Ongoing Fatigue. Pacemaker or something else?

I have read many postings where members complain of fatigue issues associated with their pacemakers.  I have been experiencing real fatigue for approximately two years and 2 months.  Pacemaker implant was August 2019 so going on three years for that.  I am paced at 100%. Along with the constant fatigue, I have internal, what I call shaking.  Only lets up when I sleep.  A past neurologist prescribed Gabapentin but I'm not sure how much good that is doing. In addition to EP evaluations and pacemaker setting changes, I have been tested for I think every disease or condition known.  I also have Neuropathy in mostly my feet and legs.  

At age 79, I wonder if most of the fatigue is related to just plain old aging.  I have always led a very active life where sports were dominant.  I cannot in my mind relate the pacemaker to my internal shaking and am wondering if anyone in the club has the same problem.  I realize that this isn't a specific question related to pacemakers, but so many of you have such good answers or advice and I would most certainly appreciate your experiences and input.  



by simonsimon - 2022-06-17 13:39:23

All that sounds very familiar to me, I am 73 and the fatigue hit me after a series of events that began with a COVID infection in 2020. I don't think I have 'shaking' but i do have real issues with disequillibrium and imbalance, serious muscle loss in legs. Like you I have been around the block with doctors and not getting any reasonable answers. Curious, did you have COVID at any point?



by benedeni - 2022-06-17 14:00:35

No Simon, I have been very fortunate in avoiding Covid.  That was one of my first thoughts but when tested, I was negative.  It is very frustrating to not find an answer.  Sorry you are experiencing much of the same.  

Covid sufferer here too

by Gemita - 2022-06-17 18:26:15

Benedeni, internal shakes as you describe sound like “chills” to me and rather like my long Covid symptoms that I have been experiencing since April 2020.  I would look for a viral or infectious cause for this.

Gabapentin is a neuropathic pain med and it can cause fatigue so it won’t be helping.  I found this with Pregabalin, a similar med.  It helped me to sleep but during the day I couldn't stay awake.

I note you are paced 100% in the ventricles for heart block and that you have or had Atrial Flutter.  If you still have Flutter, then you will have chronic fatigue from this and you need look no further.  Rhythm irregularities, however well they are being controlled, can cause awful fatigue for some of us.  They do for me.  If you can stop the Atrial Flutter you will have a better chance of recovering.  Apart from your Gabapentin, are you on any other meds, like a beta blocker?  They can cause severe fatigue for some of us too.

I send my warmest wishes to you and hope you will soon be feeling better.


by benedeni - 2022-06-17 19:57:16

Thanks, Gemita for your helpful thoughts.  I had not realized that Atrial Flutter along with the complete heartblock would cause such fatigue.  I feel better knowing that this is most probably the cause of my fatigue issues.  My PCP recently switched me from the Gabapentin to Pregabalin thinking it would be a better fit, but I couldn't handle it.  Like you, I was over-tired and it affected my speech as well as caused my ankles and feet to swell plus I gained weight rapidly.  Last week the doctor switched me back to Gabapentin. 

I take Losartan, Metoprolol and 2 baby aspirins, oh, plus Atorvastatin.  Guess the fatigue is a given then!   So appreciate your time.  


by AgentX86 - 2022-06-18 00:16:01

Metoprolol can certainly cause fatigue.  That's a very common side-effect.  I'd say that more people are fatigued by metoprolol than not.  Beta blockers need to be adjusted so they can be effective, while not causing unacceptible side-effects.

I note that you aren't on an anticoagulant.  Given that you have AFL, this isn't good, particularly at your age. There may be some reason you're not but aspirin would have similar problems but not the gain. There may be some reason behind this but aspirin isn't a substitute for an anticoagulant.

Ejection Fraction

by SeenBetterDays - 2022-06-18 12:04:09

Hi Benedeni

It sounds like there may be a number of potential causes for your fatigue including your Atrial Flutter and medications.

It may not be relevant in your case but I have experienced a fall in my ejection fraction since being 100% paced in my right ventricle (potentially pacemaker induced cardiomyopathy).  Like you, I have ongoing fatigue symptoms which can't definitively be pinned down. It might be helpful to know if you have had a drop in your EF as this could potentially also affect your energy levels.  Have they done any echo measurements of this as part of your reviews?

Hope you get some positive answers soon.



Ejection Fraction

by benedeni - 2022-06-18 12:38:19

Thanks to all.  In regard to the EF, I had a nuc stress test in April which was most concerning as it showed an ejection fraction of 30%.  My cardiologist immediately ordered an Echo to confirm.  Echo showed 55% and that reading was deemed correct.  Something about being paced 100% which meant the nuclear stress test could not show an accurate reading?  I'm not sure but 55 much better than 30 so I'll go with that one!

The fatigue is real!

by TLee - 2022-06-18 16:31:08

This has been the most difficult thing for me to deal with by far. I want to sleep ALL THE TIME. I am almost positive that this is caused by the beta blocker (Metoprolol), as it only got really bad--as in crippling--when they doubled my dosage in order to better control a-fib. Now I have had no arrhythmia for the past year, but I am completely in hibernation mode. When I began to recover from the pacemaker surgery & was taking half the amount of Metoprolol, I felt amazing. I feel it would be better to go back to that, even with some a-fib to deal with. I have a cardiologist appointment the end of the month, & I intend to discuss lowering the dose. I am thinking that it will be a bit of a battle, but I have found support here to have my opinion heard. 

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So, my advice is to go about your daily routine and forget that you have a pacemaker implanted in your body.