Spike in heart rate

Just seeking some advice

Have had a Metronic Dual Lead Pacemaker since October 17 for total heart block during the night. My heart stopped for over 20 seconds whilst I was asleep but restarted thank goodness. Only found a week or so afterwards when my Reveal Device was checked, holiday cancelled and pacemaker implanted. I'd been experiencing faintness for some time.  I'm doing ok prefer not to have one at all but obviously no alternative. 
In the early hours of Sunday morning I can see from the data on my Apple Watch that whilst asleep, my heart rate went from 54 to 114 then 129 and stayed there for some 20 minutes before dropping back down. My question is should I get this checked by the EP by having my pacemaker interrogated. My next check isn't till March but I'm worrying this is an arrhythmia especially as I was asleep and definitely not active. Both my parents had AF so I'm very aware I could inherit this. 
Any input welcome. Thanks in advance. Sue 



Spike in heart rate

by Gemita - 2022-01-03 07:09:53

Sue, I see this has been going on for some years and it looks as though there has been no indication for anticoagulation to date, if this is correct?  My main concern for you would be stroke risk if you have risk factors, especially with any new arrhythmia like AF.  You say you were asleep at the time of your high heart rates recorded by your Apple Watch so you were clearly "asymptomatic".  I am deeply symptomatic when in AF and I don't need any monitor to confirm AF occurrence.

Yes I believe you should have your pacemaker interrogated or at least speak to your doctors before March, particularly if this continues to happen either during the day or at night.  You could send a transmission to your clinic to see whether any new arrhythmia like AF has been detected.  That would be my main concern.   A new arrhythmia is always possible as is a sudden burst of a high heart rate.  I used to get these sort of episodes at night for approx three months following my implant and they would always wake me, but I have AF and many other arrhythmias which occur at any time.  I am sure over the Christmas period many of us will have noticed spikes in our heart rate.  I hope you are keeping well hydrated.  You could also get your electrolytes checked or see your GP if you have any other health conditions which might be triggering your palpitations like a thyroid condition or sleep apnea?


by Foxy49 - 2022-01-03 08:06:30

Thank you so much for your input Gemita. Much appreciated. I did wake around that time but not unusual for me as I'm a poor sleeper. I can't say I felt abnormal I know I used the bathroom think I felt a tiny bit unsteady but that's all. Last night I had another spike. This time tho highest was 110 to 115 but it lasted 35 minutes. I am definitely getting in touch with EP think no one will be there today?  I have had this before and had an extra interrogation they often say they find nothing. Then I have to wear a monitor and again never seems to occur when I have this in situ. 
I do worry about stroke risk of course particularly as my mum had many TIAs that eventually caused vascular dementia. It's scary! No I am not on anti coagulant. Cardiologist said not nevessary couple of years ago. I will keep you posted. Happy and healthy New Year and I will think about electrolytes too. Best wishes. Sue 

Spike in heart rate

by TAC - 2022-01-03 09:48:46

Actually, you are describing a brief episode of tachycardia, not Atrial Fib. After the PM implant, the heart goes through some period of adjustment to the PM and brief episodes of tachycardia may occur. When I had my PM implanted, I developed an episode of tachycardia immediately after, and it lasted about a couple of hours. My doctor said, my heart was reacting to the foreign bodies inside (the leads). He didn't think it was anything serious. Indeed, that was the only time I had tachycardia in 4 years since the implant. If you have a home monitor for your PM, I'm sure you most have it, this information will be sent automatically to your doctor's office. If it's a serious event, your doctor or nurse will call you. You don't need to call them. As you must know, the home monitor interrogates your PM every night, and if there is anything unusual, the data will be sent automatically to your doctor's office. He is aware at all times about how your PM and your heart are performing on a daily basis.

Spike in heart rate

by Foxy49 - 2022-01-03 10:13:04

Hi Tac

my pacemaker has been implanted over four years already. It is not new so I am not inexperiencef to all this! I am used to these things happening but I do have to be aware it could be AF as it happened again during the night last night and lasted over 30 minutes. Also I don't have the sort of pacemaker that's on monitor all the time. I have to physically take a reading and send it through. Thanks for your comments tho. 


by Marybird - 2022-01-03 11:07:10

Foxy, I can well understand your concern over your tachycardia, and I'd think especially about whether or not it might be aFib, with your family history of aFib. Seems as though, at least in my opinion, it'd be a great idea to contact your EP/clinic ( somebody's gotta be there, I'd think), tell them what you've observed, and figure they will most likely ask you to send a manual pacemaker transmission so they can see your heart activity during those times your watch picked up the tachycardia. If it's AFib, they can address that, if not, depending on what's there, that can be addressed, or at least your mind can be put at ease.

I don't wear a heart rate watch or any other device, haven't since I got my pacemaker 21/2 years ago, but I get little runs of tachycardia sometimes, often I am aware of them as little flutters/palpitations in my chest, but if I am doing something I may not be aware of them or pay much attention. I've come to learn ( and this was through notifications by my cardiologist's office of remote monitoring reporting of excess mode switching, ie, tachycardia which was reported as short runs of afib) I also had several longer episodes of afib- 2 to 3 hrs duration, for which the monitor sent alerts to the cardiologists office. Like yours, those episodes occurred at night, and while I did wake up, even got up through them, and was aware, sort of, of the tachycardia, I sort of half-wondered about what was happening but was too sleepy to do anything but go back to sleep.

The pacer tech in the cardiologist's office showed me those afib reports at an in-office device check, and we noticed the heart rate wasn't that high during those hours long episodes, ranging from 108 to 115. This is no doubt due to all the rate control medication I take ( 150mg/day metoprolol and 360/day diltiazem), and also makes the afib episodes not feel bad, or even asymptomatic. 

That's my sad story, ie, still have the afib episodes, I guess, but they don't feel bad and I figure my cardiologist and company will let me know what's happening when they get the monitor alerts/ reports. But after those longer episodes, they started me on Eliquis. So I figure things are under control. 

I'd check with your EP, just to get a handle on what is happening. 

Tachycardia while sleeping

by AgentX86 - 2022-01-03 13:17:24

With this information it's pretty hard to know whether it's AF or something else tachycardia. It hardly matters at this point but I believe your watch should be able to identify AF (likely not anything else).  Depending on your CHADS2 score, you need to be on an anticoagulant.  As you know, stroke isn't a good thing. Arrhythmias are a prime source of iscemic stroke.


by TAC - 2022-01-03 13:18:37

Are you sure you don't have a home monitor? All wearers of cardiac devices have a home monitor. The monitor downloads information from the PM every night and it reports any arrhythmias to you doctor or clinic. If I were you I would get rid of your reveal device. It's making you worried and anxious. The home monitor is enough to have your doctor aware of your heart condition and the PM performance. Atrial fib is caracterized by irregular heartbeats, not rapid ones. AF can happen at any time, not only at night. AF is not a hereditary disease. Episodes may last from a few hours to days. Do not fall in the temptation of self diagnosing.

I appreciate your dilemma Sue

by Gemita - 2022-01-03 14:06:15

Sue your comments tell me everything about your dilemma.  Because of your family history of vascular problems, you are naturally concerned about your stroke risk.  While your pacemaker should record episodes of a tachy arrhythmia like AF especially lasting some 20 mins or so, the only thing that can confirm with certainty and not miss what is happening to you on a beat by beat basis may be “more external longer term monitoring”.  I know it may sound crazy with a pacemaker implant in place, but external monitoring will help identify the arrhythmia causing your symptoms at night.  AF can be at a slow, normal or fast heart rate (Yes TAC also a fast heart rate.  I know this because I suffer like many others from AF with a rapid ventricular response rate).  AF is mostly irregular but my EP has seen it present as a “regular” rhythm at times too with ventricular pacing.  There is absolutely nothing regular however about AF. It is a crazy arrhythmia.

Sue, I see like me you had a Reveal Linq monitor at one time which was probably removed at the time of your pacemaker implant?  They left mine in place until the battery expired because they said it would pick up more “detail” than would be possible from my pacemaker.  This surprised me at first, but the pacemaker is used primarily for pacing, rather than for recording/storing every possible beat.  It would run out of space and battery very quickly if it could store the detail of an implanted loop recorder or an external cardiac event monitor, so even with your pacemaker I would keep pushing for longer term external monitoring.

Unfortunately the pacemaker only records what the EP asks it to record.  Specific parameters usually have to be met for the recording of an arrhythmia and if these conditions have not been met, some rhythm disturbances may not be recorded and stored.  So when your doctors tell you nothing was seen this may not give an altogether accurate picture.  For example, my pacemaker is set up to record an event when my heart rate has exceeded 165 bpm for say 30 seconds+..  I feel sure though your episodes of tachy arrhythmia lasting 20mins+ will be recorded, especially if these episodes are indeed AF.  Your cardiology team should be back from hols tomorrow.  Good luck and keep pushing for answers.  


by IAN MC - 2022-01-03 14:17:21

You write with great conviction " All wearers of cardiac devices have a home monitor " ......unfortunately that statement is simply not true !

I am in my 11th year of having a pacemaker and do NOT have a home monitor.  I played golf today with a friend who is on his 3rd pacemaker ; he doesn't have a  home monitor either.

There are an estimated 3 million pacemakers in the world.. I think the percentage  who don't have home monitors would surprise you.

Please check before stating what you wrongly believe to be fact !


You are absolutely correct Ian

by Gemita - 2022-01-03 14:57:39

We are only given monitors in our clinic (a main London hospital in the UK) when we have an arrhythmia or heart condition that needs watching.  If we are stable they may give us a hand held monitor when we can transmit a download using a smart phone whenever we need to, or alternatively wait to be seen annually in clinic.  Once an arrhythmia has been treated successfully and in the absence of symptoms, there is little to be done other than to go back for annual checks.  Of course a change in symptoms would warrant a call to your clinic.

Home monitor

by AgentX86 - 2022-01-03 15:47:40

You may both be right.  "It's a floor wax and a dessert topping!"

In the US a home monitor is pretty standard fare, whether it be a smart phone or a bedside box. In Ethiopia probably not, with the whole range between.

Home monitor

by TAC - 2022-01-03 17:47:00

I'm rather new in this forum. I wrongly assumed that this forum was limited to the United States. I apologize for my naivety.

Ya Learn Something New Every Day

by Marybird - 2022-01-03 19:46:39

And like me, ya just realize how much you don't know!

I thought I had read that current standards ( as in recommendations from the Heart Rhythm Society, the American Heart Association), at least here in the US, were leaning towards having pacemakers, ICDs ( at least those implanted within the last few years), having blue tooth capability and transmitters to which the implanted device transmitted data wireless via that bluetooth. The transmitter ( either a tabletop device or phone app) then wirelessly transmitted the data to a secure website maintained by the manufacturer, at predetermined intervals, and made available to the patient's physician/pacing clinic. Or perhaps this was just the salesmen/pacing reps from the various manufacturers pushing their latest wares?

But I really thought everybody who had pacemakers or ICDs implanted these days got the wireless technology with their devices? .

I knew there had to be many many people out there with pacemakers that predated the wireless technology, who most likely have device monitors that require manual transmissions for when the need arises, perhaps not at prescribed intervals. My daughter had one of these ( for her first pacemaker implanted in 2012) until her generator replacement in 2020, which has wireless capability and she got a tabletop wireless transmitter to go with it.

I had no idea, Gemita, that in the UK they saved the wireless pacers and transmitters for those who have arrhythmias or other needs to be monitored on a regular basis? I guess it makes sense if for those folks without the arrhythmias or needs to be monitored at least have a handheld monitor/transmitter that can be used for manual transmissions if needed. Everyone has some type of monitor, don't they?



by IAN MC - 2022-01-04 06:13:39

 TAC :  All is explained ......life can be confusing for octogenarians like us !  When I first joined the Pacemaker Club , I didn't realise that it was international and assumed it was for the British only !!

MARYBIRD :  In answer to your question ,  no I don't have ANY type of home monitor .

I am very happy with this , as my condition is stable ; also access to my local pacemaker clinic would be almost immediate if  I had adverse symptoms or other concerns.

I am due for a replacement PM in the next 6 months. It will be interesting to see if I am offered a home monitor then ........ who knows  ?

Hope the  sun is shining on you in Florida..... it''s pouring with rain here in the UK.



My personal experience and opinion only

by Gemita - 2022-01-04 06:54:20

Mary Not everyone has “some type of monitor” over here, even a hand held one.  See Ian’s post above as well.  That would be like the icing on the cake and in some cases perhaps not an essential 'add on' to pacemaker treatment especially if a patient is stable, with few or no concerning symptoms, is successfully treated by their pacemaker + other treatments and any monitor which they do hold is under the bed gathering dust for long periods until transmissions are required.  How many times have I heard this from my American friends?  

All pacemaker patients I believe in the UK should receive an in hospital annual check for battery, lead status (although during Covid some have waited up to two years I believe which rather confirms the capability of a pacemaker alone to take care of the majority of us without the extra external hardware that the manufacturers are providing).   At our checks, if a patient is found to need regular monitoring they would be provided with it, particularly if a significant event had occurred or the patient complained of new symptoms.  Perhaps I can best answer your questions by describing both my experience and my husband’s.  Of course we always have emergency services to deal with any acute symptoms.

Michael had his single lead Medtronic pacemaker implanted in March 2018 after several episodes of syncope caused by bradycardia + various Blocks. He was discharged without any monitoring equipment whatsoever.  Went back for checks at 6 weeks, 3 months and thereafter every 12 months.  He has right sided heart failure, pulmonary hypertension.  He is in permanent AF but with a very slow ventricular response rate which the pacemaker successfully treats.  He has a history of VT, due ischaemia, now successfully treated with three stents.  To date he has never received 'ongoing' home monitoring and needs to attend A & E if he gets symptoms like chest pain or breathlessness.

I have a dual chamber Medtronic pacemaker for tachy brady syndrome and syncope.  My device history started with a Reveal Linq implant monitor in late 2016 after multiple episodes of syncope.  This confirmed AF with a rapid ventricular response rate as a cause, although I had other ‘autonomic’ reasons for the syncope relating to swallowing.  I eventually got my pacemaker in May 2018.  In late 2019 my Reveal Linq battery reached EOL, was removed but I retained my old telephone monitor and continued with my nightly downloads because of continuing tachy arrhythmias.  This July when I returned to clinic they swapped the old telephone monitor for a hand held monitor which was paired with my iPhone.  They have withdrawn 'automatic' nightly downloads because my condition is now stable and I can self manage without emergency help and I only use my hand held monitor if I have a symptomatic event.  However because of my continuing intermittent tachy arrhythmias they still want to see me in clinic every 6-12 months for physical checks.

Pacemaker clinics are overwhelmed here with arrhythmia patients and I can see there is really no time to look after daily downloads from patients with infrequent, benign arrhythmias like controlled AF.  Of course in an ideal world we would all have these wonderful monitors but it takes time, manpower, effort and money to process the data, resources that could perhaps be better spent on other ‘essential’ health care services, especially here with a free National Health Service.  You pay a high price for your private health care Mary but those who can afford it certainly appear to receive an excellent service in return.  More of us here in the UK are having to resort to private health care to get something done during Covid. 

TAC thank you for your understanding and response.  Yes we all have to deal with our own unique health care systems wherever we are and I had to learn the hard way too when I first joined PM Club.  I still get envious though when I hear of the investigations, devices and care offered to members in the U.S. although I still realise we are very lucky with our free health care.  Not sure it can last though

Thanks for the Clarifications, Ian and Gemita

by Marybird - 2022-01-04 19:02:34

I must admit I assumed everyone with an implanted cardiac device also received some sort of a monitor with it, as that's all I had ever seen, but then, those I did see ( me, my sister, my daughter had arrhythmias that on occasion needed attention. I'm still under the impression that most people who get those devices here in the US, unless they have an aversion to doing so, get some sort of a telephonic monitoring device at least for uses in emergencies. Of course, it looks to me as though the manufacturers are pushing the remote monitoring along with their devices and growing it into the "standard of care", whether or not it's always needed. There is that!  Still, I'm grateful to have it.

I can see the sense of not having such a device when one's condition is stable, doesn't need the monitoring other than that which can be done in the clinic once or twice a year. And with no need to worry that one can get the needed attention timely in the event that need arises. (at least we hope that's the case).

We've seen an exponential rise, at least in this neck of the woods, in the number of people, particularly with implanted monitors over the last couple years ( got afib? have a monitor, get dizzy, lightheaded, complain of "palps", have a monitor, ablated, lets see if it went away, have a monitor.... or so it seems). Between those folks and those with the cardiac devices with monitors, I often wonder how the providers keep up with all those monitor reports, arrhthmias. It may be that they'll get more to where they don't give them to those who most likely don't need them, if it gets to where it's impossible to meet the demands they must have now.  I'd understand such a thing happening. 

Anyway, thanks for the explanation.



by AgentX86 - 2022-01-04 20:49:40

Heart monitors come in three-ish sorts. The Holter monitor is off-line and doesn't call home at all.  It records the heart off-line.  The patient is supposed to push a button when he feels something untoward.  This marks the position in the recording for future reference.  After the monitoring time, usually 24hrs to seven days, the monitor is scannned for these marks and the information is read out.  The entire record can be scanned for asymptomatic episodes. Of course there isnt someone sitting there looking at your heartbeat for a week.

Then there is the "event monitor".  This is also worn like the holter but isn't limited by its internal memory. Instead of recording the heart, it connects realtime to the mothership.  There is someone watching many monitors.  If something happens, they'll call the patient directly.  This functions much like an alarm company.

The third is the "loop recorder".  This is implanted and operates much as a pacemaker, without the pacing function. I can record more information than a pacemaker.  Like a pacemaker, it can be uploaded for remote diagnosis.

None of these have someone looking directly at the recordings.  Software will scan the data and kick out anything suspicious for a human to look at. Of course your EP isn't going to get every trace from every patient.  The data has to be filtered so the most important data can be studied, and normal stuff binned.  Wheat/chaff sort of thing.

If have something that you want noticed, call your EP's office or, sometimes better, your pacemaker tech.  He can bring up the record from the pacemaker manufacturer's site and take a look, then forward it to the EP if it might be interesting.


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