests, if your blood pressure is unstable (either too high or too low) this can cause similar symptoms.  A pacemaker unfortunately cannot prevent our blood pressure from falling as it does for heart rate.  I would go back to your doctors and ask what is going on and whether you could have some external monitoring carried out to get to the bottom of your problems.

I hope for the very best


by Persephone - 2020-09-02 20:31:07

Hi Nicole - to share my experience, which may or may not be reflective of yours - I was also feeling the nausea and other symptoms you describe after 1 year of pacemaker implant for bradycardia.  I had decided to wait it out and try to be patient to see if things improved.  I'm confident that I was told that the "rate response" on my device was set to "on" during my first check, so I believed that to be true for that first 1-year period. The good folks here on this site offered advise about questions to ask in the first check, and the rate response question was a prominent one.

My symptoms mostly occurred during exertion, so I finally requested a stress test and my cardiologist was very accommodating.  I went into what the clinician described as "tachy-brady" on the treadmill, which I believe was occuring because the pacemaker determined that my higher heart rate - which I actually needed to walk on the incline of the treadmill - was too high, so it made a correction to lower the rate, which feels like hitting a wall.  Based on the tachy-brady observation, the cardiologist and clinician immediately wanted to prescribe a beta blocker.  I pushed back, and asked about the rate response setting (which is called Closed Loop Simulation or CLS for my Biotronik device).  The Biotronik technician was also present and stated that CLS was not set to on.  It was agreed to have it turned on, and I was given a holter monitor to record what happened next.  All was well with the monitoring and has been well in the 1+ years since I had the setting adjusted. 

Since I had been diagnosed with heart block, I'm guessing that the clinic decided early on to turn off the CLS setting since atrial pacing is not typically called for to treat heart block. Or maybe it was never on and the clinician just said rate response is a feature of device. There are many posts on this site about rate response settings that are very helpful and can be found by using the search function.

Again, the experience described here may not be applicable to your situation, but if you are feeling exercise intolerance, there may be a possibility that setting adjustments could help.  Best wishes to you.

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