PACs every other beat after pacemaker check

Hi everyone,

I'm new to this forum. I recently had a pacemaker placed for sinus node dysfunction. It's a single lead right atrial pacemaker, Medtronic Azure XT SR MRI. 

Last week I went for my first pacemaker check. My setting at implant were a rate of 70-120. During the device check they added a nighttime setting for 60-120. Before I could get home, I was having PACs every other beat. It didn't stop so they readjusted my rate to 85-120 to get ahead of the PACs. It did work, but now the rate of 85 and higher makes it hard for me to sleep and is causing dizziness, headaches, and making me feel tired all the time. 

Has anyone had a similar experience or know more about this? I'm just learning about pacemaker settings, but it seems like there may be a better solution. I do have a call into the doctor's office but so far have not been able to get a doctor's appointment until the end of December. 


Re: pacemaker check

by H van Dyk - 2023-11-08 14:55:16

I don't know if this is the right procedure to handle PACs. Norrnally the rate is left to (for example) 60/130 and other problems are treated with medication. Betablockers are known for soothing your heartbeat. You might want to speak to your cardiologist at the hospital or clininc where the operation took place...

Thanks for your input

by Amara - 2023-11-08 15:30:15

I was wondering if this is the best way to deal with PACs. I've left them a message and waiting for a callback. 

Higher lower rate setting for ectopics

by Gemita - 2023-11-08 15:45:52

Amara, can I ask whether you were feeling okay when you went in for your pacemaker check, before they changed your lower rate sleep setting to 60 bpm?  I am assuming they only did this for the night time setting?  Why don’t you ask to have it restored to 70 bpm permanently if you were symptomless before they changed your settings.  

A higher lower rate setting is quite usual to try to stop or to prevent ectopic beats like PACs and PVCs.  This is to overdrive pace the slower, pausing beats.  It can be very effective.  Of course 85 bpm at night will seem high, which is why if you were better at 70 bpm night and day, I would ask for this rate to be restored?  What have you got to lose?

Returning to 70 bpm

by Amara - 2023-11-08 17:26:22

Hi Gemita,

I agree, nothing to lose to try to go back. I'm very open to trying. 

I was feeling great before going to the device clinic. They said the only thing they did was to change the sleep rate to 60-120, but the PACs started right after I left the device clinic and well before the sleep rate took effect. Something they did irritated my heart to start the PACs. I'm not saying they did anything wrong, it may have been checking the device that triggered the PACs. When they increased my daytime rate to 85, they deleted the sleep setting. I'm only having a few PACs now which are tolerable, but with the higher rate I'm having a hard time sleeping, having headaches, and now getting some pre-syncope I haven't had since before the pacemaker placement. 

After 5 days of the 85 rate, I asked them to restore the 70 and the device nurse said the doctor wanted to wait for my next appointment. It's not until 12/27 and I'm not willing to wait that long. I've called and left a message. They don't have any appointments sooner. This electrophysiologist is new to me since I had my pacemaker placed. I am so far not very impressed. I did research him well and he came highly recommended. I wish I had a better way to find out which electrophysiologists in my area are really good with pacemakers. Any tips are appreciated. 

Returning to 70 bpm

by Amara - 2023-11-08 17:55:30

Thanks, Gemita for your encouragement. The device nurse called me back and the electrophysiologist agreed to lower the rate. I'm going in tomorrow. 

Yes I would keep pushing to have the rate reduced

by Gemita - 2023-11-08 17:59:16

Amara, personally, I wouldn’t run to another EP just yet.  I would push first to have your 70 bpm setting restored round the clock since you say you were feeling great before going to the device clinic.  If you leave it set high at 85 bpm until 27th December, your heart (and PACs) may get used to the higher rate and not respond so well to it being turned lower to 70 bpm.  That would be my main concern.

I know no consolation, but since you only recently had your single lead pacemaker implanted, it can take up to a few months for your heart to settle and to get used to pacing.  My heart took 3 months to settle when I had lots of PACs and other atrial tachy arrhythmias going on.  I don't really know why they had to change your settings at all since you were feeling so well.

I also have sinus node dysfunction but I have two leads.  I don’t often hear of single lead pacemakers being implanted, although my husband has a single lead pacemaker implanted in his right ventricle.

I see you are in Florida.  I am in the UK close to London where we have some great hospitals and EP’s.  I am sorry I cannot help you to find a good EP, although you will have many to choose from where you live, I suspect.

Good luck.  Hope you get your way!


by piglet22 - 2023-11-09 07:33:19

I don't have time right now to expand, but you certainly aren't alone with this sort of complication.

It does need further investigation as it can lead to unpleasant unwanted symptoms like syncope.

As HV Dyk said, beta blockers might be the first port of call and so far have worked for me.

Back to 70.....

by Amara - 2023-11-09 16:23:37

Thanks Gemita and piglet22. I agree it's best to stay on top of these things so we don't get more ectopy or problems. I was starting to get pre-syncope with the higher rate.

I had a more experienced device nurse today. She said that some people are sensitive to the yearly tests they run and have ectopy after. Since it was my first device check since implant, they ran all the tests and that's what started the PACs. She suggested that I speak with the doc and ask him if we can do the tests every 2 years instead of every year based on what happened. 

The good news is that she restored my rate to 70-120 during the day and 60-120 at night. I haven't had any issues since, so she was right about the testing starting the PACs. Fingers crossed..... that the high-burden PACs don't return. I have a few every now and then, but that is not a bother. 

One more thing...

by Amara - 2023-11-09 16:24:28

They also gave me an rx for Verapamil in case the PACs do return so I can start it right away. 

Thank you for the update

by Gemita - 2023-11-09 17:01:50

Amara, Verapamil is a Calcium Channel Blocker which is used as a rate control medication, like a beta blocker.  It sometimes works better than a beta blocker for ectopic beats.  Did they say you were to use it as a pill in the pocket or to start on a regular basis should your PACs return and cause symptoms?  

I am glad you found the trigger for your PACs and that you are happy with your current settings.  That all sounds very promising.  I hope for the very best

Thank you :)

by Amara - 2023-11-09 17:50:15

He gave me the Verapamil to take if the high-burden PACs start again. Since I'm currently only having a few occasional PACs, I'm not taking it right now. So it is really more like a pill in the pocket in this case. 

You know you're wired when...

You have an excuse for being a couch potato.

Member Quotes

A properly implanted and adjusted pacemaker will not even be noticeable after you get over the surgery.