To pace or not to pace?

I suffer from chronic fatigue. 10 years ago I had a holter monitor that revealed a low of 37 bpm. With no blockage, I was told this was just me so anything done. I am not an athlete.

Last month I had another 24 hr and subsequently a 14 day holter and got to 28 bpm. Again, no blockage; however the heartrate qualifies for a pacemaker. To help with the decision a tilt table study was done. Resting hr was 36 flat and 44 at a 90 degree tilt. After they injected me with something to increase the hr. By the time I got to a 70% upright position I had multiple, rapid arrythmias, breathlessness, dizziness, and felt like I was having an arrest. They stopped the test. I only got my hr up to 78bpm. The doctor said I passed the test and I needed to set an appt to discuss whether or not I needed a pacemaker. It was a horrible, scary experience. I am under the impression I still have a choice! I won't find out for a week or so. Has anyone out there gone thru a similar experience? Was a pacemaker placed or did you wait till your hr got to the point where there was no choice? I am fearful after experiencing this last test.

4 Comments

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by pete - 2009-10-03 03:10:22

You have no choice , your condition is life threatening. Get the pacemaker. It will most likely transform your life. Cheers Peter

time to pace

by Tracey_E - 2009-10-03 06:10:09

I'm not a medical professional and this is just my opinion, but you should have had the pm ten years ago, or at least discussed it and been given the option. Anything under 50 or 60 is considered bradycardia and it's usually optional at that point whether or not to get the pm. The main reason would be if you're symptomatic. You apparently are and have been for a long time. Once you get under 40 it's considered dangerous, and your heart can arrest when your hr dips into the 20's. The low hr robs your organs of oxygen, and as you have learned, it also sucks your energy.

What did the dr mean that you passed the tilt test?? That you didn't pass out? It sounds like you didn't exactly pass it with flying colors. (sorry if that's too blunt!) Tilt tests can diagnose if your hr and/or bp drop off suddenly with positional changes. You didn't pass out but you sure had a lot of symptoms when they tried to get your hr up with the medication.

When they say no blockage, they could mean two things. There is arterial blockage, what most people think of when they talk about blockages of the heart. This is a plumbing problem, blocked pipes, and causes heart attacks if left untreated. It has to do with how much blood flows through, not how fast your heart beats.

The second type of blockage is an av block, or an electrical signal blocked between the sa node in the atria and the av node in the ventricles- a short circuit. An electrical blockage is the reason many of us have a pm. Our atria beats perfectly normally and goes up with exercise, but the signal either always or sometimes does not get through to the ventricle telling it to beat faster (that's the block), so our hr stays low and does not go up with exercise. The pm completes the broken circuit by watching for when the atria beats and telling the ventricle to beat when it doesn't do it on its own.

Again, I'm no doctor and I only know what you've said but it sounds like you have sinus issues, not an av block. There can be several diagnoses, sick sinus syndrome or chronotropic incompetence are two if you want to google them, but they all basically mean your atrial rate just doesn't go up like it should, at rest and/or with exercise. The pm can fix these problems first by never letting you get below a certain hr, usually 60 or so, and also by sensing when you are active and raising your hr for you.

I was born with an av block. I spent a lifetime with a hr in the mid 40's, it never went up or down. I didn't feel bad, but I never had the stamina for sports or exercise and I always tired easily. The last year before I got the pm (I was 27 at the time), my hr dipped and ended up in the 20's. I felt awful, always tired and dizzy. I literally felt better from the minute I woke up in recovery. If I had known how much better I could feel, I would have asked for it a lot sooner! That was 1993 so I've been paced for a long time, and I live a full, active life.

The surgery is very simple and recovery is generally fairly fast. If you have questions about it, or living with a pm, please don't be shy. Many of us have been there!

PACE

by donb - 2009-10-03 07:10:17

Hi, Pete & Tracey tell it as it should be!! At your age you have a lot good years ahead. I also went the exact trip as you did, the differance was my wife as a Cardiac Nurse made my decision. She said at the time, I won't live with him without a PM. She was right as I would not be 77 today. I got my first PM in 1992 at age 60 and it turned my life around. I can physically do far more today than when I was 50. At that age I felt tired and believed that was normal, an aging thing. Good luck!! Get it done and you'll remember these postings. DonB

HI

by mytrose43 - 2009-10-03 08:10:14

Hi ,

My name is Valerie and if i were you i would run not walk to get that pacemaker,The surgery to to put in the pacmaker is not a major surgery and you recover pretty quickly from it .I am sure you will feel much better with the pacemaker i got mine for low hr at night 24 bpm with up to 6 sec pauses . i would have had it put in the same day if i could had 24 bpm scared me alot not to mention 6 sec pauses i also have sleep apenea ,I did feel much better after i recieved my pacemaker as far as energy and shortness of breath go.I was diagnosed with tachy/brady sybdrome and a fib, You will be very much relieved and be able to sleep better with a pacemaker, don't wait til it is a emergency,
Valerie

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