My heart speeds up for no reason!

Hello and Good health to All!

I am 40 years old female. Two months ago I had a presyncope episode and was diagnosed with high degree AV block. So I had pacemaker implanted immediately.

I was feeling quit ok until my 6 weeks check up. After that I started feeling strange palpitations. While resting, my heart speeds up from 60-70 beats to 100 beats per minute and stays there for about 2 minutes everytime. My heart skips beats during that time and it feels very uncomfortable. I have many of these episodes during one day but they get much worse at night especially when lying down. I wear a smartwatch and I can see that these episodes are recorded during sleep also. At first I thought it was the self test pacemakers do but these should happen only once per day.

Has anyone else heard of this or experienced it?Anyone got any thoughts?

Thank you!!


I would ring your clinic

by Gemita - 2021-01-25 17:09:52

Hello Mtheo,

I am sorry to hear about your difficulties.  I am wondering if they changed any of your settings during your last pacemaker check?  You could always call them and explain what is happening.  Do you have home monitoring?

I think you mean your heart rate increases to 100 bpm (beats per minute not beats per second).  100 bpm and above would be tachycardia but only just.  The skipped beats may be ectopic beats leading to tachycardia symptoms/episodes.  I can get these often but then I do have diagnosed arrhythmias.  Do you have any arrhythmias?  They may decide to monitor you for an arrhythmia.  However since you only noticed your symptoms after your last check it makes me think they may have changed one of your settings.  Quickest solution, would be to ring them.  Good luck.  It is miserable I well know especially when it happens at night

I already did ring my clinic

by mtheo - 2021-01-26 03:44:45

Hello Gemita! Thank you so much for your answer!

I arleady talked to my Dr. and he believes its a kind of arrytmia and not something that the pacemaker is doing. I took meds for one week and got worse!

I did have some ectopic beats before the pacemaker, not very often thouth, wich never lead to tachycardia!  I had 2 times 24 holder some days before the pacemaker implantation and didn;t show any arrythmia.

On the other hand, now my episodes are daily and non stop during night. I dont have a monitor at home. I just feel it and i do have a smatwatch that records my episodes. I double check it counting manualy my pulse. The strange thing is that the records show everytime the same trend! My heart beat elevates to 100 beats and stops there everytime! Always the same! This makes me feel that is something going on with the pacemaker....

I am a new pacer of course and I dont undestant may things yet.

Could this be a Pacemaker-mediated tachycardia or something similar?

I am so much hoping that it is just a setting that can be fixed!

All the best!!!!

Yes I too thought could my tachy symptoms be pacemaker mediated

by Gemita - 2021-01-26 05:56:48

Hello Mtheo,

When I first got my pacemaker something similar happened to me, particular at night and went on for several months.  I even posted here about it (under nocturnal tachycardia) and wondered the same as you.  i did have home monitoring and nightly downloads/checks were being made.

It just seems strange that you were okay for six weeks and then you started noticing it after your last check.  If you find out they changed any settings, you could ask for them to be put back to what they were to see whether your symptoms stop?  They could try at least.  It seems so strange that the tachycardia only goes to 100 bpm every time before stopping, not at all a sign of a natural arrhythmia.  More like computer made.  My arrhythmias don't do limits, they stop, start, crash, surge - are totally unpredictable.

I would recommend some good longer term monitoring if this doesn't stop. Your clinic may offer this.  Alternatively some of us have invested in Kardia Mobile and send transmissions to our clinics when we get symptoms. I use a good blood pressure monitor to confirm tachycardia, although from neck pulse I can usually feel myself racing.  Home monitors can often error and fail to adequately or accurately capture an arrhythmia, especially if it is irregular.  They cope better with a regular rhythm.

Please let us know what you find out

Unlikely to be PMT...

by crustyg - 2021-01-26 05:59:14

Pacemaker mediated tachycardia is enabled by retrograde conduction at the AV-node.  A ventricular electrical activation travels 'backwards' through the AV-node (V=>A) and is sensed by the A-lead to the PM, which then faithfully replicates the A-activation (that it has sensed 'incorrectly') to the ventricular lead - and that activation travels backwards up through the AV-node and the problem can become self-sustaining.

Except that a) PMs are very carefully designed to avoid this, b) it requires a working AV-node, which you don't have.

And, as Gemita has pointed out, 100BPM isn't really a tachycardia, it's just a raised HR.

My *guess* is that you have a natural escape rhythm - some cells below the block in your AV-node generate their own activation, and that this is driving your vent-rate.  The AV-node is well supplied with nerves (part of fight-or-flight) and although you say you are resting when this happens, there may be emotional effects driving these cells.  I have exactly the same issue (for a different reason, no SA-node function) particularly waking from a dream - my AV-node drives my HR up to about 115BPM, completely out of sync with my A-paced PM rhythm, and it's chaotic for a few seconds, until I calm down, and go back to sleep.


by mtheo - 2021-01-29 11:07:54

Hello all!

Thank u so much Gemita and crustyg for your answers! 

After being very frustrating about my speed up heart beats and because the clinic I had my pacemaker implanted is located in another town, I decided to visit a local cardiologist that is familiar with pacemakers. So, it seems Gemita was right! It is computer made. Rate drop response is the reason for this tachycardia. Rate Drop Response (RDR) is intended to provide backup pacing and prevent associated symptoms in patients who experience occasional episodes of significant drop in heart rate. So, some parameters were changed to make this function less sensitive and now I am feeling much better. I still have some episodes but I can finally have some sleep at night!

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