Is it my Heart or my Watch.

I had a checkup of CRT-P with EP two weeks ago.  My Echo in May was great and all seemed promising, but I was not feeling as great as I was earlier.  I had complained to GP a few times on phone (no face to face since January) that I was getting SOB and tired again.  So two weeks ago I finally got to see EP for a once cancelled scheduled visit.  Find out that my left ventricle lead is not doing anything, had moved.  After a lot of testing they found the best positioned vector left and turned up the voltage to get me back on track.  That is all good I guess - I do wonder what if it moves again, I already lost one vector the day after implant.  Does that mean I only have 2 left?

Anyway, that is not my concern today.  I have a Samsung watch that I don't trust 100% but over last couple of years it has been pretty consistent showing change in heart rate when I am feeling changes.  I am set at 60 bpm for resting rate and watch has always shown 60, once in a while a 58 or 59.  In the last two weeks, since interrogation, my watch is showing lower numbers regularly.  I haven't felt it but at end of day, the lows for day have shown in low 50's, high 40's, one day 42.  Today it is saying my average resting rate (I put watch on 5 hours ago) is 55.  The highs have been consistent with activities. 
I am waiting for results from Holter from last week, see if it says anything.  
If this is actually happening, what do you suppose could cause it.  If they had forgot to put me back to 60 after testing I think my numbers would be a lot lower.

Thank you,

Chapter 🌹

 


7 Comments

Vector

by AgentX86 - 2020-11-02 17:09:32

Are you confusing "leads" with "vectors"?  A CRT has three leads (wires from the pacemaker to the heart), each of which can have more than one "vector" (AIUI, implant site within the heart).  This is so it's possible to select the optimum site (vector) to increase the probablility that CRT pacing will return the LVEF to normal and reduce the need to reposition the leads.  Apparently, in your case, one of these sites failed so they switched to another. There is no reason to assume another will fail, though anything's possible.

Never, ever, trust a watch.  They all can lie.  I also have a Samsung (Galaxy) watch.  Though it's a really nice watch, I don't trust its pulse rate numbers at all.  If you really need to know this (and you shouldn't be constantly checking it), count it manually.  The carotid or femoral arteries give the best results.

If the manual count is low, also feel for "weak" or "skipped" beats.  If you do take the pulse in the wrist, they'll probably feel like skipped beats.  In the neck or groin you'll feel every beat but some will be weak.  This indicates that you're having PVCs (Premature Ventrical Contractions).  These usually aren't dangerous unless something like 1/3 of the total beats are PVCs but can feel awful (BTDT).  These are common with new pacemaker recipients.  When this is happening and you count a low pulse rate, try sending a remote transmission.  Your EP team will be able to identify PVCs immediately and determine what to do (likely nothing). If there is another issue, they'll be able to see that too.  Count first.

 

Vectors

by Chapter - 2020-11-02 17:48:27

No, I am not confusing leads with vectors.  The left ventricle lead has 4 vectors on it, but if the lead moves, which has apparently done twice now, then it loses contact and arrhythmia starts up again.  

I have had palpitations and PVC's for years, right up to 3 years ago when I got my Pacemaker because of complete heart block.  If I had got a CRT right from start probably would be doing fine, but ended up getting worse and now have CRT and on a pile of meds - but I am alive, so that is all good.  

Vectors

by AgentX86 - 2020-11-02 19:00:18

I don't understand how a lead moves.  It can pull out but once implanted how does it move?  A vector can pull out and another can be used to take its place but move?  Educate us. I've never heard of such a thing.

Yes, they don't typically use CRTs until the LVEF gets down to 30-35%, even though a pacemaker can be the cause.

If you're familliar with PVCs (and other arrhythmias) and can rule them out, I don't know what could be causing your lower heart rate, unless your leads are completely detached.  As I said, I'd do a remote when it happens.  That's how I found the PVCs.  Never had them before. AFib and Afluttter but not PVCs.

Left Ventricle Lead

by Chapter - 2020-11-03 00:43:12

AgentX86 this is explanation I was given before receiving new Pacemaker last year, and follow up online explains it with the big words. The lead for left ventricle is inside the coronary sinus vein, it is floating, is not attached like the right side leads. At the end of lead are the four vectors (I imagine them as four dots along the last bit of the lead) reasoning is that with four there is a better chance of capture even if it is moving.

 

Watch

by ROBO Pop - 2020-11-03 00:50:29

 

I remember when My left ventricular lead pulled out of position 10 days after implant, I knew it instantly, I felt like crap. Sadly in my case none of the four contact rings (you refer to as vectors vectors) were in position to be used effectively and they had to reposition the lead surgically. That lead is actually placed inside an artery on the back of your heart ( left ventricle) and held in place by spring tension so no surprise they move. That's the lead everybody refers to as the third lead. I like to think of it as the 3rd finger cause it seems to flip me off a lot. Anyway...there's actually something like 14 programmable configurations to optimize programming, so you have some leeway still.

No idea why your watch might have suddenly started reporting pacing rates lower than your set heart rate. Could be the watch but with the lead issue I'd bet on it being a pacing problem. Make sure to bring it up with your EP and insist they give you some answers

It is your heart not your Watch

by Gemita - 2020-11-03 05:04:35

Hello Chapter,

Such an interesting thread.  I had no idea about the third lead and how it was fixed.  I thought it would be exactly the same as per the other leads.  

Your watch cannot be responsible for giving you all those symptoms !  Your heart is obviously jumping around and your Watch monitoring is unable to keep up.  I firmly believe ectopic beats or other rhythm disturbances are responsible and these are being caused by a loss of synchrony caused by pacing problems and/or other health conditions.  I note you are on many meds.  Have they tested your electrolytes for any imbalances ?  The latter frequently causes ectopics/rhythm disturbances for both hubby and me.

I can suffer from ectopics both atrial and ventricular and when they are happening together and for long periods I certainly know about it and my heart rate can surge and fall without noticeable control.  This seems to breach my lower heart rate settings at times (from my manual pulse counting) and this is something that needs addressing.  Even if this is not possible, the prolonged ectopic rhythm disturbances can be so unpredictable and cause major symptoms like poor blood flow, sudden drop in temperature and blood pressure (at least for me).  My feeling is that your rhythm disturbances are being caused by pacing difficulties and/or an underlying health condition that may need better control.  I note from another thread you have Lupus.   I would ask for a medication review and blood check, including electrolytes at the same time as getting any pacing adjustments.  I hope you feel better very soon

dont trust the watch

by dwelch - 2020-11-06 15:21:43

I woudlnt trust the watch.

when you use the watch to count to one minute and count the beats yourself (no shortcuts one full minute) with your finger on wrist or neck, what do you get?  If you already answered this then forgive the question please.  

I have a pulse ox one that uses light to look at the blood through the finger not electrical signals in the body, I trust that one.  But for the last few decades look at a stopwatch or second hand for a minute and count.

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