I've officially joined the PM club!

Hi, I had a CHB (3rd degree block), and I've got my PM inserted yesterday. On the operating table, the surgeon said that he would suggest using a "his bundle" pacemaker but I could opt for the more traditional pacemaker that he said is usually for "old people".

He gave me the pros and cons: HB pacing is more accurate so it is better for my heart long term, but the cons is that the lead is more prone to failure and therefore could require a replacement sooner. The procedure for the lead replacement, could be easy if it hasn't 'set' in place, or it could involve a more serious procedure, which he said needed to be done at a different hospital later on.

Anyhow, not having researched this, and not having much time to think, I opted for a his bundle pacer. The op took 2 hrs. I remember he was testing several different spots for the lead, whilst asking about the data from someone else, forgot what it was - milivolts or something.

The pacer that I got was a medtronic, but I don't know the model number or anything else. They gave me a monitoring device to take home.

I stayed overnight at the hospital. My chest was sore, maybe more from the pressure bandage they put on to keep the PM in place. Now that I'm home and all the extra stuff removed (the cannula was annoying), I am feeling better. I was given a course of antibiotics, and I take paracetamol (acetaminophen) for the pain, although it's not as bad anymore.

I was told not to shower for 1 week or 2 so as not to wet the dressing / waterproof bandage. Not to lift the left arm higher than the shoulder for 6-12 weeks. Not to lift anything heavy for 6+ weeks.

I'm being very careful with my left arm. Every bit of movement causes a bit of pull on the wound, but it seems to get better over time.

I have heard about people here saying that they instantly feel so much better after the op. It might be early days yet, but I do not feel any different to before.

My HB was 36-42, now at rest / sleep it is around 52-60 and rest sitting is around 60-62. I might get one of those blood pressure thingy to check my heart rate just out of curiosity.

They said that my blood pressure is slightly higher than normal. It used to be normal. 

Now I enter a new life with a pacemaker. I try not to think about the future PM or lead replacements. They told me I get to go first on plane queues if I showed them my PM card.


9 Comments

Slightly odd but pleased for you

by crustyg - 2021-01-22 16:23:36

Most folk would expect to have the 'where shall I put the pacing wire' conversation a litle earlier than whilst on the OR table.  And if you've had any sedation (instead of only local) then you're hardly in a position to contribute a lot to the discussion.

For someone with CCHB the difference should be obvious as soon as you start to exert yourself - perhaps walking briskly up a flight of stairs.

But rather than watching yourself every minute of every day from now on, looking for signs of 'Is it better yet?', I'd urge you to focus on living your life.  Life's for living and there's no time to lose, no Second Act, so while you *do* need to protect that skin incision until it's properly healed, you can get going, be active, run, skip, jump and look to the future.

Sorry to burst the bubble - having a PM really doesn't get you on any aeroplanes first!  Airport security won't find it with their metal-detecting arch, or the scan-under-your-clothes millimetric radar scanner. The hand-held wands *will* detect it and as soon as they beep, tell them it's a PM - they should move the wand away very quickly.  But you're unlucky if you get the hand-wand examination.

Happy for you.

PM

by Persephone - 2021-01-22 16:39:58

Hi Koala - glad to hear things are going well and you're feeling better. Just a thought that you could ask your doctor for shoulder mobility exercises that you can safely do during your period of arm lifting restrictions.  Up to 12 weeks is a long time.  With regard to the comment about your blood pressure, perhaps let things settle down a bit and focus on your recovery, then you can see where the BP is. If the doc used terms like "slightly higher", it sounds as if they are not very concerned about it at this time.

Best wishes for continuing to feel better with each day.

Bundle of His

by AgentX86 - 2021-01-22 17:27:21

Bundle of His lead placement is superrior but it's a difficult procedure and more prone to failure.  If your EP can do it, it's the way to go, IMO.

The model (and serial) number of your pacemaker will be on the card they should have given you.  In a few days or a couple of weeks you should get a plastic, credit card style, permanent card with all of the information on it.  No, you won't get seated first and, really, no one will care about it.  Keep it on you in case it's needed, though.  You might think about medial alert jewelry warning about the pacemaker.  EMTs might need to know about it.  It might get you priority in the ER too, but don't count on it.

A week or two without a shower seems quite excessive but listen to your doctors.  I was told 48 hours and not to get it wet.  I didn't even go a week after my sternotomy and was just told not to spray directly on the wound.  If I went a week, I think my wife would move out.  ;-)

Even if you feel a pull, you have to keep moving that shoulder.  You can give it a day or two then try to use it normally, following the restrictions given by your EP of course.  If you don't move it for the next weeks, you risk "frozen shoulder" which is quite painful and the physical therapy you'll be going through, even more so.  Do NOT use a sling for any length of time.  I used one for an hour or two a day, for the first week, when I while doing my walking.

It's great that you're doing so well, so fast.  Many of us have been there but many aren't as fortunate, either.  You shouldn't obsess about your PM.  There is no reason to constantly check your heart rate or blood pressure.  If you get curious, just feel it yourself.  No need for fancy gimicks.  If you have other rhythm disorders you  might want to invest in tools that will allow you to show your doctors what's going on.  Their EKG can only show a smapshot and can't see intermittent problems.  Otherwise do (almost) anything a normal indivirual would do (e.g. take your BP once a day, go mountain climbing, or jump out of perfectly good airplanes). Your pacemaker isn't you.  It doesn't define you in any way, including jumping queues.  ;-)

bundle of his

by koala - 2021-01-22 21:35:23

With the pacing on the bundle of his, do they still use the same pacer device as they would with the other, more common placement of dual lead pacing?

Bundle of His?

by AgentX86 - 2021-01-23 00:56:55

Not sure what you're asking but it's the same generator as a two lead PM.  It's not a CRT pacemaker.  The ventricle lead is inserted into the bundle of His, instead of one of the more typical places.  The idea is to use the heart's own nerves rather than artifical pacing.  The theory is that "normal is better". 

In theory, reality and theory are the same.  In reality, they aren't.

Living on

by Gotrhythm - 2021-01-23 17:38:01

It sounds to me like you're doing some second-guessing, maybe accompanied by a lack of real facts.

First of all, as Agent86 says, His bundle pacing (HBP) is superior to the more common 2-wire or 3-wire. The way your heart beats is much closer to normal, which means that your heart contracts more efficiently. It moves the blood better with less work. Let me add that because you have only one wire versus two or theree, the danger of a lead breaking or dislodging is reduced by 1/2 to 2/3. 

I understand that you feel like you chose HBP without having time to get the facts and weigh them for yourself. So, get some facts now. I urge you to do some internet research on HBP. Clear, easy to understand articles are easy to find, and you can even see videos about it on Youtube. I think if you could see for yourself the difference in how your heart is contracting versus the uneven contractions produced by 2-lead pacing, you would sell yourself on His-bundle pacing.

I don't know what the actual, statistical likelihood might be of the lead dislodging. I feel sure your doctor thought the benefits of HBP outweighed the possibility of problems with leads arising at some future date.

When you do your own researh, if you're not sure you comprehend the meaning of any scientific articles you might discover, we have members who are medical doctors, pacemaker techs, and other accomplished people who will help you sort it out.

You're at the start of living better. You now have the possibility of living longer and better than you could have hoped for without the pacemaker.

number of wires?

by koala - 2021-01-23 20:32:45

Thanks Gotrythm! I didn't know that his-bundle pacing only requires one lead to the heart, and i didn't know that it's still the same controller/generator/pacemaker device, just a different placement of the lead, and possibly a different type of lead.

I tried googling but so far only found highly technical science papers full of jargons I do not understand.

Number of wires

by AgentX86 - 2021-01-24 13:37:22

Just to clarify, there are usually two leads, even for a pacemaker with a lead into the  bundle of His. There is usually a lead in the RA as well.

Go to Youtube

by Gotrhythm - 2021-01-24 15:21:44

Thanks for the clarification, Agent. It's been a while since I looked it up and didn't remember that.

Koala, glad I could help. Try the internet again. I didn't take the time to look at them all, but I found, at a glance, 11 different Youtube videos on the subject of His bundle pacing. I highly recommend Youtube for quick, accurate, easy to understand explanations, pictures and diagrams, suitable for the lay person. No heavy reading required. If one isn't what you're looking for, it's quick and simple to just click on the next one.

Someone has said, "Knowledge is power." You're going to be dealing with medical professionals on the subject of your pacemaker for the rest of your life. Trust me when I say, the more you know about the subject, the more respect you will get, and the more complete answers you will get to any questions you might ask.

You know you're wired when...

Bad hair days can be blamed on your device shorting out.

Member Quotes

I've seen many posts about people being concerned about exercise after having a device so thought I would let you know that yesterday I raced my first marathon since having my pacemaker fitted in fall 2004.