Additional diagnosis?

Hi everyone, 

My original diagnosis before implantation was tachy brady syndrome.

Just saw my cardiologist on Aug 18 for my first follow up visit since my implanation on July 18.

Now the doctor mentioned 2:1 heart block and SVT. I'm starting bisoprolol 5 mg per day. He changed my blood pressure med to Hyzaar. 

Is this an additional problem? Or just a more specific clarification of what condition I have?

Found out that I am only paced for less than 10%. And that I am paced to prevent my heart rate from dropping below 60. 

Now have my home monitor set up but was advised that it was not going to alert me or anyone else if I was having a life threatening event. 

I'm understanding that I am not dependent on my pacemaker---more that it is preventative especially to prevent a stroke. Is this correct?  My mother had a severe stroke @ age 60 and lived another 20 years. But my sister died of a brain stem stroke within 3 days before age 62. 

Still feeling tired, sleep deprived, having palpitations and have difficulty concentrating. 

Thanks in advance for any insights. 



Your Indication for pacemaker

by Rch - 2023-08-21 00:39:05


Welcome to the club! You were implanted the PM to prevent a symptomatic downside risk while on beta blockers for SVT/ tachybrady. Also, to kick in for the 2:1 AV block. You didn't mention anything about atrial fibrillation or being on any anticoagulants! So, I am not sure why you got the impression that you have PM to prevent stroke. In fact, PM will not prevent stroke even if you have A.Fib. You would need to be on anticoagulants to minimize the stroke risk!

Given your history you'll do very well. I have the PM for essentially for same indication as you do, and I'm not pacemaker dependent, and my ventricular pacing is less than 1%. I do have a history of A Fib, last occurrence was in 2015!! Nonetheless I'm still on anticoagulants!!! 

All part of the same diagnosis

by Gemita - 2023-08-21 01:11:38

Hello Rosebud, 

My initial thought is that there is a great deal of misunderstanding in your post and you may need to go back to your doctor for clearer advice to relieve some of your concerns.

Your diagnosis of Tachy/Brady syndrome (part of the Sick Sinus Syndrome) will be the original diagnosis and indication for your pacemaker, although additional findings will always continue with electrical disturbances.

SVT (supra ventricular tachycardia) is a common atrial tachyarrhythmia seen in Tachy/Brady Syndrome.  

Your 2:1 heart block is clearly a new finding but not unusual with electrical disturbances.  In any event you have a pacemaker to protect you from any degree of heart block, from whatever cause.  Some forms of block can in fact be caused by certain heart rate/blood pressure lowering medication, like beta blockers or calcium channel blockers.  I also have Tachy/Brady syndrome and can experience a 2:1 block when my pacemaker detects a fast heart rate during Atrial Fibrillation and switches modes to avoid atrial tracking. 

A pacemaker will not prevent a stroke.  Anticoagulants can prevent or certainly reduce the risk for a stroke, and certain meds (like Hyzaar) can reduce the risk as well by treating any high blood pressure or high cholesterol.  Perhaps your doctor had discussed The WATCHMAN Device (not the pacemaker) as a permanent implant designed to close the left atrial appendage in the heart in an effort to reduce the risk of stroke?

Unless you have been diagnosed with a life threatening arrhythmia, for which you would have been given an ICD to shock you back into normal sinus rhythm if such an arrhythmia occurred, you do not have to worry about this.  Any high heart rate will be picked up by your pacemaker as an “event” and when this information is seen by your doctors during clinic checks or during any transmissions, they may suggest an increase in your meds to control this which is probably why Bisoprolol 5mg has been started.   Unfortunately all beta blockers can cause tiredness. Bisoprolol may also cause sleep disturbances for some of us, it does for me.  

Percentage pacing can change all the time depending on our settings, on our heart condition, on other health conditions and on our medication.  You clearly needed a pacemaker for bradycardia.  Your Bisoprolol will treat any high heart rates.  

I know from experience Tachy/Brady Syndrome can be difficult to treat effectively, to get the balance of medication to pacing just right and it will be trial and error until you find what works best for you.  I hope you will soon experience improvements


by AgentX86 - 2023-08-21 01:26:04

To put it simply, your pacemaker is there to take care of the "Brady" part.  The "tachy" part will be taken care of by drugs (primarily beta blockers - names end in "olol"). Taking care of tachycardia drops the heart rate (obviously) but that's exactly the wrong thing to do in a "Brady" episode.  Your pacemaker is then the safety net in this case. Between the two, the heart can be kept out of both dangerous operating modes.

Pacemakers are "go faster" pedals. They're not brakes.

Patient web links

by Penguin - 2023-08-21 03:43:15

Hi Rose, 

These patient web links may help you understand SVT and 2:1 block. 

There are many types of SVT - you could ask your doctor which type of SVT you have.  As explained in the link below there are also different types of 2:1 block.  If this is a diagnosis you should be advised which type of 2:1 block is present. Again, ask your doctor.

You will need to copy the links provided below and paste them into your search engine.  This forum doesn't allow you to click on links. 


2:1 AV Block -

Re: Meds - You mentioned in a previous post that you had stopped your sleep / depression meds which are tricyclic antidepressants.  You are reporting sleep deprivation, difficulties with concentration and palpitations but don't say whether or not you have re-instated them, stopped taking them altogether or are taking them erratically. IMO it would be very wise to take medical advice about this as it is usually advised to stop this type of medication under medical supervision and very gradually.  If not the medication needs to be taken regularly and as prescribed.

Some of the symptoms that you report could be linked to how you are currently taking or not taking these drugs. Your doctor could advise further. 

Tricyclic antidepressants (and this may be type and dose dependent) can cause heart rhythm disturbances. This is something which you may wish to explore with your doctor / prescriber given these new diagnoses. 

Alternative treatments for depression such as counselling may be worth exploring with your doctor if appropriate. 

Best Wishes


mixed bag

by Tracey_E - 2023-08-23 13:18:28

Many of us find that electrical problems are a mixed bag. Many of us have more than one diagnosis. They can change over the years. As that happens, the pacer can be reprogrammed to keep up. See three doctors, have 3 labels slapped on it. Don't get too caught up in the names. 

The monitor will tell them if you have an event that it's programmed to record. It can't really tell them about life threatening events. It's not an ICD, which delivers a shock in the case of life threatening arrhythmias. It can tell how fast your heart is going, it can tell how often it paces. It does not record like an ecg, or pick up on other things like a heart attack or stroke. 

Thanks for your questions and comments

by rosebud120 - 2023-08-23 20:36:08

As always, I appreciate the advice and the information. 

I'm feeling better and have fewer bouts of being short of breath.

My cardiologist told me to resume my doxepin. I'm going back for another EKG on Friday, Sept. 1 to see how I'm reacting to it. I have also discussed this with my PCP. I'm a chronic insomniac and it is rare that something works for me. Hence, my ongoing trial with doxepin and monitoring my heart for side effects. 

I'm sleeping better and am trying to walk for 20 min every day to build up my stamina. 

Definitely am trying to stay hydrated. 

Wishing everyone the best and continued recovery.


Thanks for Update

by Penguin - 2023-08-24 04:51:32

Rose, thank you for the update. I'm pleased that you've raised those questions with your PCP and consultant. Medications / treatments can always be changed so it's good to monitor their effects and to be aware of possible causes.  Sounds like you're receiving some decent advice and help in this respect which will help you either determine or eliminate this drug as a potential cause. I wish you well. 


You know you're wired when...

Your pacemaker interferes with your electronic scale.

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