Low Heart Rate

Past problems 
October 2016 – Implantation of Reveal device
Postural hypotension
Paroxysmal run of narrow complex tachycardia, possibly atrial fibrillation – longest episode was only 28 beats
No absolute indication for anticoagulation
August 2017 – Ventricular standstill (16 seconds pause) August 2017 – Implantation of dual chamber Pacemaker 

Hi I'm three and a half years post pacemaker. Recently had a remote pacemaker check. EP tells me everything is ok and sent report to my cardiologist who didn't even send me a letter nor comment on report?  I still get a lot of palpitations at times and out shopping today just walking around my Apple Watch recorded my heartbeat going from 28 to 107  in the period of one hour between 2 and 3pm Does the lower figure seem a bit alarming? I have never seen this before?? Not sure whether to report or not? 
thanks any advice welcome 




Low heart rate

by AgentX86 - 2021-04-13 23:31:16

Yes, report it but it's probably not a big deal at all.  This is most likely a run of PVCs or bigeminal PVCs.   This isn't all that uncommon and is rarely dangerous.  If it's indeed a long run your pacemaker may see it, if so programmed.  If not, it won't.  If, instead of a run, it's random PVCs or bigeminal, trigeminal,... it's very unlikey your PM will (or can) record the episode. If you can, do a remote transmission while this is happening.  Your EP will be able to identify the trouble immediately.

Don't trust watches, particularly with arrhythmias.  Always count your pulse manually.  You'll be able to feel most arrhythmias, as well.  Watches just get confused.

What's likely happening is that you get a heartbeat, or a few, then a PVC (premature ventricular contraction), which delays the next beat.  The PVC is a beat but the ventricle isn't completely filled so is a weak beat.  This weak beat may not be registered by the watch.  You'll be able to feel this as a "skipped" beat (again, it's not skipped at all).


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As for my pacemaker (almost 7 years old) I like to think of it in the terms of the old Timex commercial - takes a licking and keeps on ticking.