Mom's New PM

So glad I found the "club" and have seen some great info here.  My Mom is 85 and has always had a heart rate in the 40's without issues.  She started having some AFIB so when her heart rate would go up to around 100, she would feel it and get shortness of breath.  she was also having some pauses with the AFIB and her heart rate would dip into the 30's and she would feel lightheaded.  She was in and out of the hospital many times before they finally decided to put in a PM about a month ago.  If was set at 60.  Since then she is feeling "breathless," that's how she describes it, but only with any activity.  As long as she's sitting she feels fine.  I'm wondering if this PM set at 60 is to fast for her since she's been in the 40's all her life. The doctors are not concerned and we are very frustrated since our mother can't do as much activity as before?


Atrial Fibrillation

by Gemita - 2021-01-04 12:15:25

Hello Biscuitsmom.  

I believe the problem is not with your Mom's pacemaker set at 60 bpm but more likely to be coming from her AFib causing unwanted symptoms, particularly when she starts to try to exert herself.  I also believe any medication that she has to take, say a beta blocker, to control her upper heart rate during her periods of AFib, may also be affecting her.  AFib + medication can cause many unwanted symptoms, including breathlessness.  It certainly does for me.

I am an AFib sufferer, younger than your Mom at 72, but I can feel quite breathless during an episode of AFib, especially if I try to exert myself.  My minimum pacemaker heart rate is set higher, at 70 bpm. 

What to do about your Mom’s AFib is the question?  I would suggest you try again to speak to your Cardiologist/EP and explain your Mom’s symptoms and ask if more can be done to help control her symptoms, and her AFib.  Maybe her doctors will want to monitor your Mom to see whether the Afib is progressing or whether she has developed any other heart problems.  They may want to watch her for a few months to see how she settles in with her new pacemaker before changing anything.  They may offer better treatment options, different medication in the future to help with her symptoms.  If they do not, learn as much as you can about controlling AFib  and ask them lots of questions because your Mom doesn't have to suffer in silence.  

My husband also suffers from AFib.  Because of his age (82) and other health conditions, his doctors tend to want to leave his AFib well alone, which I find so unhelpful.  He suffers badly too from breathlessness sometimes and I will be pushing for further control of his symptoms/AFib during our next hospital appointment.

My advice is to tell your Mom that it will get better but she needs to be patient since the pacemaker is not a cure for AFib. There is a lot they can do to ease her symptoms but this will take time, trial and error with medication, with pacemaker settings, with lifestyle changes.  You could query whether the setting Rate Response is on or off on your Mom's pacemaker though, in case they need to make any immediate adjustments.  Has your Mom been back for her first pacemaker check?  

AFib is a real pest and can cause many unwanted symptoms, but there is a lot that can be done to help us to enjoy a better quality of life.

Finally is your Mom on anticoagulation to protect her from an AF related stroke?  Anticoagulation and rate control medication to prevent a high heart rate during an episode of AF are two of the most important treatments for AFib.  Keeping your Mom's heart rate controlled during an episode of AFib may well help to prevent her breathlessness  I wish your Mom well 


by AgentX86 - 2021-01-04 21:33:37

Hi Biscuits,

A couple of things.  Do you know exactly why your mom needed a pacemaker (sick sinus syndrome - SSS, heart block - CHB, etc.)?  How long were these pauses?

There could be many things going on here but it seems that she has SSS and it was getting worse.  A low heart rate (40s - 50s) indicates that something is wrong.  When it dropped into the 30s, that something gets critical.  Pauses, depending on the lenght, can elevate it to an emergency.

If SSS is the problem, they probably want to increase it back to normal (60 is conisdered normal).  She might ask that it be increased slowly but there is good reason to get it back to "normal".  She'll adjust to it but it might take a little time.  Sneaking up on it will probably make it easier for her but involves several more trips to the device tech.  Given covid, this might not be advisable.  It's only been a month and it may take her a while longer to get used to it.  This is not unusual.

Afib is certainly a PITA.  The pacemaker will allow her EP to use drugs that, because of her already low heart rate, were impossible before. Some of these drugs are very powerful and have serious side effects but equally as effective. Because of her age, even the most powerful can be used if necessary.

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