New Pacemaker - What Qs would you ask?

I'm a 52 yo female, avid distance runner (marathons and trail ultras) and casual CrossFitter. I'm scheduled for pacemaker implantation next week to address sinus bradycardia/sinus pauses with a competing junctional rhythm, plus a marked first degree AV block. A treadmill test revealed a possible left bundle branch block, as well. A holter monitor also showed evidence of SVT, but those readings apparently came at the end of my long runs so my cardiologist wants to reevaluate those after pacemaker implantation.

I was definitely the frog in the slowly boiling pot of water when it came to symptoms. It took me a long time to convince myself that fatigue and dizziness weren't imagined and that I wasn't just being lazy on my runs.

I will still have the chance to ask more questions prior to surgery. If you were at this point, what would you ask? Anything in particular about the type of pacemaker, initial settings, etc? I do know the cardiologist plans to place a LBB pacing lead, but not many more specifics.

I'd love to get back to running as soon as possible, but obviously want to balance that with doing what's best for the long term. I figure the more info I have, the better.



New member (almost)

by AgentX86 - 2022-10-02 23:56:55

Welcome to the club that no one wants any part of.

First, let me start out by saying that you'll most likely be back to yourself in no time. You can go back to running pretty much when you feel like you can.  A couple of weeks to let the wound heal, then it's up to you (and your doctors). The weight of the PM jiggling around may be an issue for a while but you'll get over it.

Your pacemaker will definitely get rid of the Bradycardia and pauses.  That's the easy part.  It's what they do. OTOH, other arrhythmias aren't really what they're designed to do.  Getting your heart rate up may bury the junctional rhythm but it's not guatanteed. 

Fixing any SVTs is far less likely. Pacemakers are really good at raising heart rate but can't bring it down.  They're an accelerator, not the brake. Since they come after a long run, it may not be a problem. SVTs aren't all that serious in any case. It may require treatment but they aren't dangerous in themselves.

Settings, at least for now, aren't all that important.  Your pacemaker will take care of the Bradycardia and pauses.  Since you can run, it seems that you don't have chronotropic incontinence (inability for the heart to increase rate with exertion).  That eliminates a whole lot of quality of life settings.  It makes things a lot simpler.

Make sure your doctor understands your lifestyle completely.  Again, if you're not chronotropically incontinent (ask about it just in case), it makes the selection of the pacemaker simpler, too.  If you are, or might become, the pacemaker does matter. Talk about how this relates to your activities.

Since you're an active, young (it's all relative 😉) woman, ask about a subpectoral implant.  The normal implant is subcutaneous and can readily be seen.  It can also get in the way if you're a backpacker or do similar activities.  A subpectoral implant is a little more difficult and the recovery may be a little bumpier and longer but it will get it out of the way. Since you do marathons, the weight may less of a problem.


Questions prior to implant

by Gemita - 2022-10-03 07:09:41

NICB, What questions would I ask?  I would imagine your pacemaker has already been selected for you since your implant is next week.  

AgentX86 has already provided lots of good info. I too would make sure the cardiologist knows about your lifestyle and that he has chosen the best pacemaker for you?  Do you know by chance the model, manufacturer you will be getting and the total number of leads?  That would be my first question so you can explore what your pacemaker can and cannot do for you? You will then be able to download the manufacturer manual and have a look at all its features before next week.

As AgentX86 says, a pacemaker is not able to stop an arrhythmia like SVT if it turns out you have this atrial tachy arrhythmia, so I would want to know what clever programmes your pacemaker runs to help control/reduce symptoms of a tachy arrhythmia when they occur? 

I presume your team has experience implanting the left lead at the LBB pacing site?  I would want to know about their experience and success in doing so?

I would avoid worrying about asking too many questions, especially if you trust and respect your treating doctors. They will take good care of you.  A  pacemaker is for life and it will be a journey, a process of learning about our settings and how to optimise them for us personally.  At implant time it is all about having a safe and successful procedure and of course getting the right pacemaker.  Afterwards we learn how best to adjust the settings to suit us individually based on our heart condition at any given time.  

I send my best wishes for a successful and safe implant.

Thank you!

by Mtn Grl - 2022-10-03 20:27:29

I really appreciate the insights, Gemita and AgentX86. I know the cardiologist plans on a Medtronic, but I don't know which exact model. I'm waiting on that info. It'll be a dual chamber with a left bundle pacing lead. The cardiologist and hospital have done many similar implants, so I'm confident on that front. Once I find out the model, I'll download the manual. That's a GREAT idea. It will give me more insight on what questions to ask. The cardiologist knows how much I run and how far, so that should all be taken into consideration.

Thankfully chronotropic incompetence isn't an issue. One upside of all the running I do is that I use a program called Training Peaks that allows me to go back and see my heart rate mapped out over my workout on any given day (my pace, if I was going over a hill, etc.) I can see how well I recover after intervals or how my heart reacts at the end of day two on back-to-back long run days. I usually gloss over a lot of the data and think in terms of the big picture, but I'm grateful to have that detailed data now.

Again, I really appreciate the answers. Thank you!


by stevebne - 2022-10-04 03:34:44

I am also an ultramarathon runner (plus triathlete) in my early 60's with a pacemaker installed around 8 weeks ago. My problem was chronotropic incompetence with a persistent low heart rate, which didn't rise much during exercise. My lactate threshold 3 years ago was around 160, but a few months back had dropped to around 105! After some PM setting adjustement, I am pretty much back at my level of run and cycle training from years ago! (swim training not allowed until at least 3 months). Next race is the Noosa Triathlon (my wife will do the swim) which will be at 12 weeks post op. In other words, the PM has been fantastic. Note that it is not a normal HR response to exercise, but near enough to be effective. 

I have a Boston Scientific Accolade which is possibly the best fit for athletes. My PM is programmed to sense both respiratory rate and acceleration to help guide the HR response (rate adaptive pacing). You can also set your fitness level to ensure the correct algorhythm: I have my PM set on 'Endurance Sports' which it defines as 'strenuous, competitive activities such as marathons.' (check out their web page with a smiling cyclist:


PS: what would we do without training peaks and Garmin!

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