Device clinic on Monday

Hi all

7 months into having  pacemaker fitted due to getting full heart block after aortic valve surgery back in January. My right ventricle is now driven by the pacemaker which follows my sinus node. I seem to have recovered well and have been fully back at work for 3 months and doing everythig I used to do before surgery, just without becoming a little breathless like I used to. A few weeks ago I had a sustained period of resting heart rate just over 50 (min set by pacemaker is 50) the rate picked up as I became active and I felt fine. Still happens on occasions now and i am not too worried about it. The device clinic called recently and said they had checked my download and would talk to me about something non urgent when I see them on Monday. I reckon it will be related to the low resting rate and that they may tell me the minimum limit should be raised from 50 upwards. My thoughts are that as I feel fine I'd rather not change the settings and leave my sinus node doing what it wants to do unless there is a good medical reason agreed with my Cardiologist. Does this sound like a reasoable approach?


John W


You will have input

by Lavender - 2023-08-11 21:50:22

I expect that if it's not urgent, they will explain it and offer a setting change. Setting changes are only done with cardiologist's approval, but you will have a chance to give your input. Mine is set at 60. 

Your thoughts sound reasonable to me

by Gemita - 2023-08-12 13:40:24

John you sound in good health, fully recovered, so that is completely reassuring.  

It is difficult to know how to answer your post.  If it is related to your lower rate, then you will have a chance to listen to what your doctors have to say first and then have the opportunity of putting across any of your concerns.  Think about your concerns.  What are they?  Do you want to share them with us before Monday?

Many members have their lower rate setting at 50 bpm and if you are not symptomatic when you are at rest or during your daily activities with a 50 bpm lower rate setting, then I don't really see a problem.  Symptoms should determine the need for any settings changes, but we both need to wait to hear what your team says?

Good luck for Monday.  By the way my lower rate setting is 70 bpm, but I am 100% paced in the right atrium with very little ventricular pacing

to Lavender......

by John_W - 2023-08-13 16:37:15

Sounds most likely. They'll probably also tell me off as my phone decided the Hospital Device Clinic was a spam number so it rejeced three calls from them before I finally got to talk to them and they explained it was nothing urgent and that they would explain more at tommorrows appointment! I've fixed my phone now.

to Gemita

by John_W - 2023-08-13 16:45:34

Thanks for your reply. I dont have any specific concerns execept that I would like my upper limit raising (was 130, 150 now). I'd like it taking up another 10 BPM as I am youngish (early 50s) and on occasions have seen my heart rate hit high 140s. I don't think they will have a problem with this. I'm not against shifting up my lower limit but would like to know why they may recommend this. I guess I am a bit anxious as this only my second check-up since implantation and they have told me there is something they want to dicuss. Bye for now. 

Clinic feedback

by John_W - 2023-08-14 08:51:50

Back from the device clinic. Upper limit now raised to 160, no issues with doing that. Lower limit unchanged at 50 and no need to change as the EP was very happy with my heart rate histogram distrubution showing that my sinus node continues to be working well. Battery life is 12.3 yeas, leads are all fine. The reason they called a few weeks ago was because the donwload showed I'd had a few episodes of short lived artrial tachycardia. The most recent and longest episode was yesterday and it lasted 7 minutes and saw the artrial rate go to 250 bpm. It happened exactly when I was dinghy sailing on a blustry day which was physical (3 capsizes) and stressful for me. So the EP is happy that the AT is most likely exercise induced, short lived and therfore not likely to be a major problem but has shared with my Cardiologist and will continue to monitor and will see me again in 3 months. I came away impressed with the level of information that can be obtained from the device, happy that the AT conincided with my activiites yesterday and glad to have been seen by reassuring and (I hope!) skilled staff at my local NHS hosptial (Papaworth). John.

Excellent news John

by Gemita - 2023-08-14 11:19:45

John, thank you so much for the update.  So reassuring that your team and device are picking up (and storing) all this important information.   They won't increase my upper rate because of my several atrial tachyarrhythmias, Atrial Fibrillation with a rapid ventricular response rate being their main concern, but I am older and less active than you, so 130 bpm upper rate is not so restrictive.

It is amazing how much the heart can tolerate for short periods.  250 bpm sounds concerning, but I have been there too intermittently.  Atrial high rate episodes can be tolerated for short periods but in the ventricles it would be dangerous.

I note you are being monitored regularly and will be seen in 3 months.  That is very good care.  I am being seen every 6 months at the moment (St. Thomas' in London) and waiting to see the EP now.  Did you feel your tachycardia episode John or have any breathlessness, chest pain?

to Gemita

by John_W - 2023-08-14 13:22:09

Hi Gemita, I was not aware of any symptoms at all but I may have been too preoccupied with what was happening on the water to notice! The EP explained that any epsiodes lasting over 6 minutes could be a concern but as this was the one and only episode over 6 minutes (so far) there was nothing to worry about for now and that it would be tracked at my next appointment in 3 months. She explained that if it became more regular medications would be the first fix but she was happy that as it was short lived and linked to exercise I should not need anything, but the Cardiologist will decide. Interestingly they were happy to revert me to telephone consultations only but I asked to keep them face to face for now. Glad they were OK to do this as I can imagine like all areas in the NHS they are facing strain. The EPs I see at Papworth change every time, the only consistent person has been the Cardiologist. Guess this is common across all hospitals but it does make it difficut to build a realtionship with the hosptial teams. Hope your EP appointment goes well.

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