First EP Clinic Appointment

Hello Everyone,

My pacemaker was implanted at the end of June following a 12-second pause.  I have my first EP Clinic appointment tomorrow (following the initial appointment a week after implantaton) and I plan to ask about my settings.  In a past post, Gemita offered some terrific questions to pose and those are on the top of my list. 

My queston today: If my settings are changed, how soon might I expect to feel a difference? 

Currently, my heart rate jumps whenever I initiate just about any kind of activity such as walking upstairs, walking my dog, even getting out of bed.  This did not happen prior to my pacemaker.  It is set 60bpm to 130bpm. While my heart rate rarely goes above 130, I feel my heart pounding and I become lightheaded for awhile after it jumps.  I also have PVCs and PACs that I hope may be addressed with settings along with my medication (240mg Diltiazem in the morning for PACs and 200mg Acebutolol in the late afternoon) for PVCs.

Thank you and I so appreciate the information, support and compassion of this group!



by Tracey_E - 2023-10-09 16:49:30

If they make a change, you should feel it right away. 


by Gemita - 2023-10-09 18:51:27

Hello Ukegirl, did I really give you some terrific questions to ask?  I cannot recall doing so.   Just a tip, asking two or three essential questions and getting good answers might be better than trying to ask too many questions and coming away feeling confused or not having had all your questions adequately answered.

Your heart rate jumping whenever you move like getting out of bed could perhaps be due to a setting like Rate Response which may need adjusting.  I used to get your symptoms when I first got my pacemaker and frequently felt lightheaded and had pounding chest symptoms from my arrhythmias.  I see you are blessed with PVCs and PACs.  Although they are said to be benign, if they are frequent and long lasting, they can cause difficult symptoms.  My lower rate setting is 70 bpm and at this higher rate, my PVCs and PACs are better controlled.  It is well known that for some of us ectopic beats can respond favourably to a higher Base Rate setting, although it clearly doesn’t work for everyone.  Certainly worth asking your EP about. 

You ask, if you have your settings changed, how soon would you feel a difference?  If the right setting has been adjusted or changed, you should feel a difference immediately.  Of course getting the setting adjusted to suit you, or getting the "right" setting changed might need a bit of trial and error (like with our medication to improve our symptoms with our PVCs/PACs or other arrhythmias), so you might need to be patient.

Please let us know how your EP Clinic appointment goes tomorrow and I wish you lots of luck

It Depends on the Setting

by DoingMyBest - 2023-10-09 20:56:22

I share a lot of the same symptoms as you and Gemita. I saw my EP last week and discussed some setting changes, then I saw my Device Clinic on Friday for my first in-person check. I ended up with two settings changed, neither of which I immediately felt, but each which will help at the appropriate time.

The first was having my Rest Rate* feature enabled and set at 50 (my base rate is 60). I generally won't "feel" the effect of this as it will mostly have effect while I sleep. But this will give my heart a little more rest and should alleviate excessive atrial pacing that wasn't really needed.

The second setting change extended my PVARP time. For me, this will alleviate excessive PMT events caused when PVCs fool the pacemaker. The problem was that a PVC could cause the pacemaker to jump into tachycardia feedback loop. It would catch itself and terminate the issue within 20 seconds or so, but now it's much less likely to happen at all. This change is one you could potentially feel immediately, but in my case the PMTs were infrequent and I wasn't really feeling them, so I can't say whether that would be felt by you.

* Rest Rate is a feature in my Abbott/St Jude pacemaker and may be something different in other makes.


by piglet22 - 2023-10-10 06:57:26

Where did you get the PVC/pacemaker timing thing?

I'm getting the same problems and due to see the consultant this afternoon.

I've thought for a long time that ectopics "fool" the PM, but mine goes into go slow and does not maintain the base rate.

Hoping to get some answers today.

Pacemaker Settings Affecting PVCs

by DoingMyBest - 2023-10-10 12:35:08

PVCs - Premature Ventricular Contractions - or ectopic beats, come at random times, causing a ventricular contraction and resulting R wave. If a coordinated atrial contraction has not preceded the PVC, the ventricle has not filled with a normal volume of blood, so the ventricular contraction is ineffective. If you are feeling your pulse or have an external monitor like a smartwatch or pulse-ox, it appears as a skipped beat. There is not enough blood flow during that beat to be felt.

Piglet, if you get PVCs while at your base rate, the heart is still beating at the base rate. The pacemaker makes sure of that. But, the ineffective beats won't get counted by most external monitors. I think that is why you see your heart rate drop below the base rated. For me with a base rate of 60, I frequently see 57-59 on my smartwatch. Since they are ineffective beats, that could be why they set the base rate higher for some people like Gemita, so as to improve the total volume of blood getting circulated.

Following a PVC, usually the heart and pacemaker settle out after a couple beats and things quickly resume to normal. But, if you're getting frequent PVCs, many couplets or bigeminy for instance, the rhythm can become pretty irratic. In any case, the pacemaker will make sure the ventricles are contracting at the base rate or higher. But if enough of those beats are ineffective, you could get faint or pass out.

The PVARP timing setting specifically helped me alleviate PMT which can be precipitated by PVCs. Adjusting it may also help smooth out other PVC-related irratic behavior. You'll have to ask about that.

PM Settings

by showbiz - 2023-10-10 14:29:20

I had a similar problem. At my first clinic visit they set the base rate down to 50 from 60 and it has made quite a difference. My resting rate prior was about 63 or 64. It is now down around 54-57. No longer any sudden jumps when I start an activity and fewer palpitations. Anxiety also feels less. I have a Biotronik. Effect took a few weeks to really settle in but some instant changes for sure.

You know you're wired when...

You fondly named your implanted buddy.

Member Quotes

My pacemaker has ultimately saved mine and my unborn child’s life for which I am thankful.