Skipped beats

Hello - 35 year old male that was diagnosed with Wolff Parkinson White last February. Catheter ablation corrected the issue, but the following November I had another non-WPW SVT arise. Need for pacemaker implant after my most recent ablation attempt this March to correct that SVT.

The question, is it normal to experience a "skipped beat" with a pacer, especially in the evening? The rhythm that develops is "beat-beat-beat-pause-pace-beat-beat etc".

Also, I am still experiencing SVT's because the source of the SVT's is positioned next to my AV node, and it could not be corrected due to the proximity; the attempt lead to complete heart block as the AV node was nicked/damaged during hte ablation. What would your comfort level be as the patient, deciding to disconnect the AV node and eliminate the SVT source while relying only on the implant tor run the heart?

Thanks

5 Comments

Skip Beats

by SMITTY - 2009-05-30 02:05:13

Hell DC Pacer,

Your question: Is it normal to experience a "skipped beat" with a pacer, especially in the evening? The rhythm that develops is "beat-beat-beat-pause-pace-beat-beat etc"."

The answer is yes it is normal. Now I'm sure your next question is how can it happen because you thought the pacemaker was supposed to make your heart beat when necessary.

I have a lot of that problem and it has gotten worse during the 9 years I've had my pacemaker. Before going further, no, I don't think the pacemaker is part of the cause. My first skip beats were noticed almost 50 years ago, so I had lots of experience with them before my PM. Although I did think the PM would stop them, but it has had no effect so far as I can tell.

What I have been told is that when we have a skip beat our heart's natural pacemaker actually sends an impulse as if it is going to make the heart beat. Our PM monitors our heart to be sure no impulse is being sent by the natural PM or the impulses are being sent to slowly. So when the PM detects one of the weak impulses form the hearts natural PM it will not send an impulse and we get what we know as a skip beat. In other words, our heart's natural PM is faking out the manmade PM. It is my understand that the sensitivity of our PM can be adjusted so that it will ignore these weak signals from the heart's natural PM and send the needed impulse. Like I said that is my understanding but frankly based on my experience I think it probably some more PM propaganda.

Mine have no particular time of day of length of time they stay around. They have their own schedule and what you describe could be me at times or some times it is beat, skip, beat, beat, skip, beat skip, skip, beat, etc. I have never found any predictable rhythm, it just happens or it dos not happen. Throw in a few PVCs or PACs and things really get interesting, but so far is has continued to beat enough to keep me alive and to keep me from passing out.

Based on my experience I would say don't get too concerned about them unless they are frequent enough to interfere with your daily activities, but of course, you should tell your doctor about them.

I'll leave info on the SVT to someone else.
;
Good luck,

Smitty

Thanks Smitty

by DC Pacer - 2009-05-30 02:05:51

It has been a heck of a process trying to go from 33 years old and "healthy" to this complicated world regarding the heart.

Your weak impulse theory sounds pretty plausible; I too have talked with my doctor and they dismiss skipped beats as no big deal.

If anyone has insight on the disconnection of the AV node in order to circumvent the chronic SVTs please feel free to comment. Thanks for your info Smitty.

My take...

by chip - 2009-05-30 03:05:44

I would think long and hard before I had an AV Node ablation for SVT and became 100% dependent on the pacemaker.

You haven’t had the pacemaker very long and it may still need some adjustment for maximal effect.

I would first explore all other avenues including a lead replacement to the coronary sinus. I had a lead revision done for other reasons but the coronary sinus placement stopped my SVT. (A great unexpected side effect)

Talk it over with your EP and see what he/she thinks. Some are reluctant to attempt the placement because it is a tricky revision. You might even consider a second or third opinion before making yourself 100% device dependant especially at your age.

Best of Luck & God Bless

Thanks Chip

by DC Pacer - 2009-06-01 08:06:45

The SVTs are a nuisance at this point; they have become less frequent. I will explore the lead revision option with my EP and see where that discussion takes us...

same problem

by E from Spain - 2009-06-02 11:06:08

Hi,

I'm 36 and I was "healthy" untill last year. Due to a WPW I had an ablation that ended in a complete AV block. Now I'm 100% paced and I'm back to my "healthy" life. I'm doing lots of sports (climbing, scuba diving, running...). The only problem is some skipped beats when I'm doing sport (when my heart demands more than 180 bpm).

The PM follows my normal HR (the atrial ritmus) and detects when I need more beats. If my HR is lower than 180 there is no problem. When my HR is higher than 180, the PM is only giving me 180 (skipped beats). The problem comes when my atrial rate is higher than 200 that the PM is not fast enough and can not read all the pulses, then the PM is only reading half of them and the PM is jumping down to 100. When that happens, I need to go down with my activity and as soon as my HR is lower than 200 the PM gives me 180 bpm.

So you have to get use to the new circumstances but there is no other big thing with a complete AV block.

Best wishes from Spain

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