Pacemaker dependability

Hi everyone so I had a check up with the EP today and he said that my heart depends on the pacemaker by 2% and 98% is my heart working I just don't get it what's the point of having it then? 

Ps. I've been diagnosed with a 3rd degree heart block and I've had the pacemaker for 2.5 months now


22 Comments

Some nasty things could happen during that 2 % !

by IAN MC - 2020-12-14 15:30:46

So your heart is beating too slowly for 2% of the time .

I make that almost half an hour every day  or roughly a week every year. Yes Omar , you need a pacemaker !

Ian

Yes Omar

by Gemita - 2020-12-14 15:45:57

It only takes seconds to collapse at the wheel, while walking across a busy street and a fall could cause harm to yourself or to others.  

2% of the time can = a lot of falls and loss of consciousness.  Also you must remember that your block could change at any time, worsening over a period of time and becoming complete.  How would you manage without a pacemaker then ?

Better to be prepared and protected.  Blocks usually progress Omar

.

by Omar - 2020-12-14 15:58:55

Thank you Gemita it feels good to hear that the surgery was worth it 

2%

by AgentX86 - 2020-12-14 16:02:43

Would you like a 100% chance of living another day  or 98%? Seems simple enough to me.

2%

by Omar - 2020-12-14 16:28:33

Never thought of it like that you're right thank you Agentx86

numbers

by Tracey_E - 2020-12-14 20:14:35

Are you sure he didn't mean 2% atrial, 98% ventricle? Because 3rd degree block by definition means your heart is in block all the time and so pacing ventricle 98% of the time is normal.

There are people who use it 0%, it paces just a few beats at a time that shows up statistically as 0%, but those few beats will keep them from passing out.  It only has to kick in once to be worth it. 

Good point Tracey_E !

by Gemita - 2020-12-15 04:03:33

Omar, have you got any paperwork to confirm what your numbers were?  Tracey makes a very good point though, so if you are still scratching your head in disbelief, I would go back and ask again and put us all out of our misery!

2% / 98% ?

by amanda_shanti - 2020-12-15 11:45:21

I totally agreed with Tracey_E and it's a very good point!

Omar, to clear your doubts and have a peace of mind, you may want to re-confirm with your doctor.

I have 3rd degrees heart block just like you and had my pacemaker implanted early Nov, this year. In my last PM check up session, my doctor told me that my PM is now 100% pacing due to 3rd degrees (complete) heart block. Atrial lead is for sensing and ventricle lead is 100% pacing. So, complete heart block with 2% pacing rate seems a bit low... I guess.

I also have doubts about the implant surgery and wondering why I need one all of the sudden. I'm 43, first degrees heart block was found 4 years ago during physical check. No serious symptoms along the years but then one & a half month ago, significant symptom was shown suddenly. Now, a month after the surgery, I understood that accepting the implantation is one of the important elements to help me recover from the surgery and live my life normal again.

Hope you could clarify with your doctor and get your answer soon ;)

3rd Degree heart block

by AgentX86 - 2020-12-15 14:32:25

3rd Degree heart block means that it's a total blockage but it doesn't mean that it's blocked 100% of the time. As opposed to a second degree HB Mobitz-1 (Wenckebach)  signal that gets through but the interval between the atrium contracting and ventricles contracting gets shorter and shorter until a beat is dropped, then it starts all over.  This isn't serious and is usually reverseable.

There is also the 2nd degree, Mobitz-II (Hay) where the dropped beats are regular and we get the 2:1 or 3:2 conduction.  This is serious because the ventricles aren't keeping up with the atria and the hearts output is reduced by a third or hald.  Mobitz-II almost always degenrates into a total block. A PM is the only out.

Neither of these are third degree.  In fact we've had several here who have had intermittent 3rd degree block.  It's serious because during the blocked time, no sgnals get through the AV conduction system so there is total AV dyssynchrony and only the ventricular escape rhythm keeps the heart pumping.  It will also inevitably degrade into a permanent block.

2% /98%

by Omar - 2020-12-15 17:40:09

The doctor wrote in a paper 

AR-vs 2% or AP can't really tell by his handwriting 

AS-VS 98% 

So is that what Tracey_E means?

I think you're right

by AgentX86 - 2020-12-15 21:23:20

AS-VS means that your PM sensed the appropriate signal from the SI node, then a normal pulse in the ventricle from the AV node (and all the stuff below) - a normal heartbeat.  So you're heart is working normally 98% of the time.  AP-VS means that 2% of the time your pacemaker doesn't detect the signal from the SI node, so supplies the pacing pulse in the atrium.  It is then sensed normally in the ventricle.  AIUI, this indicates no heart block but perhaps SSS.  Perhaps I'm missing something here but a 3rd degree heart block should show some percentage of ventricular pacing (AS-VP and/or AP-VP).

AS + AP ==100% (definition)

VS + VP ==100% (definition)

Normal heart: (AS - VS) = 100% (pacemaker isn't doing anything)

What the point then?

by Omar - 2020-12-16 04:54:56

So what's the point of having it then? Eventhough I've been diagnosed with a complete AV block and I've had loss of consciousness after fainting by 3 months I've had Holter monitor and got diagnosed with Av block 

The doctor said you will need it by the time idk if that's true

numbers

by Tracey_E - 2020-12-16 09:18:44

The point of having it is not passing out. YOu can pass out and not wake up again. You can pass out and be seriously hurt.

When you are in 3rd degree block, it's hard on the heart and hard on the body so the point of having it is keeping your heart in sync and not doing damage. 

If you were passing out, the pacer only has to kick in for a few seconds to prevent that. Statistically that can show up as 0 but it stopped you from passing out during those seconds so it's doing its job.

And I'm still not sure what he means but if AS/VP is 98 that means 98% of the time it's just watching. But that 2% it's pacing is significant because you were passing out. That's 30 minutes of every day. It doesn't statistically seem like much but it's significant. 

AS/VS means atria and ventricle both sensing, neither pacing

AS/VP means atria sensing, ventricle pacing. With 3rd degree block the VP number is typically close to 100

AP/VS means the atrial lead is pacing, ventricular is sensing

AP/VP means both are pacing

AS + AP = 100%

VS + VP = 100%

I would expect much more pacing with 3rd degree av block, but ANY pacing means you need it whether it's seconds at at time or hours at a time. 

Numbers

by Omar - 2020-12-16 11:00:33

Thank you so much Tracey that's a relief to know that I didn't go through this for nothing specially at my young age 

Oh One more thing The doctor said you technically still didn't use the pacemaker yet after 2.5 month of implanting it then he said you will need it more in the future since there's a heart muscle or something that will be weaker 

Thanks again 

young age

by Tracey_E - 2020-12-16 11:56:49

I was 27 when I got my first one, I'm still doing great at 54. No one looks at me and sees a heart patient.  We have members who got them as babies and are adults now, thriving. 

He was probably referring to the heart block getting worse. That's not the heart muscle deteriorating, it's the electrical connection between the atria and ventricles getting worse. This is typical with heart block, it almost never stays the same. You may be in and out of block now, but as you age it will progress. Most of us end up in block all the time. Which is nothing to be concerned about now that you are paced! As you need it more, the pacer will be right there fixing it immediately. 

Gotcha

by Omar - 2020-12-16 12:02:28

Thank you so much that was so informative ❤

Heart Block?

by AgentX86 - 2020-12-16 15:45:35

If AS - VS = 98% and AP - VS =2%, how can this be a heartblock?  VS is 100% so there is no V-pacing going on.

heart block

by Tracey_E - 2020-12-16 19:50:43

I'm not doctor, but that looks like pacing for sinus pauses, not heart block. 

Omar, doesn't really matter what name they put on it! Being safe and not passing out is what is important. It's common to have a mixed bag of electrical issues, have more than one thing going on. The good news is the pacer fixes all of them. 

Agree

by AgentX86 - 2020-12-16 21:08:23

I agree with everything you've said Tracy.  It sure looks like a SI node problem of some sort, not HB.

I have two reasons for bringing up the issue.  One is to try to teach, not confuse, and to learn myself.  I wanted to make sure I wasn't reading too much into these numbers.  I also didn't want confuse others trying to learn.

The other reason that I brought it up is the Omar is being told he has HB and it looks to me like some sort of SI nore problem.  Were it me, I'd want to know what was really going on.

SI Node problem

by Omar - 2020-12-17 06:37:43

I guess that's right, my holter monitor showed that I have pauses greater than 2.5 seconds and it reached 3.3 secs 

The second 48h holter monitor didn't show HB but it said I had 2 isolated PVCs and rare isolated PVCs and late beats and 17 hours of tachycardia and 6 mins of bradycardia 

definitions

by Tracey_E - 2020-12-17 09:01:30

If your holter showed sinus pauses, that would be the 2% when the atrial lead is kicking in and likely preventing you passing out. That fits better with your pacing percentages than heart block. 

PVC, premature ventricular contractions, are little half beats between the full beats. They are harmless and nearly everyone has them, most people just don't have a test to record them. 

Did they put you on meds for the tachy? The pacer is a gas pedal, not a brake. When the heart goes fast on its own, the pacer is just going to sit back and watch. 

Brady means under 60bpm. If your sinus rate gets under 60, the pacer will kick in to bring it back up. That's likely part of the 2% also. 

Tachycardia

by Omar - 2020-12-17 10:35:21

The doctor told me he will give me medication but let's see after 3 months if I got tachycardia recorded again cuz he noticed that it happened 4 times in 2.5 months since I got my pacemaker my heart rate reached 180 and above if my pacemaker will be just for the pauses I guess it will live longer with me I guess it's a good way to look at it like that 

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