Device Interrogation

Anyone else pacemaker dependent almost pass out when they test your device and essentially stop your heart for two beats? 


14 Comments

Yep

by Lavender - 2022-09-02 14:44:51

I always feel like I will black out for a second-but I have never done so. I was told that's how I would feel without the pacemaker. It's brief. They test all the leads. They decrease and increase the heart rate. Painless- but frightened me the first time. Now I know it's under their control. (I've never heard that they stop the heart for two beats.) 

You have had a pacemaker for a long time. Haven't you noticed this before?

Yep!

by AgentX86 - 2022-09-02 18:42:57

I call it the "elevator test". It means that any ectopic ventricular beats are slower than 30bpm.  Your device tech should warn you when he's going to do it so you can prepare yourself.  Surprises like that aren't welcome.

I just had an interrogation last week. She stopped it twice, with only one beat between. Weee!  Down we go!

Hate it

by jonnypacker - 2022-09-02 18:52:01

Yes, I've had a pacer for 40 years now. First started feeling it around 2000.  Had it done today and they must've did the stop, 1 beat, stop again cuz I really got woozy today. And no, some of these techs don't warn you one sec you're chillin' and they next you're seeing stars. Anyone know the mindset behind that test? 

Sorry you're among the crowd who experiences this

by Persephone - 2022-09-02 20:07:51

Is this step really necessary, is my question; if so, the techs should have me secured in a safe manner. Last time I nearly fell off of the high exam table I'd been instructed to perch on. I appreciate all of the work that the people in my medical practice do, but this particular move was outright negligent.

Some warn

by Lavender - 2022-09-02 21:47:26

Some warn me when they're about to do it, some don't. One tech told me he tries being as conservative as possible but he knows that some techs go farther. I can't believe this is how I would immediately feel without the pacemaker. Why do they do this ?

Intrinsic Heartrate Check

by Marybird - 2022-09-02 23:21:52

My daughter, whose intrinsic heart rate is a slow ventricular escape rhythm of about 25-30 BPM that kicks in about 15 seconds after the techs step down her pacemaker during that check, is always asked to lie down before they do that check now. She actually did pass out when they did it without warning, scared all of them, especially with that 15 seconds or so with no heartbeat at all. She says they've sometimes skipped that step during her in office pacemaker checks.

I'm not pacemaker dependent, despite an atrial pacing rate around 95%. My last intrinsic heartrate at the last in office check was 45 BPM. That's enough to maintain hemodynamic stability when you're just sitting there and the test doesn't last very long so I don't remember feeling much different when it was done. 

Elevator test

by AgentX86 - 2022-09-02 23:32:54

My PM techs have always have me sit in a chair similar to what is used for drawing blood - high, full, arms. Yes, it is necesary to see how dependent you are. They'd go lower than (the equivaent of) 30bpm if they could. That's the lawsuit limit (deemed medically necessary).

I'd agree that it's negligent if they have you in an unsafe  position when the test is run, any test really.  There's no reason to do it in an unsafe manner, and/or without warning, particularly if you've had a problem before (should be in your notes).  From now on, tell the tech. Note, though, this is the equivalent of a two-second pause.  Most wouldn't even know they had such a short pause. You do, so tell them.

I know it's going to happen at some time during the interrogation but am "secured" so just go along for the ride.

In your notes

by Gotrhythm - 2022-09-03 11:13:03

The techs can add a caution-note directly to your pacemaker, so that wherever you are, as soon as the pacemaker is accessed, an exclamation point in a box shows on the screen telling them you have trouble with this part of the interrogation.

When they drape the "donut" over your shoulder, ask if the caution is there. (It's either on the screen or it's not.) If it's not, ask them, please, to add it.

Strange as is may sound to those of us who do feel it, some people don't feel a thing during interrogation. It's pretty much a non-event. And that means, the techs can't be expected to guess who will or will not have a problem. Always remember they do not know what you feel unless you tell them.

Remember this: all the sensations you feel around your heart/chest are valid. They are all real. It is not always possible for you to interpret what the sensations mean--for that you need the help of the professionals. But the feelings are real and are valid. They matter.

You matter.

Advocate for yourself.

heart rate check

by new to pace.... - 2022-09-03 18:07:18

does this only happen to those who are 100% paced?  I just had the yearly in office check.  Without the rate dropping.  The puck would not stay so i eneded up holding it in place.

new to pace

100% paced

by AgentX86 - 2022-09-03 20:14:01

The test can only be done when the pacemaker has control of the heart rate.  Theoretically, it could be done with someone with less than 100% paced but onl if the pacer was in control, right then. It wouldn't make much sense, though.  Even if you're 100% paced you wouldn't feel it if your underlying heart rate was above the 30bpm.

For example, if your normal resting heart rate was 50bpm and your pacemaker was set to 60bpm. When the test lowers the rate, the heart will take over when the pacemaker is slower than the 50bpm.  The test will stop with the heart rate of 50bpm. The result the test was looking for was found.

can happen

by dwelch - 2022-09-03 22:34:49

I dont think it has anything to do with 100% paced so much as your condition.  I am technically 100% paced due to heart block, but they turn off the machine for a bit and I feel it but its fine, it just goes back to how it was pre-pacer. 

There are a wide variety of techs and chairs.  The best one they had nice livingroom recliners.  I hated techs for decades because they would never warn you.  I get that lightheaded thing and such but I dont actually pass out.  Two techs ago she would ask since they just have me sit on the end of an exam table, where I could fall off. 

Just tell them that in the past you have felt like you were going to pass out and hopefully they will be accomodating.   With the zillions of techs I have had over the decades though, I no longer have an expectation of them telling me anything, and I no longer get angry at them for the surprise.

zillions of techs

by AgentX86 - 2022-09-03 23:40:14

Never expect competency and you won't be disappointed.

ask

by Tracey_E - 2022-09-06 18:13:53

They only do that when they check mine right before a replacement. The rest of the time they skip turning it down so far. Tell them how you feel. 

Wobbly wheel

by PacedNRunning - 2022-09-07 06:34:58

Feels like a wobbly wheel in my chest. No other symptoms like dizziness or lightheaded. I guess I tolerate it ok. My HR pauses when they hold pacing and then an intrinsic beat comes along at 32-36bpm. They won't let you fall below 30bpm. They check to see if you have intrinsic beats. They usually have to check for at least 10 seconds to see if an intrinsic beat or escape beats comes out. No one heart is paused for 15 seconds. That would be crazy to do. They will never let you fall below 30 bpm. Which is 2,000 milliseconds which is 2 seconds max. It may feel longer but it's 2 seconds max. I guess I don't get symptoms because I use to go as low as 28 bpm with no symptoms. They do this because they want to see your dependency as pacing percent doesn't give the answer. If you have an escape rhythm you are not dependent. If no escape rhythm, you are dependent. But some doctors will say your dependent even if you have an escape rhythm simply because you are in CHB. I would ask next time to give you heads up or skip that part of the test. I hate the feeling even though I don't get dizzzy. 

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