New PM muscle twitch/spasm with each heartbeat

Hi. I just received my first PM, a Medtronic Percepta Quad biventricular 3 lead CRT-P device. It was implanted this past Wednesday, Sept 22nd. Since I woke from the surgery, I have noticed that every heartbeat causes my abdomen and chest to twitch or jump. I had mentioned this to the nurses while I was in the hospital, and none of them seemed concerned. Today, after poking around online, I don't think it's normal. So I contacted my EP this moring to ask if this was normal thing or not and he is having me come into the clinic tomorrow. I wonder if this is just me being overly sensitive to actually feeling my heartbeat now, or if there is a problem. I've dealt with bradycardia for so long that I am just not used to having a steady 60bpm and the lbbb was pretty severe pre-implant, so my ventricles were beating so far out of sync they weren't pushing much blood. Any others have this and is it normal? Is a lead out of place? Is there just a setting to change on my device? Thanks in advance for the help.

BTW I am a 59 year old male with lbbb, bradycardia, and NYHA class 3 stage c heart failure.


7 Comments

leads

by Tracey_E - 2021-09-26 13:06:26

If you have had a slow rate all your life, it will take some time for 60 to feel like it's not racy! My rate was never above the low 40's, and dropped lower than that in the months before I got my first pacer. It took a good 6 months before it didn't feel like I was racing and aware of every beat. 

However, twitching/jumping is not normal. When something doesn't seem right, don't be shy about pushing and going to the doctor with it. Nurses and techs are great, but they don't know everything. It's possible they can adjust the settings so it stops. If that doesn't get it, it may be that one of the leads is not in a good position and may need to be moved. If that's the case, sooner is better than later. 

 

PM Muscle Twitch

by Chapter - 2021-09-26 14:49:26

Superglide, I am happy to finally feel like I have something to contribute in this club.

When I got my first PM in 2017 it was for Bradycardia.  It wasn't very long before I started feeling exactly what you are describing.  I told my GP, my Cardiologist, my Pacemaker Tech and family and firiends, I think I even posted it on here.  It was very obvious and visible, I called it my baby kick.  My Tech tried very hard to reproduce in clinic with no luck.  The kick was very positional, could not sleep on left side, my husband could feel it in bed and would tell me to rollover.  OK try to make a long story short, after almost two years I was in heart failure from Pacer Syndrome and had to be switched to a CRT-P.  The day after surgery my daughter wanted to take me to ER because she could not believe what she was seeing.  From August '19 until April '21 I mentioned my very strong baby kick at every appointment.  One day before my appointment in April I took a video of my baby kick while sitting on couch.  At appointment when I again mentioned kick, my EP started talking about trying to induce it but instead I showed him my video and he said, Yes, For sure that is Phrenic Nerve stimulation.  He had mentioned it in passing before but didn't take it to seriously.  This time he was impressed and made adjustments and turned down voltage a bit on left ventricle lead.  It did make difference for me, I still have some stimulation but not as strong and obvious as before.  Sometimes I wake up in night and realize I am not breathing right because every heart beat - at 60 BPM interrupts my breathing, I have to rollover.

One thing I don't understand is I have had baby kick since first pacer, so why did he turn down left lead?  Anyway, that is my story, apparently we are not suppose to worry about it.

Chapter 🌹

Twitch

by Old male - 2021-09-26 23:16:54

7 years ago had my 1st ICD implant for Ventricular Tachycardia diagnosis.  A few days later I noticed a visible twitch inside left elbow forearm muscle that would last maybe 30 seconds then stop.  This went on for a couple of days and I reported to my Cardiologist.  Nurse mentioned a possible lead issue.  It was random in occurrence but perfectly timed with my heart rate.  Of course when you want to show someone, it won't happen.  Finally I was able to video the event with cell phone.  However, it never happened again.  Apparently the issue cleared up.  Had to have new ICD this past March due to battery depletion.  During the procedure, they tested my 2 leads and said both were good and didn't need replacement so I just got a new device.  All is well since.  

No fun!

by Mae11 - 2021-09-27 11:33:10

I went through a very similar ordeal, and it was no fun. I too told the nurses in the hospital and they shrugged it off ad muscle spasms and gave me Flexoril. 

By the end of the week I knew something had to be related to the surgery. I called and was seen later that afternoon.

They were able to cause it in office, and said that they had to go back in and relocate one of my leads. They called it diaphragmatic stimulation.

Surgery was the following Monday to relocate my RA lead. It was a pain in the butt, and even more frustrating to not be listened to in the hospital. So sorry you are going through this, but like Tracy said, they will fix it either by tweaking some settings or relocating the lead. 

Best of luck! 

muscle twitching

by Julros - 2021-09-27 12:24:23

From what I have read, the LV lead is pretty notorious for causing diaphragmatic stimulation, because of its location close to the phrenic nerve. The good news is that there are usually enough prorgamming options to eliminate that stimulation.

My LV lead is quadripolar, and according to the pacer rep he has up to 16 different settings to choose from. He was able to find to correct one in about 5 minutes. 

The office wasn't able to make this adjustment initailly because they said the vein that the lead was in was so big that the lead was floating and they needed to wait for it to scar into place. After that they tried decrease the output, which helped a little, and then made the final tweek. 

Much better!

by SuperGlide - 2021-09-27 18:02:37

Thanks everyone! I went to the EP pacer clinic today. The tech ran through a series of tests and was able to find a vector that worked for me. It was diaphragmatic stimulation with the phrenic nerve involved. Took about 10 minutes and I was so much better! I go back in a couple days to have my staples out and they will recheck things at that time. It feels so much better to not have my abdomen beating like it had a heart of it's own!

 

twitch here too

by Alexander - 2021-10-13 11:06:31

Hi,

I am a week into my ICD implant and I have this twitch as well. It's a bit startling and was starting to think there was something wrong with the leads. I am going to see my EP on the 24th and hopefully they can do something for me.

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