CRT and arrhythmia

Hello everyone. I'm a reasonably active, slim and otherwise healthy 45 year old female. I've had cardiac arrhythmia since childhood. In 2011 I was diagnosed as having a RBBB. On August 7th, this year, I was diagnosed with a Complete Heart Block and received a CRT-P pacemaker implant on August 15th. I wish I could say I'm doing well. I'm trying my best to present that way, but I am very frightened. Morning and night time are the hardest. I'm still experiencing cardiac arrhythmia. The Cardiologist said the CRT-P pacemaker will resynchronise the heart but won't prevent arrhythmia. They tell me that these episodes of arrhythmia, while unpleasant,  are safe. Has anyone on the forum experienced anything similar? I live alone with my three dogs and I find going to sleep each night frightening for fear of having another medical event. Thank you.


hugs and a heartfelt welcome aboard

by Lavender - 2023-09-03 13:28:13

You have been through a trauma. Your brain is trying to sort things out and it thinks you are still in danger. You will adapt and adjust in time. It is early yet! Your heart is healing too and it is adjusting to the new invader. I had a lot of PVCs when I got my CRT-P. I thought I could not stand it being this way. I was scared. I never used to feel my heart or be so aware of it, now it was leading the show every day. 

In time, my heart calmed waaay down. I still have the rare PVC, but I know they are not harmful to me and that my pacemaker is behind the scenes, watching over and making sure the heart beats. My CRT-P improved my heart ejection fraction to normal...but it took a bit of time. I was diagnosed with left bundle branch block in 2010.

I knew I was more anxious in the evenings, because that is when I had my worst episode of a 33 second pause before I got my pacemaker. As evening fell in the days after, I was anticipating an emergency. It never happened. I have had my device two and a half years now. I never fainted again.  It took time to stop worrying and being fearful, BUT IT HAPPENED-I no longer think about it. I do notice a PVC now and then but I dismiss it, my brain knows and understands that it won't kill me. 

Everything will be ok. You are new to this. Your body inside it still healing Your brain takes longer. In time, it will shut off the DANGER sign.  A little trick I learned to calm myself- 

Feel your pulse. Put your finger on your wrist or carotid and feel that steady beat. It reassures you that your heart does indeed go on. You can do this anywhere, any time. Hold still, be still and know that God is there with each heartbeat.

May God comfort you, may His peace that surpasses all human understanding envelop you. May He shower you with blessings, a total comfort and sense of safety. 


by Penguin - 2023-09-03 15:54:53

I don't have a CRT and tbh I don't understand them very well.  However, I do know how it feels to have arrhythmia which you can do little about other than to tolerate and hope / trust that you will come to no harm.  

Mine have been around for years now and used to feel pretty insignificant, but then later I had some more disturbing symptoms which were harder to understand, were persistent and kept me awake.  My heart sank when they began. 

It must feel like a test of your inner strength to repeatedly go through disturbing rhythm disturbances and yet be told that you are safe when the (fast?) heartbeats can ressemble the same unsettling feelings as anxiety.   That ressemblence can be difficult to get your head round.

I think that as Lavender says, you may have to ride this out and believe that some greater force (God if you are a believer) has your back.  

Breathing out slowly through your mouth (blowing gently) for a count of 10, then back in again slowly and calmly can be calming, and vasovagal manoevres can sometimes help.  Changing position may help too and avoiding triggers - caffeine, alcohol, stress come to mind.  Self help makes you feel like you at least have some control. Try it if you don't use it already. 

I feel for you with this. It can be quite scary. 

Please be gentle with yourself. 


CRT and arrhythmia

by AgentX86 - 2023-09-03 16:39:50

Atrial arrhythmias aren't dangerous, in and of themselves.  They do lead to cardiomyopathy and/or clotting (i.e. ischemic stroke or pulmonary embolism). Prolonged high heart rates (above 100bpm) lead to cardiomyopathy.  This can be treated with beta blockers, to bring the rate down.  Arrhythmias increase the probability of a stroke by 5x.  To bring this number back to normal, anticoagulants are used to prevent the clotting. Arrythmias can (some feel it, some don't) also make one feel terrible.  Drugs can be taken to improve the quality of life, too. To sum it up, as long as the symptoms/side-effects are treated, atrial arrhythmias aren't terribly dangerous.

No pacemaker eliminates any arrhythmias, unless you count Bradycardia (technically an arrythmia).  Sometimes, with special features and programming, they can help stave off an episode by "outpacing" it, but they cannot eliminate them.  They do allow higher doses of beta blockers or antiarrhytmics to be used.  Often the heart rate is too low to risk decreasing it more with higher doses. The pacemaker, by putting a floor on the heart rate, can allow otherwise dangerous doses of these drugs.

What a CRT does is synchronize the left and rigth ventricles.  Pacing only the right ventrical causes a dyssynchrony because it takes longer than normal for the pacing pulse to cross to the left side.  The RV then contracts before the LV.

I use the thought experiment of a water baloon.  Grab the balloon in two hands and squeeze.  What happens?  The balloon bulges up (and down but let's ignore this).  This is an analogy to the pumping of blood.

Now, just squeeze only the right side of the balloon.  What happens?  The other side bulges out.  Now squeeze the other(left) side and water is pushed up.  Then release the right side and the buldge appears on the right.

Finally, press both sides then release both sides at the same time.  We see no bulging of either side but the balloon is still "pumping blood".

This is what happens, though less dramatically, when the left and right halves of the heart aren't synchronized.  The bulges put stress on the balloon (heart) walls.  To compensate, the heart may increase the muscle on the left side, which is doing most of the work.  This is called "cardiomyoopathy" and can lead to a low LVEF, or Left Ventricular Ejection Fraction.  In other words, it's not pumping as much blood as it should be, per beat.

To correct/avoid this problem a CRT pacemaker is used to time the left and right halves so they support each other during contraction and blood is pumped more efficiently without stressing the heart.

No, it won't do anything for any arrhythmia at least any currently existing arrhythmia.  However, since it keeps the heart from "bulging" it might prevent some fibrosis, which is the cause of many of the atrial arrhythmias.

Normally, a CRT is used when the LVEF drops to a certain level, to attempt to bring it back to normal.  It often works but not always.  I'm not sure why you got one because you didn't mention any cardiomyopathy.

I have one because without my PM, I'd be in a world of hurt.  It's sort of a backup for the right ventricular lead.


Thank you

by Lamp - 2023-09-04 00:38:11

Thank you, Lavender, Penguin and AgentX86 for taking the time to reply to my message. I have found great comfort reading your messages, Lavender and Penguin. And your knowledge, AgentX86, has helped me prepare informed questions for my medical appointments today. I am very grateful for this. My heart rate is bouncing between 40 and 142 in what appears to be AF. So my GP has initiated follow up consults before my 6 week check with Cardiology. I'm frightened. I feel like I am stick between fear and terror much of the time. Being home is like opening a Time Capsule, with reminders of life 'before'. I don't feel connected to any of it. It is like standing in someone else's house. To provide some background to this incident, on July 13th I had a haemorrhoidectomy. Two days later I hemorrhaged and required emergency surgery to surpress the bleeding along with three blood transfusions. This was three weeks before my Complete Heart Block, which was diagnosed on August the 7th. I had aspirations of living life with new appreciation and living with greater intentionality. I was even excited by this prospect. My recovery is slower than I was prepared for and I don't think I realised how much I would be effected by the trauma of both events. A lot of my 'resilience' was also to reassure those around me. Now that I am home and on my own, I am faced with my old life, which I'm finding hard to reconcile myself with. Your messages are like a life line to me. Thank you for being there for me. 

living life with new appreciation

by Lavender - 2023-09-04 11:16:59

It will be ok. It will. Your recent medical adventures have shaken your peaceful world. Perhaps expressing yourself through your art might help. How about creating pottery or a drawing of your emotions? 

You mention your three dogs. Dogs have a way of just accepting without needing to know details. Silent walks with them as you take in nature will soothe your brain. 

When I came home with my pacemaker, I was very disturbed. My home was always my refuge, now I feared everything. It seemed that danger was sneakily lurking waiting to spring on me. My focus was on preparations to die. I updated my will and felt that I was doomed. I had zero interest in anything. 
I have a great faith but was sad thinking that I was too young to die. I don't fear death and believe in paradise but didn't want to leave my family without me here to mother everyone.  

I prayed and meditated. God sent helpful information in the form of leading me to people and ideas that have helped me adapt. He gave me hope.

I remembered how much I got out of Eckhart Tolle and his theory of living in the now and being present. I took a hammock and put it up outdoors. I would lie on it watching cloud shapes. Tolle says to make no judgments and not try and define what you see-just observe. I did it daily. It zoned out my brain. As the seasons changed, I observed leaves falling, color changes, and birds flocking. I was escaping the constant drone of my brain's danger and fear signals. 

A friend is a psychotherapist. She told me to lie on my bed wearing headphones and listen to Michael Sealey Youtube meditation. Just go on youtube and type in his name. Pick a meditation appropriate to your state of mind. Let go. Immerse yourself. Here's one I like, copy and paste the link:

Your anxiety and fear is a learned behavior and can be unlearned. Fight back!💕🪷


Living a Grateful Life

by Penguin - 2023-09-04 13:19:00

Not as easy as you think! We get bombarded with media stories of grateful people whose lives were saved, who run marathons after a huge life event and who find purpose following a traumatic event.  Often that part misses out the bit inbetween when you are reeling with shock, trying to piece your life back together and trying to come to terms with it all.  

Give yourself a bit of time and self love and forgive yourself for all the negative feelings. They have to come out for you to be able to change and accept and move on. It's a bit like grief for what you've lost and what you fear you may never get back and whether you will ever cope with how you feel. 

That may sound dramatic to some people - but not everyone. There are some stoic characters on here, who find out they need a pacemaker, get one implanted, feel better and live life more fully.  Good for them! 

You may take a bit longer, but you will get there too.  

Good luck with your appointment and let us know how you get on with AgentX's excellent - as always - advice. 

Best Wishes

Adjustment to a new reality

by Gotrhythm - 2023-09-04 17:19:02

So sorry you are having a hard time.

Look on the right side of the screen and you will see that TPC is currently running a poll asking how many of us experience arrythmias and what kind. Glance over the poll and you will see that you are not alone.

It has often been observed in these pages that living with a pacemaker (and the underlying heart rhythm disturbance) is much more mental than physical. What our hearts and our pacemakers are doing is outside our control. But what our minds are doing, what we tell ourselves about what is happening, that's something that can be dircted by us.  And what we tell ourselves can make all the diffference in how well we live. 

Learning to rein in our thoughts is a life time endeavor. But for right now, you need to get it into your mind that there are life-threatening arrythmias and non life-threatening arrythmias. Two different things. One is a cause for alarm. One is not.

You doctor has assured you that the arrythmias you are having now are the non life-threatening kind. Trust him/her. As often as the bumpity-bumps start, remind yourself, that they are not life-threatening. Put plainly, they don't mean your heart is about to stop and you are about to die.

So far, after 13 years of arrythmias, I haven't learned anything that will either start or stop arrythmias. No control. Some things, diet, sleep, hydration do seem to affect them. And for sure, being upset will make them worse and last longer, while remaining or becoming calm will help then not last as long--or maybe just bother me less while they last. [snort]

When it comes to tricks and techniques to control thoughts, what works for some won't work for all. Find some counseling. Cognitive Behavioral Therapy is particularly useful and often short. But don't try to fight your way through this alone, even though you probably could go it alone if you want to. Everyone can use some help now and again, particularly when life has thrown a new reality like living with a CRT and arrythmias to adjust to.

Thank you

by Lamp - 2023-09-06 19:06:45

Hi Contributors

Thank you for your posts. The echocardiogram clinic don't think I am experiencing AF, because what has been captured at night through the monitor appears to be normal.

I know what I am experiencing is not anxiety and is rapid, irregular heart beat, followed often by exaggerated thumps of the lower heart to the left- like lurches.

These incidents have been much worse in the last five days, since returning home.

My cardiologist and echogram team don't seem to be taking this too seriously.

Some background to this is that I've been admitted to ED twice in the last six weeks (for a post surgery haemorrhage, which was an unrelated surgery, and then heart block). Both times I wasn't sure if it was an 'emergency', and I almost didn't go. Therefore, I'm quite unconfident about knowing how to identify when I should do something proactive. Leading up to admission last time I had a full four days of almost constant arrhythmia. This is why I am so anxious about it now. Out the other side, I feel sick with anxiety and in a near constant state of fight or flight.

Can anyone relate to this?

Thank you for your ongoing support.


Seeking help

by Lavender - 2023-09-07 11:34:45


Your comments:

I am very frightened.
I find going to sleep each night frightening

I am so anxious about it now.
I feel sick with anxiety and in a near constant state of fight or flight.

This leads me to believe that although the medical team hasn't found a reason for your symptoms, you're having a hard time coping. 

Please ask your pcp to prescribe you something for the anxiety and/or refer you to a psychologist who can help. There are some counselors who deal strictly with medical issues and the anxiety that causes. Your life doesn't have to be this awful. There are resources out there. Push for help. Having some kind of tranquilizers may calm you while you continue to pursue answers for what you're experiencing. 
Hugs, May God light the path to serenity. 

You know you're wired when...

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Member Quotes

The pacer systems are really very reliable. The main problem is the incompetent programming of them. If yours is working well for you, get on with life and enjoy it. You probably are more at risk of problems with a valve job than the pacer.