Should I be worried about ectopic beats

Hi to the ectopic beat experts

Had to go back for a PM check yesterday at 10 weeks as I am having problems with my heart pounding in my neck - easy to see at times. The technician made some very small adjustments which she thought might help and again told me that I am only pacing less than 6% of the time. I have second degree heart block and a Medtronic Adapta dual chamber PM fitted on Feb 4. The dreadful breathlessness that I was having from day one of the pacemaker was cured when the rate response was turned off at my first check up at 6 weeks. Thanks to everyone who gave me invaluable advice as without this I would never have known about this setting and it would not have been turned off and I would still be huffing and puffing around in slow motion with the cardiologist continuing to tell me that it isn't the PM because it's hardly pacing.

Anyway since my visit yesterday I have a new problem. The pounding in my neck has stopped but now a thumping has started in my chest. So I phoned and they told me to come back in. Once I was all wired up the thumping started and she could see that they were extra (ectopic) beats. In fact there had been four thousand since I was there the day before. Apparently that isn't a lot as a percentage of our daily heart beats. But I am not happy as I didn't have this before the PM. This thumping, which sometimes makes my neck and shoulder twitch, only seems to happen at rest and when I am driving. I haven't noticed it at times of activity or exercise. Sometimes the thumps come in quick succession and I get a horrible feeling of panic inside me! The technician decided she didn't want to make any more changes so she has fitted me with a 7-day holter monitor and a diary for recording the events - it is filling up really quickly!

Is there anyone out there that knows if settings on the PM can cause ectopic beats and how to fix it? I must stress that I felt very well pre PM and had none of these symptoms as my problems were only happening during the night.

Sorry for this overly long and probably boring post!

Sue from London

10 Comments

Hope it gets better soon!

by Swedeheart - 2008-04-18 08:04:52

Hello Sue,

I do not have an answer for you... I am sorry for that. But I do know that I have had a number of weird symptoms that I never had before my PM was implanted. I received mine Feb 25th. When I have asked "could the pacemaker cause this" I always get a "no"... but some of the symptoms I have seen others post about are so similar to mine. I guess it is just hang on and be tenacious about it.

If your holter monitor is "filling up quickly" you might want to see if you can schedule an appt. with your EP rather than the technician...or with them together!

Good luck and keep us posted.

Swedeheart

Ectopic Beats

by SMITTY - 2008-04-18 09:04:24

I'll see if I can offer something for you to think about.

First let me comment on the 4,000 ectopic beats in a day. Most of us do not realize how many times our heart beats in a day. But if the heart rate is 60 beats/min. and since there are 1,440 minutes in a day, that means in an average day we have at least 86,400 beats. Throw in some extra beats for exercise and we quickly reach 100,000 beats in a day. But at 86,400 beats the 4,000 would be only 4.6% of the beats, which I guess is not very many, unless you are the person feeling them and then it can get to be a lot.

As for the "thumping" you feel, since you mention this is more likely to happen when you are not involved in physical activity (you said at rest or when driving) I think you may be experiencing the same thing I have from time to time. My PM has a low set point of 70 and if I'm doing anything physical my natural heart rate will be above 70 BPM and my pacemaker will be just along for the ride. Let me get inactive and my heart rate will go into the 50's if it were not for the PM and it seems that's when I will have some strange and unusual heart beats, I have reported this many times and have been told many times "your PMis just fine and that is not the problem." . So my guess is that what is happening to you is the "thumps" only happen when your pacemaker is working. Why, I have no idea, unless your PM needs fine tuning. Of course, if you are 100% PM dependant, then that theory goes out the window.

I agree with Swedeheart about making an appointment with the EP and have the tech present if possible. I have found the tech can tell the doctor things they have found during my checkup that may not be on a report nor any other record.

Let me inject something here that is going on and is a first for me. Contrary to what I said above about physical activity speeding up my heart rate, for several weeks physical activity makes my heart rate become very irregular and it wants to go low rather than speed up. Today for example I had a HR of 48 most of the morning. It makes me feel very poorly and I have found no way to cause any change in these episodes. After I see the EP in a couple of weeks, at which time I hope to find out what is going on I may be mentioning it here. I didn't want you to see that which will be a contradiction of what I told you in this comment and think I was fabricating something to tell you.

I will guess the ectopic beats are nothing for you to worry about now, except for them being very uncomfortable, I'm sure. But as I said earlier I think the problem can be solved with a fine tuning of your PM operation.

I'll be very interested in hearing what you learn.

Good luck,

Smitty

Extra heart beats...

by harley63 - 2008-04-18 11:04:00

The post by Smitty and many others are the very reasons I visit this site.. thanks to all that share their experiences, knowledge and feelings.... so here I go with my story on those extra heart beats.... after reading, pondering and making my list.. I set off to the MD office and had the tech check PM settings... I too was having what I felt was a lot of those extra beats (at times a pounding and at times a short rapid series of beats) since the "fine tuning" I feel less of these extra beats and have less of the chest heaviness feeling. So thanks to all for the information about settings and that I had options!! I had no clue and called up Medtronic gave them my Model # and they spit out the options that my PM had.. Yee Haw, I felt like I had hit the lottery!!! Like Smitty, early morning my heart rate drops below 50 and late at night I've discovered it does as well when I'm relaxing/destressing for the day.

Since my PM placement (Dec 06) I have had a slight tingle in my lower lip - about from the middle extending over to the left side and at extreme moments the sensation goes directly to my left lower ear lobe. Anyone else have this? Workup "guess" is that my PM must be sitting on a nerve(s) that are linked to my lower lip, face and ear lobe. It's thrilling to know that I'm not having a stroke and I've stopped running to the mirror to see if I'm drooling. Just wondered if there is anyone else who experiences this same sensation.

And to close... ya'll rock in my book!!! I feel less anxious and more comfortable in my own body now that I've seen others... normal everyday people living fruitful lives with internal devices! You all are an inspiration to me to get moving and not just dream!! Thank you!!

Low HR With PM

by SMITTY - 2008-04-19 01:04:50

Hi Sue,

Yes, my HR was actually 44 to 48 most of the time that morning. There were a few minutes when it would go back to 70 BPM for several minutes at a time. I am not certain why the PM would not bring it back to 70 when it was low. I guess that shows how little I actually know about a PM and my only consolation is I'm not alone. In Oct '07 I had an in office checkup and my HR rate at the time was bumping around from 44 to 48 and the technician could not tell me why with any certainty. Then a couple of weeks ago it was 55 and that tech (different one from Oct) was no better.

Over the years from reading messages here and looking for PM information on the Internet I have come to the conclusion that our heart's natural PM can fake out our manmade PM. Seems that before the manmade PM sends an impulse it first checks to see if the heart's natural PM is going to send one. If I understand what is happening, the heart's natural PM can send a signal that will cause my manmade PM to think it is going to give me a heart beat, when in fact that impulse from the heart's PM is not strong enough to give me a heart beat. I have asked the tech if this was possible and I got what really amounted to a convoluted answer but she sort of agreed that is probably what was happening.

Then she launched into an inquiry about how I was checking my HR and I told her I had two different electronic devices I use and I use my and my wife's fingers. She so much as told us that I was actually getting a good heart beat but it was a weak one and we, nor the electronic devices, could detect them. I gave up then. But the fact is one of the electronic devices is an Oximeter exactly like they use in the hospital where she works to check O2 percent and heart rate. My wife is a retired nurse with 45 years experience checking pulses and I have put my fingers on my wrist more than a few times over the last 25+ years. Like I said, I gave up on that discussion and that is also why I have no confidence in what those people tell me. I hope to do better in a couple weeks with the "new" EP. I'll let you know.

I will add this, I don’t think the people I have to deal with are an exception and that is why this is such popular site. Now, I’ll go so far as to say that I don’t totally blame the nurse/technicians I have doing checkups. I think the pacemaker is such complex devices that not even the makers know just how it will interact with each of us. Being humans I think most of us have about the same muscles, blood vessels, nerves, etc, in about the same places. But we are not clones and that means the impact of our PM on areas where it is not expected can happen and we learn the hard way that what worked perfectly for Mr. ABC may not be so perfect for Mr. DEF.

Best regards,

Smitty

Ectopic beats

by ElectricFrank - 2008-04-19 01:04:55

Having the pacing voltage set too high can be irritable to the heart and sometimes increase the number of ectopic beats.
The other more likely is that you are going through some sort of virus. Starting back in November I went through 2 months of having PVC's which are one form of ectopic beats. They suddenly stopped as quickly as they started. The interesting thing is that my son who lives 2000 miles from me and doesn't have a pacer had the same problem. His started several weeks after mine had settled down. His also lasted for close to 2 months.
There was an article in our local paper about a number of non-flu type viral infections going around with various strange symptoms. This doesn't help cure the problem and I sure understand how unsettling they can be, but they could just resolve on their own.
The cardiologist wanted to put me on beta blockers to see if that would help, but I turned him down. I would just as soon put up with a bit of discomfort than the side effects of the the meds.

frank

PAC or PVC

by bunnykin - 2008-04-19 04:04:31

I've actually learnt to recognize when to get worried and when to dismiss these ectopic beats. However, you will have to find out which kind of ectopics you have. Do they come from the atrium or the ventricles?

Premature atrial contractions(PAC) apparently are far more harmless than PVCs(premature ventricular contractions); Also, having said that normal people without heart problems do get these combinations everyday, every now and then, and they feel fine. For some people if they have coronary disease, or a previous heart attack,they probably need to monitor the ectopics carefully.
My own experience is, I have lots of PVCs too and recorded close to 10,000 a day and that was when I had the PM. I kept complaining about the discomfort these ectopics gave me and my EP was ignoring them dismissing them as insignificant.(I have no coronary heart disease); However, one day I felt really lousy and my palpitations accompanied by chest pain. Went to my EP and PM interrogation showed VT of 220 bpm. Now, those PVCs were bunched up into a long run, and that was dangerous which led to reimplantation and replacing PM with an ICD.
Sorry this is long but I could go on...In any case, I would still conclude that ectopics are generally harmless unless you also have other issues like congenital heart rhythm disorder then maybe you ought to have it looked into. Also, if they are PVCs and you get them in runs of longer than 30 sec. please inform your Dr. It's worth it I think.
All the best and hope you feel better soon.
Bunnykin

Thank you so much for your replies

by susanspurs - 2008-04-19 05:04:04

Wow - thanks for taking the time to reply. Just to answer a few questions that have come up:

Swedeheart - I saw my GP this week and I have found an EP who I hope to be referred to. My cardiologist is not an EP although he is a top London cardiologist.

Smitty - my low rate is 60 bpm (50 at night). While I was having these thumps at the interrogation my heart rate was around 82 bpm which is normal for me and my PM was not working - it only works for less than 6% of the time. And a question relating to you not me. How come you HR was 48 for most of the morning? Wouldn't the pm bring it back up? Also is HR = BPM?

Harley63 - do you know what fine tuning they actually did?

ElectricFrank - think my pacing voltage is lowish. Has been turned down to 1.500V on both the atrial and ventricular leads. Is this low? The virus thing is interesting. I do have a fear that they will say I need medication for this. But beta blockers definitely not! I was on them 25 years ago for hypertension and they turned me into a zombie and it took me seven years to realise it was the beta blockers! I would definitely rather put up with extra beats if they are not dangerous.

Bunnykin - thanks for the explanation about PACs and PVCs. That is on the top of my list of questions when I take the holter monitor back next week. I had an angiogram just before my PM was put in and my arteries are in good shape and as far as I am aware I have no other heart problems except my AV block. These beats sometimes do last longer than 30 secs and when they come together like that, I get this feeling of panic inside my chest.

Once again thanks for your advice and enjoy your weekend. It is a very grey morning here in London.

Sue


Trying to understand...

by susanspurs - 2008-04-19 05:04:11

Hi Smitty

I have read and reread your post quite a few times and I do find it quite hard to take in but that's probably because I am only a 'PM baby' as my PM is not quite eleven weeks old and there is so much to learn in this new world that I never knew existed. I certainly agree with you that PMs seem to be extremely complicated pieces of electronic equipment and I wonder, when new devices are coming out all the time, what extra training the cardiac technicians get in the new technology. I checked with my insurance company today and they have agreed for me to see a recommended EP. His name is Dr Pier Lambiasi and he is a Senior Lecturer in Cardiac Electrophysiology at the Heart Hospital here in London. When I looked him up on the internet he seems to have written loads of paper on the subject. Although I do feel a bit disloyal to my cardiologist whom I have known a long time as he has looked after my mother so well putting in loads of stents in very twisted arteries. But his speciality is arteries and angioplasty not electrophysiology.

Referring back to my previous post on the rate response, I was very surprised when the technician said she didn't know why all those things were listed when the rate response was off! She should have known. Did you see how to determine whether it is on or off? You look at the mode.
Mine is:
Mode AAI<=>DDD with the rate response off
but would read:
Mode AAIR<=>DDDR if the rate response was on. What does your say? I was also rather taken aback when I asked if I could have a copy of the initial and final report and she replied that it was very unusual and they don't normally give them out. Not a good start but I stood my ground and asked nicely for it.

I do hope your HR goes up - you can't feel too good with it that low.

Take care.

Sue


DDD - DDDR

by SMITTY - 2008-04-19 07:04:38

Hi Sue,

I went back and checked my reports and in Oct '06 my checkup printout copy show my PM to be a DDD - DDDR but that is now DDD - DDD. I had the rate response feature turned off in Nov. '06. All other readiings in Oct ( I did not get a copy for the Nov. visit) were about the same as I see on the report now. I am guessing, but it seems that the readings under the Rate Response section mean nothing unless the PM is in the DDDR mode.

I got the same response as you the first time I requested a copy of the checkup printout. But they no longer hesitate to give me a copy, but I do have to ask.

You say you have had you PM 11 weeks, well I have had mine for 8 years and if I live to be about 150 I still will not know all I need to know about a pacemaker. The more I learn the more I see there is to learn. Then thinking that some of the medical people involved in my PM care probably have not mastered the use of the TV remote yet, well it just gets scary.

Smitty

Thanks Smitty

by susanspurs - 2008-04-19 08:04:57

Seems like there's a huge learning curve! But it seems to be a shame that the medics get so defensive which makes the appointment go badly from the start. When I went for the first check up at 6 weeks and my breathing was in a very bad way, The technician asked me, on the way into the room, how I was feeling and I said that I was having breathing difficulties and his words were "VERY UNLIKELY TO BE ANYTHING TO DO WITH THE PACEMAKER"! I felt do deflated because it felt like a battle and this was only my first appointment!. All he had to say "let's take a look at the interrogation and we'll see what we can do". Actually it is just basic bedside manners. Keeping my fingers croosed for my new EP and good luck with yours.

I have really enjoyed talking to you.

Sue

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