Short tachycardia episodes following pacemaker

Can I get some thoughts from people?  The bottom line is my husband and I are trying to make a decision about whether it is sensible/safe for me to travel to the other side of the world on a six week holiday to Europe in October – 6 months post pacemaker insert and 12 months post SVT surgery.  Tickets are in short supply which is why we are making a decision so early if some are wondering.

The backstory is that my SVT ablation for tachycardia was successful. I had been apparently experiencing tachycardia my whole life according to the surgeon.  Once the tachycardia was solved bradycardia issue began to take centre stage.  It too was there by the time the tachycardia was diagnosed and the theory was that it may improve post ablation – it didn’t – the persistent tachycardia over the years had damaged the sinus node. Now I have a pacemaker as of 8 weeks ago. 

My surgery is healing well and I’m seeing an exercise physiologist and making good progress. 

Since the pacemaker I’ve had 3 relatively short tachycardia episodes - 5-30secs up to 170bpm – all three stopped me in my tracks.  I had to close my eyes, sit down, I felt dizzy, my husband could see there was something was wrong and hoped they’d stop and of course they did.  My pacemaker monitoring didn’t alarm my cardiologist practice - I suspect because the episodes were so short.  I am currently paced at about 80% of the time with a dual chamber Medtronic Azure DR MRI SureScan 60-130bpm.  By the way I can feel it working almost all of the time – a bit weird but I guess I’ll get used to it.

I had one tachycardia episode by the time of my review with my cardiologist.  He wasn’t worried at all and said he would only look at it if they ran for about 20mins – which is weird to me because my original tachy episodes were always short.  At the same appointment I flagged that I was planning my trip and he said to go.  Then after another two episodes that occurred on consecutive days after my appointment at about a week later, I followed up with the practice nurse and she said that I could expect some tachy episodes but if they become more frequent and intolerable let them know and they might modify the treatment.

Have others had this experience and is it normal and nothing to worry about?  Am I just settling into the world of pacemakers and I should chill out?  Is my pacemaker preventing a full blown tachy episode given the shortness of time that they are occurring – it’s dual chamber and adjusts according to my activity?  If they were going to ‘modify my treatment’ what do you think that would that entail?  Would you travel 20 hours to another county if you were still having short tachy episodes?

4 Comments

It is still early days since implant

by Gemita - 2022-05-18 08:03:19

Hello Cheryl.  It was nice to receive your message and to know that you are planning an exciting trip to Europe and that your cardiologist says you should go.  We cannot let arrhythmias stop us from living because life would end for too many of us.  Arrhythmias have a mind and a will of their own and so do we.  Once we start ignoring them, they can no longer have such a firm hold on us.  

Your cardiologist sounds similar to mine.  He is not worried about the irritatingly short runs of tachycardia which generally settle without major intervention, but if they last longer or become more frequent then you may be given a rate control medication in the form of a beta blocker or a calcium channel blocker to calm them down.  I see you have already had an ablation, so you might still be getting some breakthrough spells of SVT and they might revisit this with another ablation in the future if you became very symptomatic, but for the moment I would think these might still be occurring from the trauma of implant and getting used to pacing. 

So yes, I have experienced and am still experiencing short spells of tachy arrhythmias, including SVT.  And yes, my pacemaker certainly seems to be helping me outpace many of these since my arrhythmia activity since implant (in 2018) has fallen and continues to fall.  What would modifying your treatment entail you ask?  Depends what treatment(s) you are already on, but it might mean starting a rate control med (as mentioned above) or increasing the dosage of a med you are already taking.  It might also mean changing some of your pacemaker settings or recommending another ablation in the future if your EP sees a need for it.  It might also mean treating any other health condition you already have, so all questions for your team.  Would I travel 20 hours to another country if I were having short tachy episodes?  Yes I would since as long as they were short and well controlled, I would have nothing to worry about.  I would stay well hydrated, avoid alcohol for the duration of the flight, get plenty of rest and chill out.  I would pay extra for a sleeper seat on a plane too, if possible, but I appreciate this will be expensive.

Thank you!

by CherylLJ - 2022-05-18 08:50:57

Thank you so much for your reply.  I just knew someone out there had experienced what I am right now.  I am very grateful for your understanding and information.

Travelling advice

by Selwyn - 2022-05-19 12:00:09

Hi Cheryl,

Travel should be with the consent of your doctor who knows your case best. 

Don't forget to organise travel insurance. 

Take your certificate  with you showing that you have a pacemaker.

Don't let them wave their metal detector directly over the pacemaker. I still avoid walking through metal detectors (though not the X-ray machines) - this may be unnecessary, though your PM will trigger an alarm. 

Any medication, and perhaps you could consider a 'pill in the pocket' regime for any more persistent SVT, needs to be in your hand luggage. I always take an extra week with me just in case the flight is delayed. You should also keep the labels on your meds or have a copy of your prescription and as drugs are drugs. Not all meds. are legal in other countries. 

Have your emergency contact numbers to hand along with your insurance details.  A summary of your medical history is very useful to your doctors in Europe should the need arise in an emergency. 

Happy travels.

Thanks Selwyn

by CherylLJ - 2022-05-22 21:08:41

Thanks for those tips.  I didn't know about 'pill in your pocket' options.  I'm not on any medication at the moment but I guess that's up for debate if I continue having Tachy episodes - none for a week now.  I've only been to the airport once since my pacemaker to wave goodbye to my daughter and the people a the scanners were really helpful - hopefully I have the same experience in other countries!

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