Tiredness and Lower Limit


I feel tired pretty much everyday, this could be due to stress and work, but also i had a thought about my pacemaker settings. 


My lower limit is 50 and my average pulse is 54, I am 19 years old, dual lead pacemaker for 3rd degree heart block. I was wondering if this low limit of 50 could be causing my tiredness? If it was to be raised would that increase my atrial pacing to 100? or does it not work like that, 

Thank you,




it doesn't work like that with av block

by Tracey_E - 2023-01-23 07:43:49

If you have av block, in theory your atrial rate is normal and the lower limit is irrelvant. The pacer's job is to play follow the leader and make the ventricles beat when the atria beats. Lower limit is for when the atrial rate gets too low. It's possible this is also an issue and a higher lower limit would help. I would also check in with your GP and make sure nothing else is going on.

When is the last time you had an echo? That can confirm your heart is beating as hard as it should. The pacer can make it beat faster but it can't make it contract stronger. This is ejection fraction. 

Sleep, diet, and hydration can also affect energy level. 

Good luck. 

Lower limit of 50

by Good Dog - 2023-01-23 08:04:11

The simple answer is yes, an average pulse of 54 could be causing you to feel tired and lack energy. However, there could be other reasons. Your best alternative now is to contact your Doc and tell him how you have been feeling. If he agrees that is the problem, you should ask if he can increase your lower rate slowly (maybe 5-10 bpm at one time so your body can adjust) or he may even suggest it without you asking. You can have it increased again at the next visit if a small increase seemed to help. Another alternative is to turn-on the rate response. The rate response will increase your rate with activity. So you could possibly have both changes made. However, the problem with trying to make a suggestion here is that we have no way of knowing exactly what is going-on. My suggestions are answers to a simple problem you described, but your Doc should be able to better diagnose you to determine if there is another issue and/or other adjustments that could be made. 

You see, my lower rate has always been at 50 bpm for the 36 years I've had my PM. However, for most of those years my heart worked very well on its own until I've gotten much older and more PM dependent. In-other-words, my heart rate would increase with activity on its own and my body was very accustomed to a low rate of 50 bpm the rest of the time. I liked that low rate, because for many years before I got the PM it was pretty nomral for me. They initially started me with a minimum rate of 60 bpm and I could not sleep, so they turned it back to 50 at my request. However, in your case it does not apear that your heart is picking-up on its own with activity, but there is no way for me to know that for sure. If that is the problem it makes the case for turning-on the rate response feature. However, that is a call that must be made between you and your Doc.

The simple answer to your question: 

My lower limit is 50 and my average pulse is 54, I am 19 years old, dual lead pacemaker for 3rd degree heart block. I was wondering if this low limit of 50 could be causing my tiredness? If it was to be raised would that increase my atrial pacing to 100? or does it not work like that.

Yes, a lower rate of 50 could cause you to feel tired all the time. 

Yes, if you have a dual chamber PM it would increase your atrial pacing rate to wherever it is set. That is how it works, but they would never set your lower rate to 100. Instead, they may increase your lower (minimum) rate to 60 or 70, but would turn-on rate resonse if your heart is not working well enough to get your rate up with exercise.

I am confident that if you see your Doc and explain the issue, you can get this issue resolved.

I wish you the best!



Tired all the time

by Penguin - 2023-01-23 09:31:29


Sorry to hear how you're feeling.  I did have a quick read of your other posts and you mention some pretty stressful events in your life.  There may be another dimension to this which isn't necessarily cardiac.

Stress, anguish, grief, anger and all of those negative emotions along with adrenaline can have a really draining, energy sapping effect. 

I don't know how you feel about finding someone caring and supportive to speak to? Do you find talking helpful? In the meantime please take good care of yourself and don't expect too much of yourself. It's OK to feel drained, tired, sad and stressed. It's normal.

When you're ready, you might try to find time for some gentle, positive, relaxing activities that you enjoy or which help you de-stress a bit. Whatever you decide I really hope that you find the right answer and get on top of the energy issues in your own time.  

Check with your EP or doctor to rule out anything else. 

I wish you all the very best.



I would try having your lower limit raised

by Gemita - 2023-01-23 14:59:16

Hello Hayden,

There is only one way to find out if a higher Lower Rate Limit would help with the tiredness and that is by trying to raise it and see whether your symptoms improve?  Can I ask just one question first, please.  Did you feel as tired as you do now during your Mum’s illness?  

Sometimes when we are going through a stressful period we live on adrenaline even though our bodies are completely exhausted/spent.  It is only when the stress leaves us, that the symptoms of fatigue, exhaustion and symptoms related to the stress rear their ugly head.   Could it also be that you were so exhausted for months during your Mum’s battle with cancer that you depleted all your reserves and now slowly you are recovering but the stress/shock symptoms are surfacing? 

Bereavement and loss are very painful emotions and take a very heavy toll on our health, which is why you may need help dear Hayden.  While you start the process of winding down and saying a proper goodbye to your mother, it might trigger many unwanted symptoms, including palpitations.

Did you see your GP and have you asked for some device checks just to be safe?  During any device check you can ask whether a higher lower rate limit might help.  I have some right bundle branch block activity and also lots of atrial and ventricular arrhythmias, and I can assure you that I can feel extremely fatigued when these are active.  It could be that you are getting PVCs (a ventricular arrhythmia) since I know from your history that you have had runs of non sustained VT.  If you are getting PVCs, a higher lower rate limit would certainly help prevent premature beats (I am living proof of that).  Are you drinking lots of coffee or tea?  This could cause palpitations.  Have you had your electrolytes checked and do you still have high levels of adrenaline present I wonder?

Is your Sinus node functioning normally or have you developed sinus node disease as well as AV Block?  There are lots of possibilities which is why it is so difficult to answer your question.  Clearly if your Sinus node has slowed and you ask it to work harder, your pacing % in the right atrium will increase too.  Some members may need pacing in the right atrium as well as in the right ventricle, sometimes up to 100% in both.  I couldn’t understand this at first but if a patient has both Sinus and AV Node (bi nodal disease), then this could happen.

Take good care of yourself and remember we are always here if you need support xx


by Lavender - 2023-01-23 15:37:43

Hi Hayden👋🏼

I do think there's no harm in asking to raise your lower limit. Mine is 60. I feel pretty energetic. 

However, as we have said-depression and mourning can cause extreme tiredness. You can get help. Ask your pcp about it. (((Hugs)))

Thank you all, so much

by PacerPrice - 2023-01-24 06:16:00

Thank you all for your suggestions and support, it really does help. 


I think that with all of the stress, grief and low mood over the past year has really tired me out, gemita you made a good point of how I was feeling before my mums diagnosis, I definitely wasn't this tired.

I have contacted my heart centre at john radcliffe many times via email but have not heard back yet, I hope with time this will change. 

The tiredness and low energy has been an issue for almost a year now, strongly correlating to everything that has happened, if it was a cardiac issue would some worse symptoms of presented in a year? making me believe it is more of a psychological and stress induced issue. 

I will take all of your advice on board and try to get to the bottom of this, i think accepting the reality that I am depressed is a good idea. 

Thank you all as always,

Hayden x

depression is a disease

by Tracey_E - 2023-01-24 09:20:15

A bit of the blues will go away on its own. Depression is a disease and needs to be treated as such. It is exhausting. Grief is exhausting. Counseling will help. Meds will help, too. 

It's also possible raising your lower limit will help. It definitely won't hurt. 

Good luck figuring it out. I hope you feel better soon. 

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