Bradycardia/Knowing when I should get pace maker?

Bradycardia

by piglet22 - 2024-10-23 12:15:13

For a lot of people, your heart rate would be too slow. Normal is in the 70's.

Your fitness could account for the low resting rate.

Another encouraging sign is that you have a rate response to exercise, or at least you aren't feeling bad.

A classic symptom of bradycardia resulting from a conduction problem, is there is no rate response. I could get on a static bike, go through hell and my heart rate wouldn't budge above 40 BPM. It turned out to be Complete Heart Block (CHB). I felt really unwell.

Your loop recorder is checking that. Make sure you keep a timed diary of when you exercise and relax.

Do you look after your pulse and BP by using monitors? It's all good evidence.

Problems like heart block can be intermittent, so even a 5-day Holter might miss it. It missed mine, but as the battery ran out halfway through, that's no surprise.

Your consultant will tell you all you need to know. Bradycardia is very common and very treatable.

If it goes as far as a pacemaker, it's no big deal, in fact if you have a conduction problem, you are going to feel better and your heart will be under less stress.

As far as choice of leaded or leadless goes, I would want a convincing reason why a leadless is preferred to a conventional leaded device. I have leaded devices in the past and would like to keep it that way.

There are many types of heart rhythm disorders, and many for bradycardia itself. Mobitz is one of them.

Good luck and let us know how you get on.

when to pace

by Tracey_E - 2024-10-23 12:45:47

Being able to exercise is great, but if you are sluggish all day that might mean it's time to pace.

Until a year or two ago, everyone got leads and leadless were still considered a bit experimental. However, a shift is happening and over the next years I predict leadless will become the norm. 

I've been paced since 1994 and am on my 5th device. I am having my leads extracted soon and have been going back and forth with my doctors what my next device should be. They recommend leadless, which is my preference but the question is if it will support my activities. Unlike you, my rate does not go up on its own so I'd be dependent on the pacer to do it for me. If your rate is good with exercise now, it will continue to be good with a pacer. The pacer is a gas pedal, not a brake. When you go up on your own, it will just watch. It sounds like you will just need it to kick in at rest.

If you can't get through the day without a struggle, and it's clear a low rate is the reason, then imo it's time to pace. Most of us don't realize just how bad we felt before until after when we have a normal heart rate again. For me, it was night and day. I declined gradually over several years. We adapt and suck it up and tell ourselves we are fine, but we really are not. I felt like I'd been mainlining coffee those first few weeks. Not everyone has that dramatic of a change, but it's common to be amazed at the new energy level. 

If your doctor is experienced with leadless, and a leadless will suit your needs, then I would seriously consider it. Less hardware means fewer things to wear out and need removed down the road. 

Life after pacemaker

by Gotrhythm - 2024-10-23 14:50:17

Like you, my only symptom was bone deep tiredness that no amount of sleep seemed to help. Also, like you, my heart rate would increase with exercise. Unlike you, I wasn't smart enough to  come to this website and ask questions.

Getting a pacemaker was a revelation. Even while I was coming out of anethesia, I could tell I felt better. A day later, I could hardly believe how well I felt. It's hard to realise, since you know you're healthy, you can still exercise and do anything someone your age should be able to, that your body--truly every cell in your body--is struggling. Until you feel the difference that a pacemaker can make.

I don't know much about leadless pacemakers, but I can assure you that the leads do not limit your abilitiy to exercise. Many or our members maintain a high level of fitness.

Hi and welcome!

by Lavender - 2024-10-24 01:23:16

I'm thinking if you do get a pacemaker, your cardiac team will choose what's best for you. They can advise on whether leadless or conventional is suitable in your case. 

My heart block was so random that I fainted 25 times over six months. A one day heart monitor didn't catch it so I went through six specialists while they tried to figure out why I was fainting. Finally a thirty day monitor caught the pauses. The last pause was 33 seconds which nearly took my life. 

I have had a CRT-P device for over three years. I can do anything I used to and have lots of energy. 

Let us know what your dr says, Jeff. It's going to be ok. It just will. 

Pacemaker - when?

by Runsalot - 2024-10-24 09:16:01

I am 69 and train for competitive triathlon and running races up to the marathon. My lifetime of endurance training provides me with a big heart muscle and a low heart rate (40) and ejection fraction (45). During a pre-op for shoulder surgery five years ago they discovered I was in Atrial flutter so they did a cardioversion to get me back to normal and did the surgery. They had me wear a holter monitor for 30 days and discovered I was in and out of AFIB with a ventricular heart rate in the 30s and an av type 2 block. They asked if I was tired and had a hard time exercising. At the time I was training 12 to 14 hours a week, taking a nap during the afternoon and getting older....so yes I said I was tired. Turns out, I was also not getting enough blood flow. I did some research and we had a family history of electrical problems and both my grandfather at 64 and great grandfather at 72 died as a result. When I went into afib one day with a ventricular rate of 30....I decided to take my doctors advice and get a pacemaker. Best decision ever and now I feel so much better.

i would recommend getting fully tested, listen to what they are telling you, ask good questions and make the best decision for your long term health.

Runsalot

by piglet22 - 2024-10-24 09:34:47

Good to hear that you got sorted out.

Others may disagree, but your Ejection Fraction (EF) 49% is on the low side.

It measures pumping efficiency.

Did they explain any of the numbers?

Quite possibly with a high level of fitness it doesn't affect you.

Presumably with all the exercising, you do some home measurements like BP, HR and O2 saturation.

Just a thought.

Ejection fraction

by Runsalot - 2024-10-25 07:30:10

Yes a ejection fraction of 45 is considered low. However when I was tested with a stress test at the Mayo Sports Cardiology Clinic in Rochester MN, they found that when at stress my heart pumps more than enough blood/oxygen when paced properly. They told me my VO2 was in the high 50s low 60s which is on the rare side of high for my age. But always good to keep monitoring as we age for any significant changes.....I can stay in great shape, but somewhere along the line family history becomes a possible factor.

For Airborne

by Good Dog - 2024-10-25 09:19:35

You asked if anyone here had a similar HR and symptoms. My HR and symptoms were very similar to yours before my PM. You indicated that your HR was fine during exercise. So I assume that your heart responds well to activity and the only issue now is Bradycardia when at rest. I got my PM at the age of 38 with exactly the same situation as yours. In an effort to feel better at rest I got a pacemaker with a minimum setting of 60 bpm. However, my body was so accustomed to a low rate I was having a serious problem when trying to sleep. Before my PM when wearing a Holter Monitor it was discovered that when I slept my HR dropped to 35 bpm. So my Doc reduced my minimum for my new PM to 50 bpm and my sleep problem went away. With my new PM I went on to play sports and as an example, my HR would exceed 140 bpm when playing basketball. I discovered that my PM simply went idle while tracking my rate above the max setting (at the time) of 120 bpm.  So it is my opinion that you would be in a similar place. I think you will likely need a PM now to keep your resting rate higher which should give you more energy. You will find that you can live a completely normal lif with a PM and should feel better at rest.

If you get the PM just be sure that you have an experienced EP and your lead placement is optimal. That is critically important over the long term. You will find that getting a PM inserted is no big deal. It is a very safe and simple procedure.

BTW: It is my opinion that you likely will not need rate response turned-on since you heart responds well to exercise. I would not have it turned-on until you need it. Just my opinion.

I wish you the very best. Please come back and let us know more about your experience as you move forward.

Sincerely,

Dave