Medtronic w/ Apple watch HeartWatch app - low BPM

I am two weeks into my Medtronic two-lead pacemaker. I feel great! 

The lower threshold on the Medtronic is set to 60 BPM. A few times a day the HeartWatch app on my Apple Watch will display a <60 BPM (I.e. 45 or 57 etc.)  What is happening?

Does the Apple watch catch the dip in BPM before the Medtronic?


Your Apple watch is missing some beats

by crustyg - 2020-11-16 13:42:01

The PM doesn't wait for a minute, count how many beats it saw and then up the rate.  It waits <x> milliseconds for the next beat and if it doesn't see it, then it generates a pacing pulse.  For you, that's every 1000ms.

The only really certain way to be sure that all is working correctly is to actually *feel* your pulse, and count for at least 15seconds (30s is better). *IF* you are 100% confident that you can feel every beat and there aren't enough of them then one of your leads has developed a problem.  99 times out of 100 for folk in your position (recently installed) it's the external monitor that's missing the beats and not your PM.  And even an ECG isn't necessarily perfect - electro-mechanical dissociation means that you have activations without a decent ejection into the aorta.  But if you have this, then you would have serious problems.  It's extremely unlikely as you 'feel great.'


Ectopic beats?

by Gemita - 2020-11-16 14:36:39

What you are experiencing are ectopic beats I believe.  This is a benign rhythm disturbance (arrhythmia) which often tricks our home monitors into thinking that our hearts have missed a beat.  Many home monitors cannot cope well with rhythm disturbances however insignificant and benign as are ectopic beats.  They are generally weak inefficient beats which are often missed by our home monitors but not missed by our pacemakers.  However they can really make us feel extremely symptomatic as I well know.

As crustyg says, I would check pulse manually (I check my neck pulse).  If you get symptoms or feel that you have worsening rhythm disturbances, tell your doctor for further external monitoring to see what is going on.

Heart rate watches are inferior to chest bands

by quikjraw - 2020-11-16 15:48:01

Hi my experience with watch mounted heart rate monitors is that they are nowhere near as reliable as ones that communicate with a chest band and even they can throw up weird results from time to time 

Hope that help



Thanks all!

by Fourstring - 2020-11-16 21:51:55

Thanks for the comments.  Great supportive community here. Glad to be a part of it. 

Heart Rate measurement of irregular heartbeat

by dogtired - 2020-11-20 13:45:27

I have 4 devices to measure HR and NONE of them agree!  More amazing to me is that sometimes none report actual beats for 30 sec X 2!  My Kardia , I would expect to be right on , which most of the time it is but  often it reports higher than the actual count ie it reports 56 when actual count indicates 40.    My Apple watch can report 80 when actual is 40 .  My watch and chest strap are close, and my Kardia and BP device are close.  My guess is that the Kardia is taking an average time between beats and calculating beats/min as opposed to counting actual beats.  I have no idea what would cause my watch to report 80 when actual count is 40.  In the past its always agreed with the actual count (verified by EKG comparison)

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