Sinus pauses=pacemaker choice

Welcome🌼

by Lavender - 2024-06-19 22:14:30

After me fainting for six months and seeing six different specialists, a heart monitor finally detected the pauses. Yes, the pauses had increased over time. Initially I felt nothing, then it progressed to a very brief feeling like I was going to faint to full out drop attacks with no warning. The last two were near death experiences. The last pause was 33 seconds. I have a rare arrhythmia called Ventricular standstill. 
 

Three years ago, I had no choice but to get a three lead CRT-P pacemaker. It fixed me. Yes I was scared but more scared NOT to get one. 
 

Leads do not necessarily have to be changed in fifteen years. People here have them three times that long. Don't believe everything you read. Most people have a simple box change as outpatient when the pacemaker battery wears out and leads are left alone. 

It is hard not to worry in advance but it is nice to plan getting a pacemaker rather than get one as an emergency. 
You will be fine. There will be recovery time and you will get through and go on to live a normal life. 

nervous

by Tracey_E - 2024-06-19 22:25:49

Well, of course you are nervous! You are absolutely making the right decision because pauses only get longer (and more dangerous) and it's great that you have faith in your doctor. But it's still normal to be nervous. As surgeries go, it's a minor one, but it's still a surgery. 

What do you do for exercise? If it's something that doesn't move the chest much such as cycling, then you'll want one with rate response that uses breathing rather than just depending on movement. So, tell your doctor if you cycle. That said, if the pacer is only for short pauses, it's only going to kick in for a few beats at a time so any of them will work. But it's nice to plan ahead in case things change down the road.

Leadless have been around for about 5 years, I believe. Two chamber leadless was only FDA approved last July, and many doctors have not yet done them. It's hard to say which is the better choice right now. It would be nice for them to be better tested and have more doctors able to take care of them, however they have a lot less hardware which means less places for things to go wrong. I've been paced 30 years with traditional leads with no major problems at all. We are discussing leadless for my next one so I've done a lot of research. I still don't know which way I'll go, wishing I had a few years instead of a few months to make a decision! 

As for complications, all complications from the serious to the very minor, are less than 2-4% of implants. It's easy to think the number is much higher by reading the posts here. For every one person coming here for answers, there are thousands out there with no reason to seek out a forum like this. So, it seems like everyone has complications, when that is very much not the case. 

p.s.

by Tracey_E - 2024-06-19 22:28:00

I have one lead that was replaced at 15 years. My other lead is 30 years old and just now starting to show wear. 15 is an average. 

Worry

by Tennis player - 2024-06-22 01:45:05

I completely understand your worry and nervousness.  I had asymptomatic 8-10 sec pauses 7 years ago.  My EP took a conservative approach and did not recommend a PM at the time. Last Dec atrial flutter was discovered by chance through a routine EKG during a physical.  Again no symptoms but I decided to have an ablation in March due to the risk of a stroke.  The ablation was successful but that night when I got home my HR dropped to 30's and 40"s (still no symptoms).  My husband and I went to the ER as a precaution. They immediatley admitted me and wanted to implant a PM the next day, however I needed more time to assess the situation. Like you (fabmom), I had never experienced the typical symptoms of bradycardia....even while I was in the hospital.  I'm a very active 65 year old - tennis, hiking, running.  Just last September I hiked across the Grand Canyon in one day and felt great! I must have been lucky!!  It's a "big decision" and a hard one to make when you're asymtomatic. I ended up deciding to get the PM a day later on March 20th.  I'm back to doing all my favorite physical activities.  I'm still working out a few kinks through PM adjustments but I'm getting there.  I have a Biotronik Amvia DR-T.  This club has been fantastic to address my concerns and questions.  Feel free to message me if you want to chat.  Best of luck!!

Choice - Leadless / Traditional

by Penguin - 2024-06-22 15:14:22

If it's any reassurance to you, after many years of traditional pacing, if I was offered a leadless PM I would hesitate at this moment in time.  Trust your doctor's advice and then go forward without regret.  

  You will probably end up with leadless in the future if you are likely to need a replacement device at some stage.  Extraction of leads which may be 7-10 years old by then may be something to discuss with your doctor in advance of your decision.  I'm told that lead extraction is routine these days, but you're wise to discuss it in advance with your doctors.  Your decision will feel more secure if you have explored all options and eventualities.. 

As for risks, (of surgery) they are quite minimal for most people and the operation itself sounds scary but is considered very minor and routine by EPs.  Easy for them to say but probably accurate in the vast majority of cases.   We get some scary stories on here from time to time, but they are very uncommon.  A forum will always attract the rarer cases. 

Good luck and welcome from me.

It's a balance - and ultimately your choice

by Xtrabeat - 2024-06-25 08:49:02

Hi - just a note of caution before you proceed. You don't mention how slow your pulse nor what lead this to being discovered. This site is an amazing source of info and encouragement but I think most of us have had PMs because of symptoms where there was not much alternative. 

I my case I have had a slow pulse for as long as I can remember - usually low 40s at night and occcasionally into the 30s. About 12 years ago I was fully investigated because of feeling faint and this was attributed (in the end) to some sort of vaso-vagal syndrome (proved on tilt table for what that is worth) but not before I had had exercise echos, 24 hr ECGs MRI and coronary angiography. Ultimately the advice was to eat more regularly and keep hydrated. I remained well until the end of last year when I had a few episodes of being very faint (nearly blacking out and having to lie on the floor) but by that time I was monitoring myself more carefully and was able to record complete heart block on an ECG on an Apple watch. 

The PM was inevitable but while it has kept me safe (and allowed to drive!) I have had a lot of problems with the settings and episodes of pacemaker mediated tachycardia which has meant my upper limit is now only 120 and this has seriously curtailed my hiking activities. It is all a matter (for me) of coming to terms with the situation and accepting I am a bit older and adjusting my pace accordingly. Like a lot of other people, this has had a profound effect on my psyche and lots of anxiety and poor sleep which (reading here) seems almost the norm.

In your case I would be very keen to have a fairly intense cardiac work-up before proceeding and maybe even a second opinion - it is ultimately going to be a decision based on risk of your having a major event or waiting to see what happens. I do not think the doctors will make this decision for you as the downside risk may have consequences for them too. Good luck