Pacemaker pulsing

Hi

I had a pacemaker implanted in September 2022. For the first month I felt nothing unusual but since that time I have had intermittent but very pronounced pulsing, showing up in my abdomen, directly under my ribcage on the left side, so pronounced that I could take my pulse just by watching the movement of of my shirt over the abdomen. This pulsing often wakes me during the night and is so pronounced that my wife can feel it from her side of a wide bed. The cardiology department at the hospital tell me that it is just a synchronicity with the phrenic nerve. Is this normal? Has anyone else had a similar experience? Thanks. Slán.

Terry


3 Comments

Phrenic stimulation

by Lavender - 2023-07-17 06:35:03

Hi there. Sorry to hear that you have this situation.  It can happen. There's a lot of info on this site about it. 
Go to the top left and at the magnifying glass symbol, type in "phrenic"  and you'll find lots of discussions on this.

Hoping that they can try some setting changes (?)

There is some very good insight here, copy and paste the link:

https://www.pacemakerclub.com/message/41709/phrenic-nerve-stimulation

Julros had a great comment in that link:

 I have a BiV, and intially, my pectoral muscle twitched, and occasionally my my diaphram twitched, due to the higher inital settings. The voltage needs to be higher initially, until the heart muscle heals and inflammation around the leads goes down. In my case, they said my cardiac vein where the lead was, was so big that initially the lead was "floating", so higher voltage was needed for capture (properly triggering contraction). 

They eventually turned down the voltage (I don't remember at what point, maybe 3 months) and my pectoral muscle stopped twitching, diaphram intermittantly. At about 1 years time, the diaplhram twitching was worse, and triggering gastric reflux.I suspect this was because I acheived a 40 pound weight loss. 

I had a treadmill test to optimise settings with the manufacturer's rep and he was able get the twitching to stop. And yes, my LV lead is quadripolar, and per the rep, because of that there are up to 16 different options, so it takes some time for optimal adjusting. I suggest a device interrogation with the manufacturer's rep present, because they should know all the options for your device. 

Pacemaker Pulsing

by bardnamara - 2023-07-17 10:55:08

Thank you very much Lavender. 

I just had a chest X-ray for a different situation but mentioned my pulsing problem and I'm now due for an ultrasound. No idea whether that will tell me anything.

I'm going to forward your information to the technician [physio cardiologist?] who might learn something from it.

Thanks again.

Slán

Pacemaker Pulsing

by Gemita - 2023-07-18 03:50:26

Terry, I am sorry you have had to tolerate this discomfort for so long.  Although it can be common for initial high settings to be a cause for pulsing sensations following pacemaker implant, they need to rule out other possibilities too, just to be safe, like perhaps, abdominal aortic aneurysm.  Perhaps this is why they have ordered an ultrasound?  

Following my pacemaker implant and other relevant investigations some 5+ years ago, I still experience occasional pulsing sensations in my stomach/diaphragm area and indeed in other places too unfortunately.  Nerve trauma/stimulation can occur following pacemaker implant so settings adjustments may help.  I hope it will be a simple fix for you, so please let us know whenever you can.

Good idea to forward Lavender’s information to the Electrophysiologist**.  We sometimes need to let them know that we want to understand what might be going on, to save precious time (and discomfort) and to get those settings, if it is a settings problem, adjusted.

**An Electrophysiologist (EP) is a person who specialises in treating the electrical system of the heart (heart rhythm specialist).  In my London hospital, my EP is both a consultant cardiologist and EP.  His cardiology role includes treating heart failure, problems with heart valves and arteries.

Hope you get this sorted quickly and good luck

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