Stand by mode

I had a successful ablation for atypical atrial flutter in December 2012 and had been problem free since, now in June 2014. I have had a pacemaker since 2000. It had been set to permanent pacing with a minimum rate of 70 bpm with max of 120 bpm (after which my own rhythm takes over).

At a recent Pacing check the technician altered the settings to 'stand by mode' only operating if my heartrate fell beneath 60 bpm. I was told my natural heartbeat was in very good shape so I ought not need to be permanently paced.

A few days after the change I had an irregular rhythm episode. I've contacted the hospital and await guidance. I am wondering 9a) the merits of the change when all was going well, and, (b) whether this is merely a 'blip' with my own heart's natural pacemaker readjusting. Has anyone else experienced this?

Any views?

7 Comments

trial and error

by Tracey_E - 2014-06-10 08:06:20

Less pacing is always best so sometimes they'll try out something else to see how you respond, or sometimes they'll make tweaks to make the battery last longer, or sometimes you get someone new who thinks they are smarter than the last person to adjust so they change it up. Was it just the one episode or have you felt bad overall since the change? If it was just the once, it could be a blip.

Reply to TraceyE

by Dave Bishopstone - 2014-06-10 09:06:12

Hi Tracey, Thanks! Just a one off, four days after the settings were changed - hospital are going to do a 24 Holter monitor test to check on the rhythm, but they don't think it's a problem with changing the settings - watch this space lol.

Changes Cause Me Problems Initially

by NiceNiecey - 2014-06-10 10:06:25

but then my body adjusts and I do fine but it seems to take about 2 weeks each time I'm tweeked.

Doesn't 70 bpm seem high? I think most people are set quite a bit lower; i.e., if your heart beat drops under 70, your PM kicks in. If that was me, I'd be pacing 100%. Mine is set to pace if my HR drops below 50. Hopefully Tracey or Donr or one of the regulars can clarify. I wonder what's happening between 60 and 70 BPM in your PM.

Niecey

by Tracey_E - 2014-06-11 08:06:47

Sometimes when the heart goes into afib or flutter, they can trick the heart by setting the minimum rate a little high. You would have a higher pulse but the heart doesn't have time to flutter. So, the rate is intentionally high in this case.

Indications for a pacemaker

by Selwyn - 2014-06-11 12:06:49

Atrial flutter is not an indication for a pacemaker. You need to understand why you had the pacemaker in the first place. Without this knowledge, you may find that fiddling with the settings, as described, adversely affects your ability to exercise.

Update

by Dave Bishopstone - 2014-06-14 05:06:04

Further irregular episodes and an emergency visit to pacing clinic - result they restored the settings that existed pre the latest change. that is permanent pacing at 70 bpm min with 120 bpm max (thereafter own heart pacing takes over). Now operating well as before.

Selwyn: Fully aware of why I have a pacemaker for atypical atrial flutter.

It appears the changes they made (without authorisation of the Electrophysiologist) were to conserve battery power.

They admitted sometimes they tweak in the hope of improving things but sometimes it has the opposite effect. Perhaps they should look at the patients full history and consider that against other issues - i.e. if it ain't broke it doesn't need fixing!



Update:

by Dave Bishopstone - 2014-08-09 02:08:37

Since last visit to Pacing Clinic at the end of June it was decided by the Cardiologist / Electrophysiologist to turn the pacemaker right down so that it only kicks in if my own heartbeat slips to 40 bpm - so in effect it's not going to kick in at all and I'm working solely on my own heartbeat. (remembering that I had a successful ablation in Dec 2012 and that the recent problems were due to 'inappropriate pacing' due to a defunct atrial lead and not the original condition of atypical atrial flutter).

For 98% of the time I'm perfectly OK, the remaining 2% present only short term problems of palpitations which resolve on their own sometimes in minutes or less, a few have lasted longer and resolved with 100mg of Flecainide in under an hour.

We jointly (Cardio and I) are reviewing whether to replace the defunct lead and pacemaker - (which is almost battery expired) or whether to leave matters as they are with my natural heartbeat doing all the work. I'm minded that in 2000 when the first pacemaker was implanted after a failed ablation in the hope of managing the condition, now 18 months after a successful ablation - I ought not need a pacemaker ??? For some reason, maybe insecurity I hesitate to say - no more pacing - that seems odd perhaps.

What I have noticed however is how strange it is not to be paced, quite forgot what a natural heart feels like and that takes some getting used too.

Has anyone ls experienced moving from permanent pacing to none and how did it feel to you?

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I am 100% pacemaker dependant and have been all my life. I try not to think about how a little metal box keeps me alive - it would drive me crazy. So I lead a very active life.