Pacemaker - now or wait!

Hello,  I hope it was OK that I joined before I had my pacemaker surgery.  I wanted to get some opinions, please.    Dr. said I could wait 5 to 8 years before having it done. Dr. asked my opinion about waiting and I mentioned that it crossed my mind maybe I should have done sooner while I am younger (65) rather than waiting til almost 75 plus it should help with my episodes of being tired by pulse is low or BP is low.  Dr. said "OK, we can schedule it for next month!"  I was surprised becasue before it was " let's wait.  Your are not fainting or passing out".   .  Diagnosed with sinus node dysfunction (without chronotropic incompetence on ETT) - not on AVN blocking agents, PACs, bursts of atrial tachycardia, and a preserved LVEF on echocardiogram and bradycardia.  Also now with the up tick in Covid cases I wonder should I have it done now or wait, too? Opinions and thoughts, please?  Thank you!


9 Comments

Should I or shouldn't I

by AgentX86 - 2021-08-24 22:22:03

A pacemaker is unlikely to solve your low BP but will fix the rate.  You don't mention what that is.  A low BP will certainly make you lethargic but not necessarily a low heart rate, within reason. Your atrial arrhythmias are unlikely to be fixed by just a pacemaker either. I think I might ask for a second opinion on this one.

As far a covid goes, I wouldn't think about it for a minute.  Hospitals have gotten quite good at isolating covid patients from others (the one I go to kept ebola patients isolated). It might be worth asking what precautions are being taken and how the isolation works.  They often have completely separate HVAC systems, different floors, and different personnel. The surgery is about as simple as surgeries get so isn't usually done in an operating theater at all.  It's normally done in the cardiac cath lab. Ask if you're really concerned.

Should I ?

by disneyfan - 2021-08-25 01:04:46

Thank you for your response.  Yes, it is true that the pacemaker won't resolve my BP issues, but Dr. said once I have pacemaker, she can treat blood pressure more aggressively with different medications.   I think it is a great idea to get a second opinion!   I will do that!  Thank you for easing my mind regarding covid too!  

Have it done!

by crustyg - 2021-08-25 11:44:10

I'm always curious when folk who say that they have Sick Sinus Syndrome go on to say 'but no CI'.  The only way that makes sense to my mind is if you have a reasonable escape rhythm at the AV-node or thereabouts, so that even though your natural pacemaker - the SA-node - is failing, you can still raise your HR in response to additional needs.

Whatever process is damaging your SA-node is likely to be progressive, so your resting HR is likely to carry on declining.  Don't be a twit like me and boast to your athletic chums about how low your resting HR is (as a marker of how fit you are) - because it's not really a marker of health at all.  At PM implantation my true resting HR was about 42BPM, and when we turned my PM off in March 2020 (for an MRI, and as a check) my resting HR was 28BPM, so my SA-node is completely gone.  All from AV-node, and that means no A=>V synchrony so reduced cardiac output when demand increases.  And that AV-node escape rhythm may fail.  The reason why your doc has started suggesting getting the PM done now is because a) he knows that the SA-node failure will get worse, b) that accumulated evidence shows that, each year, a very small proportion of patients (like me) who rely on their escape rhythm discover that this also fails => Game Over.  Now I have an atrial-pacing PM.  You should have this too.

Despite all the nonsense from DANPACE, there is still a valid argument for RA-pacing-only those folk with healthy heart muscle but a failing/failed SA-node.  By all means accept a dual-chamber, dual-lead PM, but get it set to AAI with or without Rate response.

Is it time for a pacemaker?

by Gotrhythm - 2021-08-25 12:46:02

Nobody should get a pacemaker they really don't need, but on the other hand, if you need one, even just sort of, there's no reason to wait.

With hindsight, I can see that I would have benefitted from a pacemaker at least 10 years before I got one. No, I never passed out, but when I think of the movies I fell asleep in the middle of, the parties I was just too tired to enjoy, and the times I emotionally beat myself up for not participating, for not getting things done, for not keeping my focus...I know now that those things were happening when my heart rate would drop.

I can't make any predictions about your blood pressure, but mine was running between low and very low. Post pacemaker, it did go up to 120/70.

A pacemaker is still just a machine. It's not the same thing as having a normal sinus node, but it can give you a steady, reliable heart rate, and one that's actually fast enough--not just to keep you alive--but fast enough to support having a whale of a good time!

Why would you want to put that off?

Pacemaker

by disneyfan - 2021-08-25 15:23:19

I appreciate the comments regarding having PM done now rather than wating.  You both made great points!  Due to your points, I will go ahead and schedule my PM surgery.  Thank you!

A few questions regarding pacemaker surgery....after surgery, adjustments are made, etc. how often do you have to get checked (batteries, PM itself, etc.)?  Do they ask you which side you want the pacemaker on?  If they do, does it matter which side?  Is there anything you wish you new before you got your pacemaker?  Is there any restrictions you didn't expect?  Anything else you would care to share regarding your procdure, recovery and life with PM?  

How often?

by AgentX86 - 2021-08-25 20:14:41

For the first year, I had an in-office pacemaker interrogation every three months. After that, the scedule has been more like to in-clinic interrogations a year and two remote, unless I thought I needed a settings tweak. If there is something I didn't like, I scedule an appointment anytime. To tell you the truth, everything has been so smooth that I forget about it. I notice my clock being off during DST but don't bother to have it reset anymore. As you get closer to the battery's EOL, they'll want to check it more closely.

They're almost always placed on the left side. It's easier to get into the rignt atrium from there. /i, for some reason that's not possible (e.g PM already removed because of an infection), it certainly can be put on te right. I've hesrd of south-paws having it put on the right so they can continue with their shooting sports (a 12ga. recoil to the PM would not be fun).

My recovery was so drama-free that I could only wish everyone the same. I felt infinetly better before I left the recovery room.  While I did stay overnight and they fed me pain killers, I don't think I really needed them. I filled a prescrition for vicodin but didn't even open the bottle.  I've really only had a few hickups since.

The only restriction I didn't expect (and amazes those here) is no lawn tractors! This is being enforced by SWMBO. Or darn! I can't mow the lawn anymore. I can use other tools but specifially lawn tractors (you're sitting on the alternator).  Welding, I knew about but don't really care (I work with wood). There are some things that don't quite work as I expected.  Stairs can be a problem as is moving heavy objects (wightlifting would be problematic). My pacemaker doesn't know I need more oxygen to do the work so I try to suck more air, which doesn't help.

Over-all it was the best thing that's happened to me in a long time.  It gave me back my life (it wasn't really the PM that did it but it was a necessary component).

age

by new to pace.... - 2021-08-26 05:07:06

Age does not make any difference, as i had my pacemaker implanted at 79.  No Dr. mentioned i needed it before then.   Now that i know why wish someone had said something. 

  Now it prevents my falls.  As my right leg would stop.  then when i started walking again would start with a lurch then fall.  Would have saved many fractured bones.  The slow heart beat with the pause.

Wish I'd known

by Gotrhythm - 2021-08-26 15:34:02

A couple of things I wish I had known:

It's practically impossible to damage a pacemaker. Any misadventure that would damage the pacemaker would kill you as it happened.

Once the pacemaker is healed into place, it's practically impossible to accidentally dislodge either the pacemaker or the leads (wires.)

Pacemakers are adjustable. It's shocking how many people have pacemakers that are still on the out-of-the-box, one size fits all settings. Settings that will keep you alive and able to walk across a room, but probably won't support vigorous exercise. In many cases RR has never even been turned on much less tuned to an individual's needs. 

Insist on a "settings" appointment after you'll all healed up. Don't settle for "okay" or "getting by." Don't believe the HR must be set at 60BPM to "conserve battery." Small changes can make a big difference in how you feel.

Do learn all you can about your pacemaker and it's functions.  Do not assume the doctors, nurses and techs will tell you all you need to know. It's your pacemaker and your life. And ultimately, it's you who will live with the consequences of anything that's done whether good or bad.

Thank You!

by disneyfan - 2021-08-29 14:38:43

Thank you all for answering my questions!  I appreciate all the advise, information and personal experiences you have shared!  

You know you're wired when...

You have a $50,000 chest.

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