Intermittent heart block

Hi! I got a pacemaker for exercise induced 2;1 high grade 2nd degree block. I use to mainly pace if my heart rate went over 100bpm. If I was under 100bpm, I wouldn't pace much. Mostly my own heart working. About a year ago, I started having heart block 2;1 outside of exercise. It would start at a heart rate of 80 then 70 then 60  Now all day. So now I pace 100%. Went from pacing 40% to 100% since implant. Which was almost 2.5 years ago. Is this normal for block to go from intermittent to persistent? I'm now have CHB when they check my underlying rhythm at PM checks. I'm just shocked it progressed this fast. I know they don't get better but worse. I just didn't expect it this fast. Anyone else go from barely pacing to 100%? Did the pacemaker make my heart weaker pacing? Does pacing make it weaker relying on it so much? Any insight would be appreciated. 



by Tracey_E - 2020-11-08 07:31:51

That's pretty much normal, and why it was smart to get the pacer when you when they did. As the block gets worse, the pacer is there for you making sure your heart stays in sync. 

Pacing does not make the heart weaker. The pacer is reactive with heart block, it's not setting the pace. It watches the atria every time it beats and gives the ventricles a fraction of a second to keep up. It will always give the heart a chance to beat on its own before it kicks in. As the heart block gets worse, the pacer kicks in more. Most of us with heart block pace every beat, that's normal.

The pacer doesn't physically force the heart to beat. It sends a signal that mimics what the heart should have been doing on its own, the muscle responds by contracting. Our hearts are always doing the beating, the only difference is the source of the signal. 

It is not about percentages but about how you feel

by Gemita - 2020-11-08 08:44:24

You ask some difficult, fundamental questions that I often ask myself not only about my pacemaker but also about my other health conditions and the interventions I have had.  If I had left well alone, what would the outcome have been I wonder ?   

Electrical disturbances are often progressive and recently I have seen many posts similar to yours where progression from intermittent to persistent heart block has occurred and sometimes where the reverse has also occurred.  I believe this is the normal course of electrical disturbances which can be so variable depending on our other health conditions present and whether they have progressed, on our pacemaker settings which may cause a shift to higher % pacing in either the right atrium or right ventricle, on any medication we are on, on our energy requirements.  So much can affect these percentages.  

I would ask myself several questions:

Do I feel better overall with my pacemaker?  

Do I have worsening symptoms?  

Can I exercise/carry out my daily activities as I would wish?

If you have worsening symptoms then clearly these need investigating, but if you feel well and can go about your daily routines without difficulty, I would say try not to worry about those percentages.

I am now almost 100% paced in my right atrium (pacemaker in 2018) and feel so much better.  I have SSS (tachy/brady) and intermittent Bundle Branch Blocks and horrible arrhythmias.  My husband who had Mobitz Type 2 block/left bundle branch block at implant (2018 too) is now almost 100% paced right ventricle, from 47% two years ago, and doing very well too now, even though a high percentage right ventricular pacing concerns me for the potential to develop heart failure.  With any intervention though we will never know what the result over time will be.  There is always a risk, but most of us needed the help of a pacemaker to prevent worsening symptoms/health and in some cases, loss of consciousness, or worse.

My heart clearly relies on my pacemaker to keep my heart rate at a level where I can function better.  Has it weakened my heart?  I would say personally, no, because what weakened my heart more was the struggle I had to stay warm, to exercise, to circulate my blood to all parts of my body prior to my pacemaker when my heart rate would crash to levels that would not support my needs.  With the help of my pacemaker, my body can function as nature intended



Unfortunately it's progressive.

by Graham M - 2020-11-08 18:39:09

About 15 months ago, I was diagnosed with a Type 2 block and had the pacemaker implanted.  At my first check up at about 6 weeks, I was pacing 17% of the time in my RV, but at my most recent check up a couple of weeks ago, I discovered I was being paced 74% of the time.  I knew that this could happen, but I was really shocked at how quickly it had progressed, and it really shook me up for a few days.  Thanks to some help from another member of this club, I have had to take a good look at myself and realise that it doesn't matter that much because my PM is dealing with it, and I am feeling much better than I did before the PM.  The only downside is that my battery life will be shortened, but I'll cross that bridge when I come to it.

Best wishes,



by Tracey_E - 2020-11-09 10:38:28

How much we pace is actually only a small part of how long a battery lasts. The bells and whistles we use, the safety margins, how much juice it takes to get the heart to beat, the condition of the leads all have an impact. I pace 100% ventricle, 4-5% atrial. My current battery is from 2015 and it still has 9-10 years left. And replacements are super easy, I'm on #5. 

Thank you Tracey_E

by PacedNRunning - 2020-11-10 22:01:54

Thank you for your response. I keep thinking the pacemaker made my heart weaker.  I know at one point my pacing went down and I thought, great the PM made my heart stronger.  Then it went zooming back up and I thought it made it worse. Makes sense. I would think weaker without a PM.  It's just hard to swallow 100% usage of this thing.




by PacedNRunning - 2020-11-10 22:07:21

Yes! Exactly! You know what I'm saying.  I just didn't expect that it would happen this fast. I also thought I would stay with low amount of pacing forever. :). Even my doctor at implant said I may not pace much at all. It would just keep me safe.  My first year of pacing was ok, several setting changes to get it right since I only needed it with exercise.  I had about 3 good months before I started feeling pacing intermittently and times when I normally didn't have heart block. Took a good 6 mos for them to figure it out and make me feel better. I was absolutely miserable and it just got worse and worse. I finally was knocking on the doctors door to fix this!!  They actually wanted to change my settings to pace me less.  I said heck no!  Pace me more and let's see what happens. If not, take this thing out. I was that miserable. It worked! I felt like a new person.  NO more chest pain, shortness of breath or dizziness.  As it got more frequent, I had to go back for more changes to finally in a great spot! it is night and day difference. I honestly thought the shortness of breath in my mask was just normal. It was crazy to know what I thought was normal for me, actually wasn't. So yes, I do feel better and very happy overall.  I don't despise my PM as much anymore.  My new problem is I have 2.5 years left and Ive had this thing 2 years.  It is what it is and as long as I feel good, I guess that is all that matters


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