New Pacemaker


Once again im new to the club and forum and im wondering if anyone can offer me some insight about this.

I had my pacemaker installed last week and have been monitoring my heart using a fitbit and checking my Blood pressure regularly.  My HR never goes below 60bpm and when im relaxing I feel pretty good.  But im experiencing what feels like palpitations or pounding heart once I start to walk or exert myself a little like go up a flight of stairs.. I also. get a littke shortness of breath.  I called the Dr and his nurse told me im scheduled for a follow up on Feb 9th and the Dr might have to make some adjustments. Is this typical and normal??  I really dont want to wait another 3 plus weeks before these adjustments get made. Not only is this  making me anxious but I reslly don't feel good. Im worrying that maybe something else is wrong. Can this have something to do with a Rate Response setting??

Just like to hear some opinions??



Please try to stay calm

by Gemita - 2021-01-19 04:03:31

Hello Steve,

Firstly, welcome.  I also have Sick Sinus Syndrome (Tachy/Brady Syndrome).  My dual chamber Medtronic pacemaker was implanted in May 2018.

My best advice is to try to stay calm, not to overcheck your blood pressure and heart rate because they will certainly be responding to your stress levels.  Additionally we all know that with a pacemaker, home monitors can be subject to error because a pacemaker + an arrhythmia like for instance a simple ectopic beat (PACs - premature atrial contractions or PVCs - premature ventricular contractions) can affect the results, making them unreliable.  I usually feel my neck pulse quickly when I get troublesome symptoms to see whether my heart rate is slow or fast, regular or irregular.

Please remember too following any stressful event (and an implant is a stressful event) our hearts may respond by throwing some unexpected palpitations which can be normal.  This happened to me and lasted intermittently for a few months but eventually settled without too much intervention.  In fact my doctors knew this could happen and wanted to wait before going in and changing anything too quickly and then potentially throwing another setting out.  It is a fine balancing act initially to get our settings right and our hearts to calm down, but both will Steve.

Can this be due to Rate Response, yes it can but it may be due to something else too.  I feel if your symptoms are really troublesome you should ask whether you could 1. do a home transmission direct to your clinic for them to see what is happening when it is actually happening (say at home on climbing stairs) or ask courteously if you could 2. go in to see them earlier for some checks since you are highly symptomatic and finding it difficult to tolerate your breathlessness and palpitations.

Steve I had the same symptoms initially on climbing stairs when I found myself sometimes fighting for air.  Mine were not caused by rate response alone but also by arrhythmias (like simple ectopics mentioned above and other more significant ones).  My rate response is now turned on.  They may be able to correct the problem by adjusting the rate response settings or changing other settings but you need to be seen for this to be done.

So no worrying please, ask about making a home transmission direct to the clinic if you are set up with a home monitor or courteously ask to go in for some checks immediately if you are unable to tolerate your symptoms.

New Pacemaker

by Selwyn - 2021-01-19 05:51:49

It certainly is not normal.

Your resting heart rate at 60 bpm sounds normal as the lower rate limit for a PM is often set to this. I have just had mine raised a bit to try to help with the shortness of breath on stairs and postural dizziness. Shortness of breath on stairs seems to be quite a common problem.

It is predominantly a waste of time and effort taking your blood pressure, in this situation once it has been found to be within the normal range. Anxiety can certainly raise your BP and who is not anxious after having a pacemaker?  A Fitbit is not accurate. 

Palpitations mean different things to different people.  Almost all people are more aware of their heart after someone has messed around with it. [I remember asking the doctor why I was feeling the pulse in my big toe!]. If palpitations are in runs then this is more of concern. It the palpitations are irregular, this is more of concern. If there is concern, you  need an ECG or monitoring. 

With regard to keeping an eye on your heart, I have found the Kardia device helpful. Then again I do understand ECGs. If you are prone to anxiety it may help, or it may make things worse, you will have to have a think about your own personality. 

Look, in spite of Covid, if these palpitations are happening in long runs I would phone the nurse again, explain your distress and try to be proactive in getting an ECG done and some monitoring. 

There is no doubt that anxiety can cause palpitations - you should avoid caffeine and alcohol, as this worsens the situation, as does tiredness. Understand that anxiety is universal after a pacemaker.

It is normal to have to wait a few weeks before the PM settings are changed to your specific requirements. Like fine tuning a car engine, this can take a little while of trial and error depending on the experience of the mechanic. I expect the reason why the fine tuning, check up is delayed is that they have to let the leads embed, some of the PM functions are self adjusting, anxiety has to settle etc.  Having the odd palpitation is normal after exercise, associated with anxiety, after caffeine and alcohol, and having some medications and medical conditions.  If this little list does not apply to you, then again get back to the nurse and ask to be seen - they are employed for a reason.

Lastly, with regard to rate response, this is likely to be set ( IF AT ALL)  on the low scale by default. I cannot see anyone being turfed out of hospital with a fast onset setting. 

My personal experience was my pacemaker was by default set to unipolar return - this caused muscle twitching across my chest, and, I was putting this down to anxiety. It was such a relief to have the switch thrown!  Just walking up stairs for my first check up ( fancy putting the cardiology department up a flight of stairs?) was enough to send me into atrial fibrillation, such is the effect of anxiety and exercise.

Sounds like a classic rate response issue to me

by jds66 - 2021-01-19 08:29:58

Prior to your PM< sounds like you didnt have any short of breath during exercise?

If that is true, you probably dont need rate response on. What you describe is exactly why I told them to turn rate response off when I went for my first checkups after my pacer implant. It can make you feel like your heart is thumping and way over reacting to anything, even walking across the room. 

And, that can lead to plenty of anxiety and the anxiety itself can lead to shortness of breath. 

Remember, what is your condition. Only bradycardia? If so, then turn off the rate response if you dont need that boost, you may calm down alot quicker. 

I had to suffer the first 10 days or so in 2012 with that RR on, and until it was turned off did I start to feel normal, somewhat again. Took a few months to really feel right, as I have outlined before. 

Push them to get in before Feb 9, it is only a simple thing to change, and they can fit you in. Sometimes you need to be the squeaky wheel. 

Also, keep track of any changes. I use a spreadsheet that gives all my readings, dates, changes, etc. As you change things, dont rely on the docs to know and remember, keep your own tally. 

Irregular heart heartbeat/shortness of breath

by TRASH ARTIST - 2021-01-24 16:41:54

I recently had an episode where my heart was beating abnormally for short periods of time. I wasn't even aware it was happenind, but it showed up on my monitor. As soon as it was detected my doctor called me into the office. He felt it was serious enough to take some remedial steps. He precribed Metoprolol Succinate 25mg  before bedtime, I have to go back in on e month to see if the condition has been corrected.

As far as shortness of breath, I think you have to live with it. An get yourself in the best possible physical share. I was a marathon runner before the pacemaker but still have shortness of breath after the implant. I learned to accept it and do the best I can. My doctor tell me my heart is in good shape, it's just that one side is unable to communicate with the other.

Good luck, I hope this was of some help


I was thinking it could be your rate response too

by heckboy - 2021-01-25 13:23:35

I tweaked my settings quite a bit in the beginningand rember jumping up off the couch to get snack and my heartfelt like to was going to jump out of my chest.



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