Skipped and ectopic beats

Hi. Had my dual chamber PM for just over a year and had no problems. But the last 3 days I've been having loads of skipped beats. The pause seems to last for ages. Also quite a few eptopic beats as well. Palpitations are quite strong just to add to the fun. Just wondered if anyone else has suffered from the same. Mine was fitted for AF and flutter. Will add my BP was a little high as well. I know the PM tends to let the heart do its thing then kick in when it feels the need but just looking for a bit of peace of mind. Thanks in advance. 


ectopic beats and the rest . . .

by Gemita - 2021-01-06 13:49:53

Hello Fitzy,

Yes immediately after my pacemaker and for the last few years despite being paced I have continued to be troubled by ectopic beats and more significant arrhythmias like Atrial Flutter and AFib.  This is very normal for me.  

Did your EP explain to you that a pacemaker cannot cure AF or Flutter?  Both these arrhythmias can be treated with anti arrhythmic meds or rate control meds, or when these fail, by a cardio version or an ablation.  Having high BP will not be helping.  High BP is a real risk factor for AF and arrhythmias in general and of course many other serious health problems, so it is best that you get this under firm control.

Can I give you peace of mind.  Yes I think so.  Providing the upper heart rate and blood pressure is well controlled with medication and you are protected from the risk of an AFib/Flutter related stroke if you have risk factors, then you should come to no harm.  Also I find with a minimum pacing rate of 70 bpm, many of my awful ectopic beats are outpaced and smoothed out.  Without ectopic beats I am less likely to slide into Afib or Flutter anyway, so the pacemaker really helps me most of the time.  

Have a word with your doctors and a review of any meds you are taking.    Maybe ask about adjustments to your pacemaker settings.  Ectopics for me were caused by too slow a heart rate and by increasing this to a higher level (70 bpm) my arrhythmias cause fewer symptoms, occur less frequently and last for shorter periods. 

Make sure that you drink plenty of water - hydration is important.  Reduce caffeine (which is in chocolate and Pepsi/Coke too) and go easy on alcohol.  Caffeine/alcohol can trigger an episode of AFib very quickly in my personal experience.  Get plenty of good quality of sleep, try not to worry and leave your pacemaker to do the work.  It will take good care of you.  As you learn to relax those little devil beats will often disperse.

If however, despite all your efforts things do not improve, don't be afraid to tell your doctors.  They may ask you to do a remote transmission (if you have home monitoring) for them to see what heart rhythm disturbances you are getting or ask you to wear an external event monitor to try to capture what is happening.  Make a note of any symptoms you get, time and date they occur to discuss with your clinic.  In that way they can correlate your symptoms with a particular heart rhythm disturbance.

Good luck



Skipped beats

by AgentX86 - 2021-01-06 18:48:46

My bet is that these are PVCs or PACs (premature ventricular/atrial contractions).  They feel like skipped beats but in reality the beats are still there, just pairs of PVCs and normal beats that are too close together.  This causes the heart's chambers to incompletely fill beteen pairs so the beat is weak and you may not feel it at all in your wrist/hand.  If you palpate your carotid artery (neck) or femoral artery (groin) you can usually feel these weak beats.  PVCs/PACs are rarely dangerous but they can feel awful.

As Gemita says, hydration is critical and not just water.  You have to make sure you're getting the minerals (primarily potassium and magnesium) you need.  Without these, your nervous system can't work properly and it shows in the heart first.  BTW, too much water without these minerals can wash what you have out of your system.  There is a thing called "water poisoning" which is essentially this process.

If this continues, you should seek medical help.  Again, it's rarely dangerous but it should be checked and the relevent blood tests done.  If it is an electrolyte imbalance, it's easily and cheaply treated.  I take daily magnesium and I think it costs about $10 for two or three months.  I get it from Amazon.

PM and ventricular arrhythmia

by dorothea - 2021-01-09 07:42:50

I agree with the above comments. but you should be aware, that there might follow an AV synchrony  (atrium and ventricle contract at different times), and that would cause a loss of cardiac output.  I had this, they call it a pacemaker syndrome. My energy deteriorated and I had difficulties to lie down.  If so, you should talk to a cardiologist. 


pm and ventricular arrythmia

by dorothea - 2021-01-09 08:29:40

Maybe a misunderstanding. Of course the atrium and ventricle contract at different times, but not in "harmony" with each other, wenn there is a loss of AV- .synchrony.

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