Dizzness and tightness feeling in heart after pacemaker implantation

Hi,

My father, implanted a dual chamber pacemaker (pm) to treat atrial flutter and atrial fibrillation 2 weeks ago, but ever since he is not feeling ok. He still feels dizzy when stands up, when walking normally in flat surfaces and of course when walking on stairs. He feels strains and tightness in the heart occasionally as well. He needs to stay for a while until his situation normalizes. During this symptoms he feels he is having arrhythmia as well. He describes this situation as worse than before the implantation of pm (before which he also had unexpected syncope). He felt dizzy since the day he underwent the procedure, but it thought it was due to this fact. The days to follow my father explained the symtoms to the electro physician who suggested to perform a ECG and measure the blood pressure, but they were ok. So the doctor said it was not from the pm. But due to the continuous symptoms, the days to follow my father contacted the doctor again, who invited my father to a meeting to check the equipmet. It resulted to be ok so the el.physisian cut us the way for further complains. My father though consulted witht the cardiologist of the same hospital who prescribed the medication to be taken after the pm (bisoprolol) and the cardiologist seemed to be the same surprised as the el.physicians advising my father to be checked for ventrigo, which absolutely my father does not suffer. My father does not suffer from heart failure as well. We are all new to this issue and have few information about it. We truly don't know what to expect. I try to read any information I get but I don't find anything about these symptoms in any medical website save the "pacemaker syndrome", which I don't think to be the case and none of the 2 doctors mentioned it at all. This is the only sitte I manage to read something about pm problems. I truly don't think this situation normal. My father is a biochemist and he understants that something is not going well between the beats of the atria and ventricle. I doubt the same as well. I don't think all this dizzness is only due to his sensitivity. 

Does any one had the same situation and resolve it?

Thank you,

6 Comments

Hi and welcome

by Lavender - 2023-10-19 19:55:21

So sorry that your father is having such disconcerting symptoms. 
 

My thoughts are perhaps he is dehydrated? We need to drink a lot more water than normal. The heart is beating more efficiently and needs more fluids. I'm also wondering if it's just the healing process. He's only two weeks in. I was told to eat pretzels and drink more water. 
 

It is some comfort knowing that his EP and cardiologist both feel that his heart is ok and the pacemaker is working fine. 

After this type of surgery, we can get a lot more PVCs while healing. The heart is adjusting. Your dad needs rest, fluids, and to get used to the new medication.

Perhaps his pcp (general doctor) has some ideas? 
 

 

your father

by new to pace.... - 2023-10-19 20:05:20

It would help us to answer better if we knew what make, model  of  his pacemaker, where he lives, year born.  As sometimes our answers are different based on where he lives. You can fill in the bio profile with his information not yours.

I agree with Lavender above.

new to pace

Atrial Fibrillation and Atrial Flutter can certainly cause the symptoms you describe

by Gemita - 2023-10-19 21:43:49

Moliona, 

Atrial Flutter and Atrial Fibrillation can cause dizziness and many other symptoms.  These arrhythmias can also cause chest tightness as you describe.  A dual chamber pacemaker cannot stop a fast arrhythmia, but your doctors have given your father a beta blocker, Bisoprolol, which can slow/calm these arrhythmias and are often a first line treatment.  

Your father has had his pacemaker checked and has received an ECG and BP checks and all appears to be well.  I agree the problem is likely coming from his “intermittent” arrhythmias, not caused by the pacemaker, although he may need longer term monitoring to pick up what is happening.

Following a pacemaker implant, arrhythmias can become active until the heart settles down and gets used to being paced.  I had a worsening of my Atrial Flutter and Atrial Fibrillation too, so this would not be unusual.  

We will all experience an arrhythmia differently depending on our heart health or on other health conditions.  If an arrhythmia is well controlled (not fast) we may not notice our symptoms, but dizziness/syncope, at least for me, is often a sign that my arrhythmia is not under control.  A fast arrhythmia, if not controlled can lead to symptoms of heart failure, so it is important that your father continues to seek advice if his symptoms cause concern (if he gets breathless, dizzy, has chest discomfort for example). 

I wouldn’t look any further for a cause for your father's symptoms.  An irregular fast atrial arrhythmia like Atrial Fibrillation, or a fast, usually regular atrial arrhythmia like Atrial Flutter can certainly push the ventricles uncomfortably fast and your father would certainly be feeling symptomatic during episodes.  

A dual chamber pacemaker has a setting called Mode Switch which can be set to stop the tracking of a fast atrial arrhythmia, so you could discuss how this setting works with your electrophysiologist and what other settings might help?  They may be able to adjust the pacemaker settings to help relieve some of your father’s symptoms.  A well set pacemaker can make a real difference.  However a pacemaker is not a cure for an arrhythmia and if your father’s symptoms cannot be relieved, he may need to try a different medication, a higher dose of Bisoprolol, or more invasive treatments to try to stop his atrial arrhythmias. 

In the meantime, he could try drinking more water, reducing caffeine or alcohol, getting plenty of rest and gentle exercise, breathing slowly and deeply and finding an activity that helps him to "relax" and to take his mind off his problems.  Remember arrhythmias thrive on stress.  Good luck to both of you.

 

.

Arrhythmia

by Penguin - 2023-10-20 07:03:22

I suspect that Gemita's post above is quite right. 

However, I'd add that atrial arrhythmia can also set off something called PMT or other pacemaker mediated tachycardias. These are rhythm disturbances caused by the pacemaker itself. 

Most pacemakers have a PMT detection algorithm which terminates it.  However the detection settings need to be appropriately programmed.

There is a pacemaker mediated tachycardia named RNRVAS which is not easily detectable. 

It is also possible that your father's arrhythmia are not being detected by the device if they occur in the lower heart rate ranges. Bisoprolol might help and Gemita knows more about this drug than I do.  However, I do know that arrhythmia which are not detectable can cause uncomfortable symptoms because the pacemaker may not do something called 'mode switching' * which normally helps.  

*mode switching = making sure that the device doesn't track uncoordinated beats down to the ventricles by 'mode switching' to a non tracking mode. 

If you find out the manufacturer and model name for your father's device, we may be able to advise further as each make / model has it's own range of settings and quirks!  People with the same pacemaker may be able to offer further advice.

I hope he gets some answers.  Patients usually know when something isn't right, so trust your father's good instincts. 

Best Wishes

 

Reply

by moliona - 2023-10-21 04:56:05

Hi guys,

Thank you all for your comments and time. It makes you feel you are not alone.

My father is 71 years old and lives in Albania, Europe. He first experienced tachycardia in February of 2023.  During all this time he  went several of times in ER, physicians tryied several medication with no effect and thereafer he underwent an electric cardioinversion and was treated with amioderone which my father stoped in August due to side effects, leaving him with shortness of breath, severe weeknes and dizzness. Two days before the appointment with the cardiologist to sett a new way of medication, tachycardia started again (as always 130 beets per minute) leading my father in ER where he was kept monitoring for 48 hours and treated with amioderone. Syncope, dizzness and bradycardia (35 beets per minute) started again in the ER. The physicians stopped amiodarone but beets were still irregular and my dad continued to feel sick. He was though released from the hospital as thye couldn't kept a patient more than 48h in ER but was put under holter monitor for 48h. The result of the holter was: Atrial flutter, heart reate was from 32b/m to 120b/m and several pauses of the heart from 3 to 4 seconds, during which I had to say he fainted. Meanwhile, because he was not feeling ok., my father had his second electric cardioversion in a private hospital as the public hospital didn't do it in ER but in other departments and the procedure was longer. After that, my father was presented again in ER showing them the result of the holter and it was this time the ER decided that my father had to be hospitalized for implantation of Pacemaker to treat now his bradicardia. So it was implanted an Endurity Core PM 2152 of St. Jude Medical and the medication to take in continuance for the atrial flutter was Bisoprolor (5mg per day). We were made aware that the PM does not treat and cure arrhythmia but nobody told us for any adjustment period of the heart with the new pace.

My father is very acctive person. He walks a lot and swim 2000 meters. He works as a gutarist in church and gives guitar lessons for the kids in church and do other works as well. Because of the symptoms he feels after the PM, he fears he won't be able to do this things again which form him are not just a job but a hobby.

Thank you very much for your answers.

after pacemaker

by new to pace.... - 2023-10-21 07:37:13

Thanks for filling in your bio.  Your father should not have to stop what he is doing now.  Although he has to heal first before returning to swimming.  Everything else he can do and more with a pacemaker.  While he is healing he should  not raise his left arm about his shoulder.  Lift anything heavier than 5 pound with his left arm.  That is to make sure the wires and the stiches do not pull out.  He should move his left shoulder so he does not get a frozen shoulder.  While healing he should make sure he drinks enough water so he does not get dehydrated. Keeps up his walking.

new to pace 

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Sometimes a device must be tuned a few times before it is right. My cardiologist said it is like fine tuning a car.