New PM - had an alarming situation

I am a 50 yo man and I had a biotronic PM (dual chamber) put in 2 days ago.  This is my first PM and it was put in only for a slow heart rate.  I was symptomatic with lightheadedness and lack of energy.  It went in without complications.

This morning my wife was driving me to church and after about 10 minutes in the car I felt a very strong weird feeling and my Apple watch told me my HR was at 120 bpm.  It was VERY uncomfortable and within a few minutes it went back down to what my new normal HR is - around 65 or so.  

I was told my PM was set to adjust from 60 to 120 bpm.  Any idea why it would suddenly do this when I was not active at all?  I was just riding on the interstatel

I called the cardiologist on call and he said through his nurse to not go to the ED, but visit their PM clinic tomorrow when they are open.

That was a very scary experience.


12 Comments

Sorry to hear

by Lavender - 2023-04-02 15:55:25

Danno, I feel bad that you had this uncomfortable feeling. You are just starting to trust your pacemaker and certainly don't need any scares. I don't have an Apple Watch so I can't speak for their accuracy. However, about two weeks after getting my pacemaker, I was sitting at home and my heart suddenly felt odd. It sort of panicked me and my blood pressure went up. I called the cardiologist emergency number and they said to go to the ER. They kept me overnight to monitor me.  Nothing was found to be wrong. It's never happened again. I've had my pacemaker two years now. 
 

Hopefully it was just a fluke. Given that your cardiologist will check you tomorrow and didn't say rush to the ER, I think all will be well.  
 

 

Heart rate

by AgentX86 - 2023-04-02 16:00:12

Yes, and it wasn't your pacemaker.  It was (99.99% liklihood) an atrial tachacardia of some sort.  Afib is the most common but since your watch didn't show a possible Afib, it was likely some other atrial tachacardia. This isn't an emergency situation (i.e. don't freak out) but you're going to want to see your cardiologist as soon as he can get you in.  There is no reason, right now, for an ER.  Just relax and try to see your cardiologist in the next couple of weeks.

If your heart rate runs up again, take your pulse manually and see if it's regular.  Afib won't be regular but other can show irregular patterns.  It's good information to relay to your doctor when you see him.

You may be right

by Danno - 2023-04-02 16:15:03

You may be right. I think I had another episode but just for a few seconds. I have never had any A-fib. Can a pacemaker cause it?

rate response

by busby - 2023-04-02 22:51:25

hi Danno, I think you may have a factory setting of rate response turned on. if, for instance, you were driving on a bumpy road, your pacemaker thinks that you are running and will increase your heart rate. I had this happen to me when I first got my pacemaker 20yrs ago and it was not very pleasant. I did not end up needing rate response and it was turned off at my next visit. I haven't had that sensation since.

Pacemaker causing Afib

by AgentX86 - 2023-04-02 23:09:20

I suppose anything is possible.  PVCs are much more common but they wouldn't be seen as a large increase in HR, usually the opposite.

Sometimes it takes a while for our hearts to get used to being paced and it reacts unusually.  I've not heard of a tachyarrhythmia caused by it but, again, anything is possible.  I'd contact your doctors about it at your eariest convenience.

If you have a remote monitoring box, you could push the button to initiate a transmission so your cardiologist can take a look at it.

 

Atrial or Pacemaker mediated tachycardia

by Rch - 2023-04-03 03:11:54

It could be an Atrial or a Pacemaker mediated tachycardia where the pm tracks the racing intrinsic atrial rates or if any retrograde conductions into pacing the ventricles at the MTR ( max tracking rate). When that happens, PMs have a built in algorithm to terminate the PMT by prolonging the post ventricular atrial refractory period every few seconds or mode switch at MTR or MSR to slowly break the run down to a preprogrammed level. That said, since your's is only 2 days old, it could also be an atrial capture issue. I have had these kinds of tachycardias almost daily for several days soon after my implant, and once the atrial sensitivity and PVARP were reprogrammed, I haven't had those issues again. But everytime I get any PACs and PVCs , I get the jitters if they would set off an arrhythmia. 

 

Cause?

by Penguin - 2023-04-03 09:28:19

You're doing the right thing by going into the clinic.  If you can remember the date / time of the feeling that you had, this is always helpful because the pacemaker records your heart rhythm / rate etc on it's internal ECG (most of the time) and if you know the date / time of the event that you suffered, it may be easier to pinpoint what happened at that time much more quickly.

A new device hasn't yet been fully adjusted to meet your needs and it is very usual to have teething issues with settings. You've done the most sensible thing e.g. contacting your team and letting them know that you feel uncomfortable / worried.

All of the reasons that others have supplied and no doubt several others may explain what happened to you.  We can help more and offer further insight after your meeting tomorrow and once your EP has told you what he/she thinks is going on.  Let us know what the clinic find out and in the meantime, please don't be too concerned.

Best Wishes 

Thank you

by Danno - 2023-04-03 09:35:54

Thank you for your kind comments. I have a lot of trust in my EP and your comments have given me reassurances. No more instances, and I look forward to hearing what they can read from the PM. I have exact times of the events recorded on my Apple Watch and I have begun a log. I like to help them as much as I can. 
 

Peace. 

It was the PM

by Danno - 2023-04-04 09:55:03

Verdict is - it was the pacemaker!  I'm not sure yet why it did it, but thankfully it was the PM that was driving that heart rate.  My EP confirmed that - I'll talk to him today to see what can be done to prevent it.

Now though, my BP is a bit out of control.  I was on a BP med and it was working well, but now it doesn't cut it.  He is putting me on a beta blocker and I'm not so sure about that.  I'll talk to him about that today as well.

Thanks for your input.  I'll be glad when I get to the point where I can forget about all this because it's all just working.

Rate response

by Mad Hatter - 2023-04-13 00:39:34

Was it a bumpy road?  I had that experience and it was the rate response thinking I was exercising.  Had a similar response with putting sheets on the bed and putting clothes in the dryer.  The sensitivity can be adjusted but in my case it was turned off and I am much happier without the pm "helping" me.  Check with your EP as you may need it but in my case all I needed was the lower bound.  

Elevated Rate

by Edna - 2023-04-22 19:41:46

I have a Biotronik (since 4/14/2023) and have also experianced "random" uncomfortable elevated heart rate. Based on what I have read in the club and elsewhere it is not uncommon for sudden movement or  bumpy road to trigger the elevation. I don't understaned it all YET but I believe it can and will be adjusted at my first (one week) check-up. But it never hurts to call EP office an ask.

Resolution

by Danno - 2023-07-13 21:24:53

I think the issue is resolved.  There is a setting called CLS on PM that is a sensitivity setting.  It tells it how aggressively to change the heart rate based on what it's picking up.  The settings are from 1 to 5 - a higher number is more aggressive.

Out of the box they are set in the middle at a 3.  This was much to sensitive for me, and with little to no provocation my heart would race.  It was nice when I was out hiking in hills though - it got my heart rate up and it felt good, however I couldn't stand the racing while at rest.

They changed it to a 1 (as low as it goes) and this was too low for me.  My HR rarely went above the minimum setting of 60 bpm, and I would get dizzy if I started walking fast too quickly.  Finally I settled into a setting of 2 which is about right.  It's not perfect, but rarely do I have any issues any more.

I recommend people talk to their PM rep about their settings and attempt to get it right.  I also highly recommend keeping a log so that you can show them exact instances with dates and times where the PM wasn't acting appropriately to your situation.  That helped them a lot.

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