Do I need to see an Electrophysiologist?

My resting heart rate was in the low 50's for over 15 years.  But, I was always told that it was ok for it to be low, so long as the heart rate goes up appropriately during the day. (I had several occasions of wearing holster monitors, etc... over the years). 

My cardiologist implanted a loop recorder, this past September, and based on it's readings, said that my HR was not going up like it should during the day. So, less than two months after getting the loop, the loop was taken out, and a 2 lead pacemaker was put in.  I have never been given a reason for any of my issues.  No heart defects, etc...  

I also have congestive heart failure, with a very elevated wedge pressure.  Also, no explanation, other than I am overweight. This has also caused mild Pulmonary Hypertension. 

Any way, my heart rate is set to 60.  I do not feel any better since getting the pacemaker. In fact, I have been pretty miserable from it, I am still suffering from frozen shoulder, (physical therapy for this was just started today), and the site itches like crazy at times.  I was told that it paces me about 40% of the time. But, I do not feel even the slightest bit of improvement,

I have two questions, is the heart rate being set to 60, normal?  I feel like it might help me feel better if that was raised.

Also, I only see a cardiologist.  Do I need to try and find an electrophysiologist?  I never even heard of this , until reading on this forum. 


Yes.You should see an EP

by seenu302 - 2021-03-25 23:18:20

Electrophysiologist or EP's are specialized experts in arrythmias and in my opinion they should be doing PM placement surgeries.Based on what I have read on this forum, looks like some cardiologists do it too but why not go to an expert (EP) instead of a generalist. EP's offices are more equipped to deal with all aspects of devices.This is my experience based in Dallas TX. 


by AgentX86 - 2021-03-25 23:42:11

Many cardiologists implant pacemakers (usually known as "Intervential Cardiologists") and monitor these patients.  My cardiologist does this regularly but he's also knows when he's over his head.  He referred me to an EP well before I needed a PM. 

After six months, if you're still feeling badly, yes, I'd want to go to a specialist's specialist (EPs are cardiologists who have done two additional years residency in electrophysiology).  Go to the best EP that you can find.  It does make a difference.


by Tracey_E - 2021-03-26 10:28:42

I would say it all depends on the cardiologist, some have more experience with pacers than others. Most ep's will adjust the pacer themselves, cardiologists tend to not be that specialized and either have a staff member trained to do it or bring in the manufacturer's rep.  Cardiologists are primarily plumbers where ep's are electricians. When I was first diagnosed, ep wasn't a thing so I always had a cardiologist until a few years ago. My cardiologist was excellent, the rep who did my pacer settings was outstanding, and I was happy with his care. I see an ep now, but making the change had nothing to do with not being happy with the care I was getting. 

Most electrical problems happen at random in an otherwise healthy heart and we never know why it happened. 

60 is fairly normal but if you'd like to try it higher, just ask. If your problem was your rate going up on activity, and you aren't feeling better, it sounds like perhaps your rate response needs adjusted. Rate response is the feature on the pacer that gets our rate up for us on exertion. It's common to take a few tries to get it just right for us. They start with a good guess then go from there. Never be shy about telling them if you aren't feeling better, there is usually a fix.

Itching, keep it moisturized. Make sure whatever you use is all natural, no added preservatives or other chemicals. I like vitamin e but coconut oil, aloe, cocoa butter will all work. Just make sure it's pure. 


by Marybird - 2021-03-26 10:45:55


I'd have to second, third or 4th hand the suggestion that you see an EP for the pacemaker issues you mention.  From what I have seen and experienced it seems to me the EPs are better equipped by virtue of training, experience to customize and optimize the settings on your pacemaker for your best everyday well-being, and activity levels. Interventional cardiologists may implant and manage pacemakers, but when you need a little more help than your cardiologist can provide, the EP is your best bet- it's his/her field of expertise. Your cardiologist can refer you to an EP if you indicate you'd like to go that route.

The other thing is that EPs are cardiologists too, so they can also address some of  your other cardiac issues- especially if they're secondary to your "electrical issues, such as the CHF, hypertension, or work with your cardiologist in this regard.

Hopefully you can find a good EP that can help you. I know it's miserable to feel lousy, have something done meant to improve things, and you end up feeling worse. 

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