Meeting the criterial for a pacemaker

July 2007 I experienced my first pre-syncopal event, which landed me in the hospital. Since then, I now live with a resting heart rate, while awake, in the 40 to 50’sitting and high 50’s to low 60’s standing. I have been experiencing profound lightheadedness for over a year. I would like to emphasize there is nothing athletic about me. The lightheadedness has been disabling and I have been unable to work or finish grad school.

Now, my family doc wants to “try” a PM sense nothing else has worked. There is one doc locally that will put one in. However, I have received opinions from EP docs at the Mayo, Cleveland Clinic, and another hospital where I live and they all say “no.”

Consistently, I have heard the same thing from the docs that have said “no” to a PM. I don’t meet the criteria set forth by the AHA.

In addition, if my BP remains stable (mine is around 110/70) and I have a pulse in the 40’s and I am lightheaded, my pulse in the 40’s is not causing my lightheadedness. If I got the pacemaker, “yes” it will increase my resting heart rate but the likelihood that it will help my symptoms is small. Now, if my BP was really low or dropped causing me to faint and my pulse was low then the pacemaker would be beneficial. Raising my HR would raise my BP, which would decrease my symptoms.

▪ Nothing structurally or mechanically wrong with my heart
▪ Negative tilt test
▪ Autonomic testing was essentially normal
▪ Proper chronotropic response.
▪ Extensive lab workup unremarkable
▪ No blocks or pauses

These docs feel as if I am campaigning for a PM. One doc actually told me if you keep trying hard enough there are EP docs out there that will gladly put one in. They don’t understand that I have a poor family doc, which has left me to be the one to be proactive and assertive when it comes to addressing my medical condition. I am not opposed to a PM. I just want to feel better. I will try anything!

Maybe someone out there can shed some kind of explanation to what I have been told would be greatly appreciated.


7 Comments

Not a Rose Garden

by bobad - 2008-10-23 04:10:12


Hi Buster,

Having a pacemaker isn't all good. There are many down sides to them. Unless your quality of life is fairly poor, I would listen to the top notch docs at Mayo and Cleveland and pass on the PM. And don't believe the 1-2% complication rates they quote you. Those are encountered only during surgery, but in reality most complications are after surgery. So they don't have to tell you about those. Just read these pages and you will get an idea of what all can go wrong. Not trying to worry you, just playing Devil's advocate.

Here is 1 criteria you didn't mention, and it's a great general catchall for the docs and patients that really want a PM:

If you need to take a certain medicine (like beta blockers), but that medicine does things to your heart that cause you to require a PM, you qualify. See how fuzzy that is? :)

Best of luck in your decision.



frustrating

by Tracey_E - 2008-10-23 04:10:29

Does your rate go up normally when you exercise? I assume with all the doctors you've been through that they've done a Holter and a stress test.

It really doesn't sound like a pm would do much more than raise your heart rate. More oxygen could possibly help with the lightheadedness but it sounds like it's not your heart so treating the heart is unlikely to help you. Have they checked for inner ear issues?

My rate was in the 40's then dropped into the 30's and I had a lot of dizziness, however I have a third degree block and my atria was beating significantly faster than the ventricle. The pm isn't artificially raising my rate, rather it's just putting it where my natural pacemaker thinks it should be.

Off the wall question... have you tried a chiropractor? Anything they do is temporary- no drugs and non invasive- so you have nothing to lose by giving it a shot. Upper cervical misalignment can cause dizziness, that's what they fix. I've also heard of people getting good results with acupuncture and herbalists for things that regular MD's can't diagnose.

Chiropractor, are you kidding?

by ted - 2008-10-23 10:10:48

The last person in the world that I would go to is a Chiropractor. They are mostly a bunch of charlatans who prey on people in distress with the nonsense of "misalignment" Many strokes are caused by chiropractic manipulation. Their fraudulent claims and advertising keep suckers from going to real experts for the help they need, They claim that they can cure everything. They do know how to transfer your money from your pocket to their's Sorry for coming out so forcefully, but I have witnessed so many people taken in by these quacks.

I had my PM implanted in vitro

by Buster - 2008-10-24 01:10:25

I apologize that my profile indicates that I already have a PM. That was not my intention. This group over the year has provided me with a great opportunity to gather information and to learn from others experience. It has in some ways helped me be better prepared when meeting with these Drs.

Yes, my battery is dead. LOL. Mentally!

I cannot wrap my hands around their thought process. My HR was above 60 at rest while awake for as long as I can remember but now it is not for some unknown reason. Ironically, the same time my resting HR shifted to bradycardia is when I started experiencing the lightheadedness and breathlessness. But increasing my resting HR won't help? It just doesn't make any sense.

I am not on any medications that would lower my HR. I have no problem increasing my HR with exercise. However, after exercising I am extremely fatigued for days.

Actually, I was on Levsin (anticholinergic). Basically, it is oral atropine. It is intended to decrease those that have high vagal tone. Didn't work.

Now, I am on Theophylline. Again, intended to decrease vagal tone and increase my resting HR. At this time, no significant change.

I did see a otoneurologist. Some indication that I could have cervicogenic dizziness. Very controversial. Many believe it is not a dx. and does not exist. Not having anything to lose, I tried PT and nothing worked. I actually would scare the heck out of the PT staff. They would check my HR and it was in the high 40's, low 50's. They couldn't believe it.

The only thing that was remarkable was this special circulation test. It showed that I have marked venous pooling in my legs. Very odd for someone my age. I blame the damage done to my legs on the statins. Whole separate issue. How much of the lightheadedness can be attributed to the venous pooling is unknown.

The last seed planted in my head:
This EP Nurse recently told me the benfits do not outweigh the risk. So, unless I crash and burn they are not going to put in a PM. Then, the EP doc follows by saying...trust me you will know when you will need a PM. My wife and I were like what the heck does that mean! You will know. How about some signs that I should be aware of in case we reach that point doc!

Healthcare! You gotta love it!

ted

by Tracey_E - 2008-10-24 07:10:08

There's no need to be rude. There are a lot of good chiropractors out there. Sadly, the bad ones make it hard on the good ones. Mine is awesome. I went from chronic severe back pain (left from a head on car crash) that the physical therapist, ortho and gp all wrote off as nothing could be done but keep me on painkillers, severe allergies with chronic sinus infections and migraines that kept me in bed two or three days a week to a pain free life. Literally pain free. I rarely even take an aspirin now and I haven't taken a prescription in ten years. So, yeah, I stick by my statement- a good chiropractor can work wonders.

Sorry

by ted - 2008-10-24 10:10:31

TraceyE: Sorry if I offended anyone. The poster had complained of heart rate, blood pressure and lightheadedness problems. Those complaints are really not for chiropractors. I'm glad that you have gotten relief for your back pain from chiros. I know others who have also. There are bad and good in every profession but it just seems to me that chiropractors as a group are prone to make extravagant claims about being able to treat conditions that cannot be relieved by "manipulation" and are not caused by "misalignment". Again, I meant no offense

I see your problem

by ElectricFrank - 2008-10-24 12:10:49

I was looking at your profile for the forum.

Year of birth: 1972
Year of Implant: 1950

You already have a pacemaker that was implanted 25 years before you were born. Likely the battery is going dead.

LOL, frank

You know you're wired when...

Your heart beats like a teenager in love.

Member Quotes

At age 20, I will be getting a pacemaker in few weeks along with an SA node ablation. This opportunity may change a five year prognosis into a normal life span! I look forward to being a little old lady with a wicked cane!