Pacemaker

Simple bradycardia isn't usually an indication for a PM

by crustyg - 2021-01-04 05:46:30

Usually there would need to be some other factor(s) that would justify a PM - dizzy spells or fainting episodes, pauses in your heartbeat, reduced ability to increase your HR when needed, etc.

From personal experience, I went from about 42BPM to 50BPM.  There's no particular reason why a lower-rate limit should be set to 60BPM for you - you're a little older than I am, but there's no reason why your EP doc shouldn't be able to give you 50 or 55BPM.  For me, surviving on a junctional rhythm, going from 40BPM - big thumps in my chest esp when lying on my left to sleep and with the PM having 50 regular, properly co-ordinated A=>V much gentler beats was quite pleasant.

Again, in *my* experience, headaches usually reflect under-filling - too little water - and if you find that moving around makes them go away, that would suggest to me that you're suffering from reduced blood flow to the brain - so perhaps your low HR is more of an issue than you currently credit it.

pulse oximeter

by marylandpm - 2021-01-04 06:22:05

  Pick up a Pulse Oximeter at a drug store and monitor you oxygen. If it  is low you will need a pacemaker.  

A pacemaker I believe would be of benefit

by Gemita - 2021-01-04 06:33:55

Dear Joe,

Reading your post makes me feel that you would definitely benefit from a pacemaker as recommended by your cardiologist.  A heart rate during the day of 35 to 45 bpm in my opinion is far too low to perform regular daily activities, or to enjoy them and to have a quality of life.  You sound as though you feel so much better with a higher heart rate of 50 bpm anyway and your headaches disappear also, so this tells me that blood flow to your brain and other parts of your body would benefit from a steady, higher heart rate.  A pacemaker will provide this Joe.

I have a pacemaker predominantly for bradycardia, although my history is slightly more complicated with arrhythmias, pausing and syncope.  My heart rate at night often fell below 30 bpm and during the day used to hover around 40-45 bpm.  I felt cold, miserable and just wanted to keep warm and sleep.  What a difference a pacemaker has made for me.  My lower heart rate is set high at 70 bpm day and night and everything seems to be working better, my brain especially - well more than before my pacemaker !  I am also 72 Joe.  Yes from 40-45 bpm during the day to 70 bpm day and night felt exceedingly fast at first, but my body soon settled down.  I feel warmer, am able to enjoy more activities, feel less tired, enjoy better health overall.  

I believe your bradycardia will only get worse as you get older, which could lead to pausing and arrhythmias and worsening symptoms.  Why wait for this to happen when you could get a pacemaker now while you still have good years ahead of you to enjoy the many benefits of a higher heart rate?  

I wish you well whatever you decide Joe

Your low rate if you get a pacemaker is up to YOU

by jds66 - 2021-01-04 12:14:55

I agree with crustyg and gemita also. If you weren't having some other issues, like some heart block, or not feeling well, then there would be no medical indicator to allow them to bill insurance and give you a pacemaker. What is your diagnosis other than non symptomatic bradycardia?

Is the bradycardia symtomatic? Do you have heart block, any degree of it? Are you ever light headed or feel like you are going to pass out? Have they put you on a holter monitor to see if anything is going on while you are sleeping? Before you decide to get a life altering pacemaker, make sure they do the basic tests on you. 

I was 45 when they diagnosed that I needed a PM. Which is about 27 years younger than you are right now. I was at that time (and still am at 54) active and able to get my heart rate up with exercise. My heart rate during the day was in the 42-50 range, at night, it went into the 30's. I was beginning to get symptoms over the years up to getting a PM- long pauses at night, sluggish during the day, feeling woozy, etc. So, I had symptoms, basically Sick Sinus, wtih first degree heart block. My heart was running on the junctionals basically all the time. 

I decided to take the chance, instead of hoping that my heart would just stop one night and not restart, and get the PM in 2012. They give you the settings when you get one implanted that are the default settings. 60 bpm is generally a default. Also, depending on the brand and model, some will have a mode that will help a persons heart when they exercise, called Rate Response. I personally did not need that, as my heart, as you say yours does, responds normally to exercise, and I found Rate Response, which is a standard default setting of ON, did not work for me. 

So, I went from, like you, used to sleeping at 35-45 bpm at night. Now, with a pacemaker, they had me cranked up to 60bpm, ALL DAY!  I simply could not sleep, for weeks! An hour or two here and there, but it was really bad. To the point that I wished that I had never had the pacemaker installed, that it ruined my life. 

Unfort, the model they put in me at that time, the Medtronic Revo, MRI compatible, did not have a sleep hystersis feature that could be turned on in the mode I was paced in. So, I truly was stuck living with one rate all day. 

I eventually got relief when they put my low rate down to 40 and turned off the useless, for me, Rate Response. That mimicked my natural feeling heart rhythm, and at the very least, insured that my heart was not going to stop in the middle of the night. 

I did still feel sluggish at 40 and eventually had the low rate turned up to 50, which I ended up being able to sleep at fine. And, now that I have received my second device about a month ago, I let them talk me into leaving the hosp with my low rate at 60 and the Rate Response on. Dumb move- within 2 days I was back to the EP, telling them to turn off my Rate Response(as I tried to tell them before I left the hosp) and due to other factors of my condition that still have not been solved, told them to turn me back to 50bpm for now as my low rate. 

In other words, how you feel is really who is calling the shots. They may try to tell you what is best for you, but I will almost guarantee that they are going to be turning your rate down within a few days, at your urgent request, if you get a device that cannot be programmed to go lower at sleep. 

So, quick answer to your question- what symptoms beyond a headache are you trying to overcome in regards to your heart? And, if you decide to go through with this, then make sure they implant a model that has a sleep setting function, that you can program a lower sleep rate and have a higher daytime rate. That would be your best bet. 

Bradycardia and Rate Response

by Marybird - 2021-01-04 14:30:47

I also have sick sinus syndrome ( tachy- brady type) though my bradycardia became symptomatic over time. 

My baseline heart rate was set to 55, the reason given was so I would not pace unnecessarily to 60 at night while I was sleeping. The rate response was also turned on, and the EP assured me I wouldn't see a 55 heart rate much as any activity would increase the heart rate. I have found this to be true. I wouldn't want the base heart any lower than 55, but I find it comfortable when I'm sleeping or playing extreme couch potato, and the rate response does keep the heart rate where it needs to be with any activity. So I'm happy with the settings where they are, along with the meds to keep the tachycardia mostly at bay. 

I know there are criteria for pacemaker placement listed by the American Heart Society, American Association of Cardiologists, the Heart Rhythm  Society and European Society for Cardiology for sinus node dysfunction, heart blocks causing pauses, and other conditions. The criteria depends on documentation of EKG and other testing, for the heart rate, pauses, and documented symptoms ( such as lightheadedness, passing out, inability to carry out ordinary tasks due to "tiredness", that sort of thing.) as Class I ( considered necessary and beneficial with benefits outweighing risks) indications for a pacemaker.  But there are also Class II criteria, where a pacemaker would be considered beneficial but there are differences of opinion as to whether or not the benefits would outweigh the risks. I see in this category they include an overall heart rate less than 40 while awake, when the patient is asymptomatic. 

Without knowing any of your medical history, Joe, it sounds to me as though you might fall into that Class II category, with such a low heart rate but no symptoms. Meaning that some docs would recommend a pacemaker, others might take a wait and see attitude to see how your cardiac activity affects your activities of daily living, if you develop symptoms associated with poor perfusion due to the low heart rate, or your inability to get a HR above 50 during exercise keeps you from other activities ( chronotropic incompetence).

I guess that leaves you where you started, ie, pacemaker or no?  I'd think that either way your cardiologist would do any testing you need to determine if there are any physical reasons for your low heart rate, testing under controlled conditions to see how your heart functions during activity ( ie, stress testing). And he'd keep an eye on things to see if you do develop any symptoms, or any other issues related to your low heart rate. 

Anyway, I wish you the best of luck in making decisions, whatever they may be, for your best outcome.

Bradycardia

by AgentX86 - 2021-01-04 21:39:51

IMO, a reasting rate of 45bpm wouldn't be a big deal but dropping to 35bpm has "pacemaker" written all over it.  Has he carried a Holter monitor around for a week or so?  If not, he should have, and it should be done ASAP.  There could be some other serious things going on, like sinus pauses or maybe a heart block.  Either could be a bomb ready with the fuse lit.

Bradycardia ( slow heart rate)

by Selwyn - 2021-01-05 08:56:55

I would agree iwth Agent X86, you need further investigations. Having a PM is a treatment, not a diagnosis. Almost anything could be happening whilst you are asleep ( I was having asysole for varying periods , no heart beats in the night unknown to me. This is associated with sudden death). 

Headaches may be caused by other pathology than a slow heart beat. You need a broader medical opinion than 'have a pacemaker fitted'. Some people have sleep apnoea, some people have brain tumours, migraines, etc. (https://www.medicinenet.com/morning_headaches/article.htm

Seek a proper diagnosis from a proper doctor.

A heart beat of 35 could indicate complete heart block - rather dangerous to your wellbeing. If your ONLY abnormality on recoding your ECG over a few days is sinus bradycardia, then a lot depends on whether you are getting symptoms. As mentioned, the situation is likely to get worse with age. I have had my present PM for 12 years and the batttery is still going. When you need a PM, you need a PM! Having episodes of asystole without a PM is a bit like Dirty Harry's words, "Are you feeling lucky, punk?".