heart muscle twitching

I had a Guidant placed August 16th. I feel a heart muscle "twitching". My pacemaker tech says it is probably the ventrical lead kicking in, but I shouldn't really feel it. Does anyone else feel such heart twitching? My pacer is set for 50, and when I feel twitching and take my pulse at that time it is always 50. I don't feel it when I check my pulse at other times, when it is 50+. Any thoughts or advice?



by ela-girl - 2007-08-30 08:08:51

Hi, jeanhowser!

Well, it could be the ventricular beat you are feeling. I know when I first had my pacer implanted, I felt a strong heartbeat a lot the first few weeks. My EP said that if someone is going to feel anything, it is usually the ventricular beat because it feels like a strong heartbeat. I still feel it from time to time, but I was definitely more aware when I first had my device implanted in my chest! I probably even felt things that weren't really there! But it was defintely a strong beat, not a 'twitch.' Also, you come out of surgery most times with factory settings that need to be tweaked the first few months to get things right for you. Honestly, you really shouldn't be feeling the pacer at all--it should be nice and quietly tucked away in your chest doing it's job. Keep an eye on things and definitely keep an open line of communication with your doctor if you feel it's just not right. Maybe you are just over-sensitive to the whole experience right now? I think I would drive myself crazy if I was taking my pulse a lot, too.

Happier pacing!


by cottontop - 2007-08-31 01:08:48

I have a Medtronic PM and I feel the same thing. I got mine June 20. I have had a partial pericardial sac removal Nov.28,2006 and I am extra sensitive to my heartbeats. I never thought of the term "twitching", I always have described it as a hard beat that feels like my heart shifts towards the right. Like you I use my wrist bp and pulse cuff and it reads 60 ,61,62. Mine is set at 60. Just to see if that was it I was feeling at times check it when this happens and it will be 60 or just little more. I told my cardio I can feel it "kick in" and he just said oh really. So I don't like the fact that I feel it. But I guess from what I read on the posting we all are so different in recovering. I guess I wasn't much help but you probably feel like I do, that everyone says that you won't even notice that you have one. I wish! Best of luck! Some of us take longer to recover than othersI cottontop


by SMITTY - 2007-08-31 09:08:22

Hi MH,

As others have already told you, you should not feel your pacemaker. Now let me qualify that. You will feel your pacemaker as it pertains to your surgery. The surgical skills of the surgeon will often be the final word of whether you do or do not feel the pacemaker more than a few days after the implant. According to the reports I have seen from electrophysiologist after the implant area is healed you should not feel the presence of that PM unless you're checking out the site with your hand or, God forbid, you get a lick directly on the PM site. Even if you get a lick directly on the site and it is painful it is not likely to damage your PM.

Now, I’ll comment on your feeling the twitching of the heart muscle. You are the first one I have seen call it twitching, and I have seen it called some dandy names. But that is as good a description as any if that is the way it feels to you. For example I said mine felt like bee stings. As for you feeling it when your heart rate is 50 BPM and the low setting on your PM is 50, I will guess that means your PM came on line and is providing the impulse to make your heart beat at least 50 BPM. So, I don’t see anything about you feeling at that HR, and to say you know you PM is on the job. However, you feeling that PM as it does its work is another story.

The causes of being able to feel the PM can be many, but a couple that come to mind are, the voltage is set too high or a lead it located in such place that the impulse from the PM is stimulating a nerve in the immediate area. If you are lucky, it is a high voltage setting as a simple adjustment can correct that. To reposition a lead requires additional surgery. Your doctor or technician will be the one to correct your problem.

Since I have a little extra time (it is either stay at my computer or my wife will send me to cut grass) I’ll delve into why you are feeling this twitching only when your HR is 50. You say the low set point is 50. Like all of us, when we leave the hospital we are usually told what the settings is for our PM. In my case those numbers were 80 to 120. Over the years there have been several different ranges for reason I’ve never been quite sure about, but my range right now is 60 to 100. For the sake of simplicity, I’ll use my numbers, but I am 99% certain that what I say will apply to your PM although you have a different range.

For me what these settings are saying is that if my HR drops below 60 BPM my pacemaker will come on line and work 100% of the time, if necessary, to give me a minimum HR of 60 BPM. However, if my HR goes above 60, my PM will stay involved, but not necessarily working 100% of the time. The pacemaker is designed to give preference to the hearts natural pacemakers when making the heart beat. The PM does this by checking to see if the hearts natural PM is going to cause the heart to beat (it does this for both the atrium and the ventricle) before sending an electrical impulse to make the heart beat. The PM continues this checking and sending an impulse as necessary until the heart rate reaches the maximum setting. After that the heart is on its own and the PM will not come into the picture unless it senses that the heart rate is within the range in which it is set to help and needs help, again, in my case that would be 60 to 100.

Of course I’m guessing, but I think in your case you PM is working 100% of the time when your heart rate is 50 BPM. However, as your HR goes above 50 the PM continues to check to see if it needs help, but sends no impulses since you have a stable heart rate, therefore you do not feel the twitching.

In my case, my heart rate is never stable. I have PVC, or skip beats, going all time so my PM is constantly sending impulses to keep it at whatever rate my heart’s sensory system is needed for my activity at that particular time. The problem with those PVC and skip beats and this can happen to any of us with a PM, is that they are the result of a signal from my heart’s natural PM that are not good enough to cause a heart beat, but my PM thinks they are good signals and send no impulse. The result is my heart is faking out my PM and I will often have a heart rate in the 40s even with the help of PM.

For some reason the minimum heart rate I have seen since getting my PM 7 years ago, is 43 BPM. I don’t know if that is as low as my heart’s natural PM will let it go, or if my manmade PM is designed to take over completely at that rate. Whatever the reason I have not seen my HR below 43 since getting the PM implanted.

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