Pacemaker Heartrate

I had my third pacemaker installed last November. They told me it is set so that the pulse cannot go below 60. However, I have a new cuff at home, also an oxi-pulse finger device which many times record a HR of as low as 38. Has anyone else had this problem?

 

Another thing is they were going to change the 2 lead wires which are now 22 years old. But last minute they decided not to, due to my age (88) and possible bleeding etc. The one wire is known to give off "noise" when testing. I wonder if this has anything to do with the low recorded HR?

 

Also I was diagnosed with Afib last August. HR of between 122 and up to 170 once. Of course, the pacemaker can't help that. I was told I had the Afib just about the same time I came down with HyPOthyroidism, TSH of 10.25, (.4 to 4 range) Taking the proper thyroid med has the hypo in control now. I wonder if it could have caused the Afib, as the thyroid has so much to do with so many things, including the heart. Anybody else have anything like this going on...Thanks.

 

 

6 Comments

pacemaker heartrate

by new to pace.... - 2023-12-04 18:13:30

I cannot answer many of your concerns.  Glad to know that someone on this site is older than me.  I got  my first pacemaker in 2019.  As to  that finger pulse thingy , from previous comments on this site.  Many say to use your 2 fingers an put them on your cartoid and then count the beats.  I've not been successful at that location or  your wrist.  i find if it test's low like that i get up and walk around then sit it comes back up. 

new to pace

Finger Oximeter and BP Cuff

by ANDREW75 - 2023-12-04 23:10:07

Hi PMSIEBREN35

Yes my second post was about Finger Oximeters and BP Cuffs. I had very similar issues to you. I even visited my EP when I found this was happening with my pacemaker installed.  Story here:

https://pacemakerclub.com/message/43894

Conclusion I no longer can use these devices.

Your other issues I have no comments, good luck

Andrew 

 

Heart rate

by piglet22 - 2023-12-05 04:55:20

Hello

Normally the base rate say 60 BPM will be maintained, however other factors can come into play where your palpable pulse does not match the settings.

The best way always is check your heart rate is to find a location where you can feel it and then time it.

I've never had success with carotid or ankle and always use the radial pulse. Get two fingers tucked into the depression in the joint just below the thumb.

The upper arm cuff BP monitor is my go to reliable confirmation if I think something is not right.

I don't fully trust oximeters for heart rate but that might just be the model.

Having said that, it's the same as the GP uses.

If you can determine that the pacemaker is not maintaing the base rate, then that needs investigating.

From personal experience,  underlying problems like ectopics can play havoc with palpable pulse.

If you can get your clinician to explain it, you might get the "pacemaker is fine" reassurance, but you can feel it isn't.

What is happening is the ectopics (Ventricular Ectopy VE in my case) are interfering with the pacemaker timing.

The pacemaker senses the VE and doesn't trouble to initiate a useful pulse signal. The VE is weak and is difficult to feel which is why you feel a low heart rate.

As far as I know, there is no way to correct for ectopics through pacemaker settings.

If your palpable rate continues to feel low then you need to get it checked.

If there is an underlying problem, it can result in further complications like dizzy spells or even blackouts

Atrial Fibrillation and falling heart rates

by Gemita - 2023-12-05 10:17:40

PMSiebren,

Hello yes my husband and I both have AF and there are many causes but getting older and having thyroid disease are two important causes as is high blood pressure.  My husband has slow AF.  I have AF at high heart rates.  

Yes I am frequently getting a lower pulse during arrhythmias as described by Piglet and I know that other members report similar events.  In the presence of some irregular arrhythmias, our pacemakers may not work so well and may develop timing issues, issues that I don’t fully understand but clearly this causes symptoms for many of us.

A dysfunctional lead or pacemaker can certainly cause pacing problems and worsen your arrhythmias too so you need to speak to your team if you start to notice worsening symptoms. 

At 88 I think you are doing extremely well.  AF is a horrible condition especially at high heart rates.  I hope this is being controlled with a rate control med like a beta blocker and that you are protected from any stroke risk ?  Take good care

 

Timing issues

by piglet22 - 2023-12-05 12:25:24

A tricky one to get your head around.

Here's what I think is going on when ectopics (PVC, PAC, VE) interfere with PM timing.

Ectopics are rogue contractions that are triggered outside the normal PQRST scheme of things. Rather than radiate through the tissues in an orderly way, they originate in places or loci that cause specific areas like the atria or the ventricles to contract out of sequence.

They tend to be weak and may not be felt. The weak contractions give rise to symptoms like dizziness or fainting.

The IPG base rate of a pacemaker, say 60 BPM is the regular rate the PM would pulse at if it detected no residual wave from the heart. If the PM was sitting on a bench and not connected to anything, it would pulse at 60 BPM until the battery ran out.

It works by running for 1 second (1000 milliseconds), pulses, resets the timer and just keeps repeating the sequence.

The 1 second timer can also be reset by a normal heart generated pulse. Doing that, it means the heart rate should never fall below 60 BPM and if the normal heat rate is faster than that, then the rate will increase. Here's where the ectopics mess that up.

The ectopic gets sensed by the PM and resets the timer, but it's not an effective contraction, so you don't feel it.

If the ectopic comes in at say 900 milliseconds, it could be 1900 milliseconds before the PM steps in to restore normal heart rate.

If ectopics keep on coming in at 900 milliseconds, the PM may never fire and you fall over.

This is my best stab at how I might design the timer and in practice it's probably a lot more complex.

Hopefully, after a while, the PM might recognise that the normal pattern isn't working and do something to correct things.

The last pacing consultant I saw said he wasn't aware of a pacemaker manufacturer that had anything to correct for ectopics.

The approach is to try and dampen the ectopics with large doses of beta blockers or if all else fails, it might be to try and locate the loci and burn them out.

From personal experience, 100 PVCs an hour can be enough to put you on the floor. I suspect that there is a link between activity and the frequency of ectopics and 100 is just an average.

I'd be interested to hear any views if my crude explanation fits a more clinical one 

Great post Piglet

by Gemita - 2023-12-05 14:12:42

I will have a think about this but perhaps we should make a separate post. It is too important an issue not to dig deeper.  I believe I have something useful to add and with input from other members, we might be able to make some real progress in this area at last.  It would certainly be worth all our efforts

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