Hi All, not been on for a while. Annual PM check up today (2nd degree heart block diagnosed 2017). Technician thinks I might be having episodes of possible PSVT. Been feeling tired, drained, dizzy, brain fog, not sleeping....PM check showed episode of possible PSVT for 20mins, BPM can this be as I have a dual lead PM that is supposed to pace when things are wrong?? Now on Holter monitor for next 3 days and see what happens after that. Any advice??


Paroxysmal Supraventricular Tachycardia (PSVT)

by Gemita - 2021-10-04 19:11:17

Hello GNR,

I am not surprised you are feeling dizzy with brain fog and other symptoms with intermittent high heart rates nearing 200 bpm.  If three days of holter monitor doesn't identify the arrhythmia responsible for your symptoms and it may not, I would push for longer term (7-10 days or longer) monitoring.  It is important that they identify the atrial tachyarrhythmia present so that they can treat it appropriately.  Sometimes vagal manoevers can help stop an episode of SVT, whereas with Atrial Fibrillation or Flutter these may require medication (rate control), antiarrhythmic meds and/or an ablation.

No with a simple pacemaker it cannot stop a fast heart rate from occurring, it can only prevent a bradyarrhythmia (slow heart beat) from falling below the minimum set base rate.  Even though many pacemakers may have anti tachycardia programs which might help, or programs that mode switch (stop tracking the fast arrhythmia in the atria for the duration of the episode), that is really all they can do.  Pacemakers do not treat arrhythmias.  Doctors use medication and/or an ablation when we are really symptomatic.  If we have a dangerous arrhythmia, doctors will implant a defibrillator which can stop the heart rhythm disturbance, although they might still need to consider using medication or an ablation to get any arrhythmia under better control.

You need to control that heart rate and then you will start to feel better.  Good luck



by AgentX86 - 2021-10-04 22:27:13

Ad Gemita said, pacemakers can't do a thing for high heart rates.  They're accelerators, not brakes.  When the heart goes too fast, a pacemaker could only make things worse (go faster) so they sit by and watch. As Gemita says, there are pacemaker programs that will try to break arrhythmias with varying degees of success.  My EP didn't even think it worth trying.

The one thing that a PM will allow is higher doses of rate lowering medication.  Without the pacemaker, these drugs may push the heart rate dangerously low.  The pacemaker will prevent this while allowing the drugs to work on any  intermittent high rates.


by GnR - 2021-10-05 01:08:22

Thank you Gemita and AgentX86 for the advice and taking the time to respond. Really helpful. Still trying to understand all this PM stuff even after 4yrs!


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