How do you know if your leads are failing?


It's been some time since I last wrote this group.

I have had my pacemaker for idiopathic third degree heart block for a little more than four years now. I am in my late thirties, I jog three miles regularly, and apart from the heart block I otherwise have zero health issues.

Today, I had a concerning experience. After walking quickly up two flights of stairs to my apartment, I had a series of really strong heart palpitations. My underlying heart rate felt slow, and then I felt these regular, very strong beats over the underlying beat every 3-4 beats or so. While I was feeling this, I was fortunately able to capture a mini ECG on my Apple Watch, and, honestly, the tracing looks like a heart block rhythm with the big escape beats and all. It quickly resolved itself after a few minutes, and I haven't noticed any other weird rhythms today.

Is it possible that -- going on months now with not enough sleep, likely a little too much caffeine, and high stress due to working from home while simultaneously watching my toddler due to the pandemic, etc. -- this was just a random palpitation, no biggie, just get some extra sleep tonight?

Or, because this seemed to be a heart block rhythm, could this mean my leads are failing and I need to get in to see my EP right now? Would there be other signs telling me there's an urgent issue afoot?

I'm wondering specifically about the leads because I have a strong and active toddler who I probably lift more than I should, and he's accidentally hit me pretty hard a few times on my Pacemaker side, and so this possibility has been in the back of my mind for some time.

I'm due to see my EP, coincidentally, for my annual check up on 12/16. The rhythm I felt today just really freaked me out, and I'm wondering if I should be advocating to get in there sooner.

Thanks in advance for any advice!



Stress, too much caffeine or a failing lead ?

by Gemita - 2020-12-04 01:43:41

Hello KCambridge,

I would try not to self diagnose or assume anything since it will just push up your stress levels. 

A rhythm disturbance like this may need to be checked if it happens again.  It may just be a one off and a warning sign for you to slow down but I would suggest you send the mini copy ECG in any event to your Cardiologist/EP for his/her opinion.  A mini ECG may not be sufficient for them to accurately diagnose the problem, but it is better than nothing.  

It could well be that you are totally exhausted from lack of quality sleep and lots of caffeine/stress can certainly keep us awake at night.  Caffeine, stress and lack of sleep can be major triggers for palpitations too.  However it is possible that you might have developed a new rhythm disturbance and your doctor may want to monitor you for a short period with an event monitor.

Warning signs of a failing pacemaker lead might include shortness of breath, unusual fatigue, the feeling that your heart is racing or beating too slowly, dizziness or fainting, difficulty exercising (in fact all the symptoms you might originally have had).  You might also notice some twitching of chest/abdominal muscles or you might start getting hiccups, although in my experience many of these symptoms can be warning signs of an arrhythmia and other conditions too.

Hopefully this was just a one off occurrence.  If it happens again and you have home monitoring you could try to send an immediate download to your clinic for assessment.  It goes without saying that any new, worsening or more persistent symptoms like breathlessness, dizziness or chest pain should be reported immediately.  In the meantime, reducing or cutting out caffeine, drinking more water, eating well and resting/relaxing may be all that your body needs to recover.  Difficult I know with a toddler!

Remember, go by how you feel.  A failing lead would trigger worsening, more persistent symptoms.  If your heart feels steady most of the time, this would be a reassuring sign.  Good luck for the 16th. Hope you get reassurance that all is well with your heart and with pacing.


by Tracey_E - 2020-12-04 10:09:06

Leads are strong enough to handle any toddler. We bruise up long before the pacer will be damaged, and as long as nothing else is going on we don't generaly have weight lifting restrictions after we heal. 

If your lead wasn't pacing, you'd feel like you did before with a very low rate. 

When in doubt, call and talk to your doctor's office. Do you have a home monitor? If so, send a download and let them know to look for it. 

I'm no doctor but if I were to bet, my money would be on caffeine and stress being the culprit. 

Trying to slow down

by Kcambridge - 2020-12-04 22:31:28

Hi there,

Thank you both for your very thoughtful and reassuring responses. This pandemic schedule has been grueling, and I think my body's maybe just trying to get me to rest!

No issues today, and so unless I feel any other symptoms or weird rhythms, I'm just going to wait until the 16th for my EP appointment to see if anything is going on.

Thank you!

it's hard!

by Tracey_E - 2020-12-05 08:35:14

This pandemic has been hard on everyone, but I think it's worst on working parents! My heart goes out to you.

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