Recent "episode"

Hi All.

I've had a pacemaker now for 3 years. Last night I had a rough bradicardic episode: the PM did cut in and slowly resolved the problem but I felt really Ill with all the symptoms.

I intend to contact the cardio unit at my local hospital on Monday.

My question is, what pulse rate do other members PMs cut in at? 


Minimum Rate

by Penguin - 2023-03-11 13:27:15

Hi Mariner, 

I have bradycardia due to pauses in sinus rhythm. 

My 2nd PM is set at 60 bpm but my previous PM was set between 50-55 bpm initially.   

Do you mind explaining the symptoms you had last night?  I ask because pacemakers usually deal with bradycardia pretty efficiently.  How low is your bottom rate and do you think that this is the cause? 

I hope you have a better night tonight. 

Minimum Rate

by Mariner - 2023-03-11 13:54:59

Thanks for your reply, Penguin.

Whilst sitting watching TV, I suddenly felt extremely hot and sweating and I felt sick and weak.

Knowing what was happening I laid on the floor, and whilst checking my pulse rate: it was initially 50 and continued going down - it was scary. My wife dropped a cold wet flannel on my head and loosened my clothes. I tried to move but felt sick and my breathing was hard. These have been my previous symptoms.

i spent a long time on the floor and eventually crawled to bed. Experience has shown in the past that standing at this stage of an episode usually ends by collapse and unconsciousness. In the past, when contacting my cardio unit, I have been told that the PM is doing its job. I have a home monitor running all of the time so there will be a record.

I think I will ask to have the limit raised - that should, I hope, stop the scary feelings.

not the pacer

by Tracey_E - 2023-03-11 14:08:47

You should be seen asap. If that happens again, go to A&E. 

If your pacer is set to 60, that means one beat per second so it won't let you get as low as 50. If you go a second without a beat, it will pace. They don't let you drop before they kick in, that's not how they're programmed.

Other things can happen to make the count off, like afib or pvc's. If there are small weak beats between the strong ones, the pacer is still keeping you at 60 but your count will be off. 

Other things can make you feel like that such as a drop in blood pressure or a heart attack. You really need to be seen. Don't assume it's the pacer. 



by Penguin - 2023-03-11 15:02:23

That does sound pretty worrying.  Sorry to do this, but I'm going to make some suggestions that you will undoubtedly have considered yourself! 

I know it can feel like a difficult decision to ring 999 even when symptoms are severe, but situations like this are what they are there for.  Please ring if those symptoms happen again, even if it is a Saturday night and A&E and the ambulance service are busy. 

Rather than waiting for another attack why not ring 111 now for advice whilst you are symptom free?  This would allow you to speak to someone with medical training whilst the attack and symptoms are fresh in your mind and to get some advice to consider calmly.  Your out of hours GP service is another option.  That would be a very sensible option to pursue right now and will put you in a better position to act appropriately and promptly should it happen again. 

Please don't feel that you are wasting their time. You need some reassurance and advice. 

Take care please.  

No Node

by Stache - 2023-03-11 15:49:07

My sinus node stopped working totally two years ago.  My pacemaker is 100% at 60 BPM.  Have to admit it is better than my sinus node beating at 32 bpm previously.

Cut in

by AgentX86 - 2023-03-11 23:14:36

As Tracey said, that's not how pacemakers work.  There is a timer set to some time (60bpm = 1 second).  When that timer goes to zero, the pacemaker inserts a beat then restarts the counter.  If it detects a pulse, it resets the counter.  It doesn't sit there and wait until the rate goes below the set rate before starting to pace.  It simply doesn't allow the rate to get below some set value.

I han an AV ablation so I have not atrial pacing at all, not even an RA lead. My sinus node doesn't do a thing, nor do my atria. My ventricals are paced at a minimum of 80bpm (50bpm at night) and maximum of 140bpm.

My two pennuth

by piglet22 - 2023-03-12 08:50:26

I had my base rate changed last week from 60 bpm to 70 bpm to try and overcome an erratic pulse.

I'm OK during the day and active, before and after the rate change.

The problem kicks in as soon as I start relaxing and by bedtime, it really kicks in.

The perceived pulse rate can go as low as 40 bpm even at the new rate of 70.

If anything, though early days, the erratic pulse is worse now than it was.

The physiologists explained, again, that ectopic beats are causing the problem.

You might not be able to feel them but the PM is picking them up and readjusting the timing of the next generated pulse.

So the tweaking exercise was a waste of time.

Last night it was so bad, my normally very efficient Omron M10 Intellisense monitor was struggling to get a reading at all and just kept throwing up errors.

I'm starting to think that as things are with the NHS, I'm going to have to live with this until sometime in the future, there is an opportunity to speak to a cardiologist without shelling out a lot of money.

One cardiologist who contacted my GP appears to have at least three private clinic jobs on the go as well as running his own company.

I don't know how they find the time for the NHS.

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