A few issues with pacemaker.

Greeting..

I had a PM installed 1 week ago.  A Medtronic x2dr01 astra xt dr mri for those who know.  It was for low heart rate, under 30 bpm at times, you know the story, tired, dizziness, fatigue, and so on.  

My issue was a second-degree heart block of the AV node..  The sinus node doing OK, but the ventricles not getting the signal.  

So to keep it simple, it has been a week now of just walking around so went for a moderate bike ride, I am a competitive cyclist and needed my fix, lol.  Kept it down to a moderate level, zone 2,  a steady heart rate of 120-130 which was huge for me since in the last year I could hardly get it over 100bpm.   It all seemed great, nice steady beat, on the odd small climb I pushed it a bit and hit 145, my PM is set for a max of 130, but it let me push the upper limit in short bursts.  I could feel my heart was working hard, but it felt healthy.  

So what's my problem?

Am I pushing too hard to soon, will take tomorrow off.

Can a person dislodge a heart lead going too hard?  Hardly worked up a sweet at all,  so that is not an issue for infection around the wound which is healing well.

 

Also, I noticed that my PM will let my heart rate drop below the set 60bpm bottom limits for 5-10 seconds at times and then click in to bring it back to 60.  is this delay normal?

 

I'm just afraid I will pull a lead, or something.  I know, no weights, no swimming, etc, etc...it all felt great overall, and no shortness of breath!  Wow,,

One more week gives me two then I'm going to push it a little harder, a short 1min maximal burst type thing.  Does anyone else have similar advice or experiences?  I know I should just dig into the forum, plenty of wisdom.  THX.

 

 

 


3 Comments

take it easy

by dwelch - 2023-09-19 02:36:11

You are one week in, take it easy.  I understand or well can try to, being an athlete you want to get back on that horse.   

So second degree you didnt have every beat messed up like myself and others with complete, level three block, our pacers fix pretty much every beat.  But in any case the pacer will make the heart pace nice and steady now.  

What you used in the past to measure your heart may or may not work anymore, note that.  if it appears to be working great.

Dont assume that every single beat is going to be perfectly timed to exactly meet your minimum and maximum.  over the course of a full minute for example is the average (now this is finger on wrist stop watch not some electronic device) within limits?

you are a week in, you are thinking and feeling and seeing normal concerns, and asking very normal questions that we all had or even still have sometimes (i have had pacers for 36 years).

For us normal, non-super-athletes, week one is like no sleep, cant sleep on that side until like week two, defintely not riding a bike (well okay many of us are driving a car on day two or three).

Give yourself months if not a full year to get used to being paced, learning how to use your heart rate monitor tools all over again.  Depending on how often your heart was out of sync your rythm may be better and more efficient, certainly was for me.  I could literally feel and hear every beat, and that was silenced when i woke up with device number one, and it took a good chunk of the first year to mentally overcome that.

IMO testing the edges every day of movement during the recovery is good, but not pushing way past it and risking anything. If you fall and have to catch yourself or something like that, that goes well past the dont lift 5 or 10 pounds for the first X weeks/months.  

I dont think any doc is going to give you an honest answer on pulling a lead out.  They are going to say do not ride your bike.   IMO from a mechanical perspective I think it would need to be a strong tug, raising your arm up very fast before things are settled. catching yourself in a fall with that arm.  The leads are well secured so IMO small repetitive motions shouldnt have the ability to pull it out. but standard disclaimers, etc, not a doc, just my opinion, docs and device vendors are going to tell you not to do these things for weeks/months.

things may have changed, but historically after some number of weeks you have another visit, they will check the leads then if they got disloged they will know (and yep, go back in, but hey you are early recovery right now so wont as suck as a whole new recovery from scratch).  and then some number of months after that another visit another interrogation and they will know if the leads are in place and working, by then they should be well secured.

 

Totally agree with dwelch

by quikjraw - 2023-09-19 06:44:24

Yes i would agree to take it easy I have the same heart block as you and a runner, road and mountain biker and pretty robust. I weighed everything up and wanted to ensure everything was fully healed and bedded in before doing anything other than gentle walking. 

In terms of dropping below 60bpm (assuming 60 is the minimum level set on the pacemaker) that is unlikely to be happening.

One thing it took me a while to appreciate is that the pacemaker measures BPM at source to a high degree of accuracy between each single beat. The best we can do is measure more of a mean BPM as even garmin chest monitors etc. will struggle to measure every beat to the same accuracy. So the most likely situation is there is a slight inaccuracy in measuring heart rate for your watch or chest strap. I also agree with Dwelch in that chest electrical monitors stopped working (completely) for me after my implant I had to buy an optical sensor. (polar do a good one that links with most watches)

If you think about if the chest strap or watch measures 0.95 seconds between beats then instead of the correct 1 second then that equates to a bpm of 57.

Take it easy

by Medronic Man - 2023-09-19 08:27:40

 dwelch.  thanks for the info and good advice.  I sleep ok and am feeling great considering where I was pre-PM.  I found that my strap-type heart monitor would not give a good reading, going off my Garmin watch, seems okay, although wrist-based monitors are never all that accurate, so I know.

Give yourself months if not a full year to get used to being paced, learning how to use your heart rate monitor tools all over again.  Depending on how often your heart was out of sync your rhythm may be better and more efficient, certainly was for me....   Yes, good advice.

 

quikjraw 

In terms of dropping below 60bpm (assuming 60 is the minimum level set on the pacemaker) that is unlikely to be happening.  that's it, im going off my Garmin watch, its probably off a bit.

 

f you think about if the chest strap or watch measures 0.95 seconds between beats then instead of the correct 1 second then that equates to a bpm of 57.  truly, anyway, it's pacing at 60, so I won't lose any sleep over it, seeing my Cardiologist end of Oct for a look/tuneup if required...  Thanks.

 

Anyway, after decades of competitive cycling I have learned you keep your hands on the bars all the way to the ground, it saves breaking your arm... falling is never good anyway,  might give a PM a good jolt. These days I am sticking to the wide-open paths around here, doing local individually timed tt races,   and at my advanced age of 65 who want's to fall under any condition.  No pack races for me anymore..

Take it easy, take it easy, my new mantra...

You know you're wired when...

Your heart beats like a teenager in love.

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