Pacemaker adjustment

LIGHTHEADEDNESS

by Gemita - 2021-03-20 14:43:45

Hello Linnie,

I am working at 70 bpm day and night and loving it.  If they try to touch my HR I would not be happy.  I am so glad you are more comfortable with your lower HR and that your breathlessness has eased.

The lightheadedness, if it is new, could certainly be from the lower rates, although it could also be from a fall in blood pressure which of course is not controlled by the pacemaker.  Make sure you drink plenty of fluids and get up slowly from a lying/sitting position to a standing position.   Feel your pulse when you come over lightheaded and see whether you have a regular, or irregular pulse since it is possible that a heart rate change may make ectopic beats worse and these irregular rhythms can certainly cause a bit of lightheadedness for me if they are frequent and prolonged.

I would not be too concerned providing your pulse is steady but check your blood pressure with a monitor when you feel the symptoms.  If your blood pressure is low (or indeed high?) one of these extremes could be the reason for lightheadedness.  I am sure however that your symptoms will ease as you get used to the lower rates.  It is possible that a change in heart rate has affected your blood pressure.

I see you are only operating on one lead because your sinus node was damaged during an ablation.  

If the lightheadedness continues do consult your general doctor or pacing clinic for advice and some additional checks.  If you are on medication, they may wish to review your meds for example and to check your blood glucose levels to ensure all is well (which I am sure it is).  Good luck

Pacemaker adjustment

by Linnie - 2021-03-20 16:07:24

Thank you Gemita!

I've noticed that since the adjustment my pulse is a little high when active. 104 walking across the room, dropping 90-61 when I sit down. I am a hiker, 67 years old, living at 6200' in Colorado and before my ablations, my resting pulse was 56. I was always able to hike 3-6 miles and after the PM I am limited to 2 miles with my legs feeling very heavy towards the end of the hike and I was short of breath. Very fatigued every day. I had asked my EP yesterday if the 70 BPM he set me at was keeping me from getting a restful sleep. He made the adjustments yesterday. When I woke up this morning, my pulse was 53 and I felt very rested. After 6AM it went up to 67. The lightheadedness is not making me truly dizzy,  I just feel like I have a fog around me. My BP was 110/70 pulse 64 this morning. Which is fairly normal for me. Not on any meds except thyroid. He checked those blood parameters yesterday and they are all normal. I'm hoping this foginess will pass.

My ablations were needed because of an atrial septal defect repair done in 1972 had caused me to have atrial flutter from the scarring in my heart. My first ablation, 3 years ago, I had a 364 pulse on top and a 64 on the bottom. (3 pathways) Second ablation, June 2020, was because the electrial activity found a new pathway and I was up to 186 pulse and 64 on the bottom. He said he made a speed bump all along the ASD scar to keep any new pathways from forming, but after that ablation, my pulse went down to 43 during the day and even lower at night. Then my pulse would stop intermittingly and the PM was needed. He said the sinus node had been clipped. I am new to this page and it looks like a great place to have common questions answered. Thank you!

Sinus node

by AgentX86 - 2021-03-20 22:05:21

This all makes sense now.  Your EP likely set a night time mode on your PM to turn it back to 50bpm at night and something above that during the day.  My EP did that, too, so that I could sleep better.  My sleeping HR was on the 40s and and daytime in the 50s.  He originally set it to a flat 80bpm.  After complaning, he set the night mode (12:00 to 6:00AM at my request) to 50bpm and a daytime resting heart rate to 80bpm (longer story).  I can now sleep and function.

Since you, too, are chronotropically incompetent ( heart rate doesn't vary because your SI node damaged) your EP has undoubtably turned your Rate Response on.  This can be a really tricky group of settings to get right.  What RR does is to attempt to mimic the function of the SI node that regulates heart rate depending on the oxygen demand of the body.  The PM doesn't have access to your blood and can't measure its oxygen content.  Depending on the PM, the only information it may have is motion, assuming motion = exertion.  Well, it doesn't take much exertion to drive down a bumpy road.  This fakes out the PM and the rate can go nuts, interestingly, causing breathlessness.  It's counterintuitive that more oxygen (higher heart rate) would cause lightheadness but it does. 

It takes some time to get used to RR and often a lot of work tuning the settings to get a compromise that you can live with.  It's easy to set for couch potatoes and, really, that probably describes 80% of the people your EP sees. FOr active people, it may take some time and perserverence to get it right.  Make sure they don't blow you off.  It is important to your quality of life and there is no reason that it can't be done.

Sinus Node

by Linnie - 2021-03-24 14:31:54

That explains so much. I have been waking up at odd times during the night-1:30 or 4:30 and I feel my heart racing. I reach over and take my pulse and it is at 90. Could it be just turning over in bed caused the HRR to respond? Maybe it is set too sensitive? I noticed that when my pulse is up during the day, 115 after walking down the hall, I take my BP and it is low. 95/71. Right now, both EP's are off for spring break so he said I would have to wait to get it adjusted for a week. But maybe that gives me time to adjust? I want to get back to hiking, but I'm fearful with my pulse going so high and lightneadedness, just walking around the house.