The pacemaker "twitch" sensation, now on ECG

Twitch

by Lavender - 2023-08-03 23:35:12

I have had an electric vibration type sensation since I received my pacemaker. It's when I am deeply at rest but not asleep. I told the pacemaker technician and they changed the way the pacemaker (the can) signal moves. I described it as I find that if I try to lie on my left side the thumping (like cat purring) goes away but sleeping on my back or right side the thumping pounds against my diaphragm.  Like cellphone on vibrate for 7 or 8 seconds. Muscle quivering in upper body-chest and arms.

After the tech changed the ring to can set up, I still get this sensation but it's mild and still lasts 7 or 8 seconds. 

My notes from that visit about a year ago:

Changed from ring three to the can to ring four to can

80- 90% of pacemaker people have this vibration get used to it as per the tech

Pacemaker is autochecked between 12-3am

At my last pacemaker check, in March, with my new cardiologist present, the tech tried to get this to happen while the cardiologist had his hand on my pulse with me lying down. They couldn't cause the sensation, but at one point, as I felt faint, the cardiologist told the tech that he couldn't feel my pulse and to stop the test. He told the tech to make a note that they're not to test the right lead anymore at my clinics.  

I actually think it has to do with me either falling asleep or just as I awaken...hence they couldn't duplicate the sensation because I was awake(?)

I give up trying to figure it out and am certainly not going to wear a home monitoring device because that would make me hyper vigilant about my heart again. Lol in my case, ignorance is bliss (for now).

Also, I understand that others with more tech interest in the working of their pacemakers can certainly be comforted with increased research. We all have individual levels of "need to know". 😉

Thank you Lavender

by John_Locke - 2023-08-04 06:01:13

What you're describing sounds different from what I feel. I don't have a prolonged vibration but rather individual very distinct twitches. Still, it's interesting to hear about your experience!

Could you explain what they actually did to change it? I understand that each lead really is two wires, one going to the tip attached to the heart muscle, and one to the ring a bit further up on the lead within the heart. Normally you'd pace by sending a signal between the tip and the ring but it's also possible to go tip to can (to the pacemaker through the body) or ring to can.

I'm not sure what they mean by ring three and four though, do your leads have multiple rings on them?

Rings

by Lavender - 2023-08-04 08:19:53

I have a CRT-P. I don't understand or want to know how it works. I tend to ruminate on things if I'm feeling like I'm in danger and must try and regain control. 😵‍💫

I have slowly learned to have enough knowledge to make me feel safe. I'm slowly learning to trust the experts that they know volumes more than me. When I first got a pacemaker, I was reading everything-really too much. It made me more anxious. 
 

So, all I can say that the tech told me is that there's more than on ring on the lead. She explained a bit of how the signal goes through and changed which ring was communicating with the can, from what I recall. It was a setting that she changed using the laptop computer they bring along to do the pacemaker interrogation. 
 

One site I read was:

https://www.howtopace.com/basics-of-pacing-leads/

Also

by Lavender - 2023-08-04 09:02:03

I know the tech tried to put things in terms that a lay person could understand. I did research more but with no engineering background, came up with not much more comprehendable info. I am thinking my leads have options for transmitting signals. Like this:

Bipolar leads

The two electrodes are called «LV tip» and  «LV ring  or LV anode». If a bipolar left ventricular lead is implanted, four programming options are available with the new generation of defibrillators: LV tip to RV coil; LV ring to RV coil; LV tip to LV ring (LV bipolar) and LV ring to LV tip.  LV Thresholds are often higher with the LV ring to RV coil configuration. The tip electrode (cathode) is generally used as the active electrode, the RV coil or ring VG (anode) being used as a neutral electrode.

Quadripolar leads

The 4 electrodes are called LV1, LV2, LV3 and LV4, LV1 being the most distal electrode. Sixteen different configurations can be proposed.

" Multipolar leads offer various pacing configurations to minimize phrenic nerve capture and may permit reprogramming to alternate stimulation vectors to ameliorate this problem without re-intervention"

Quadripolar leads

by John_Locke - 2023-08-04 09:48:27

Thank you Lavender, this seems to be a type of lead specifically used for CRT devices, so I don't have that option.

It's the pacemaker alright

by John_Locke - 2023-08-05 16:38:05

To follow up here for anyone interested. I've continued this experiment and made a not of the time each time I felt the "tick" or "twitch" that I associate with the pacemaker whenever I worse the ECG monitor.

The sensations are not always identical, and the ECG doesn't always look the same, but every single time after now over 10 cases checked, I see the "fat" QRS shown in the image posted above that can only really be from the pacemaker.

Twitch

by piglet22 - 2023-08-06 09:44:58

I would include end of life (pacemaker battery) pectoral and arm muscle twitching.

In 2016, I was sitting quietly at home when my pectoral muscles started twitching, then involuntary left hand arm movement. It started as sensations directly over the site of the PM and soon spread to my left arm. PM is on left side.

I was coming to 11-years on this first PM and on 3-monthly in person checkups.

The twitching was exactly in time with the PM pulse of 60-BPM.

To cut a long story short, I ended up in A&E, saw one of the physiologists past midnight who confirmed a mode change and made some adjustments that stopped the twitching.

About 8-hours later, the PM was replaced.

Some might be sceptical about external pulsing and one senior ambulance man said a PM couldn't stimulate muscles. Heart muscle?

What tells me it was, is the timing synchronization, heart and left side muscles, and the fact that altering the PM settings reduced or stopped the twitching.

They didn't tell me what the battery voltage was, but after all those years, it must have gone low. One physiologist remarked "We had you on our radar". This was pre-home monitoring and all checks were done in person.

The other sensation which is common for most PM users is the slow heart rate test where they either turn down the base rate or maybe examine what remaining natural pacemaker function you have.

Some people don't notice it, I do and my notes include the fact that I am sensitive to that test.