I am confussed - need some advice

I am about 8 weeks post PM surgery. I feel like I got my life back - getting more energy everyday and feeling great. I had my appointment and asked about the % of pacing my PM is doing because I always see that number on this site. I was told that my atrium is doing the pacing and my problem was with the conection between the atrium and the ventricles. My ventricles would only beat about once for every 3 or 4 beats of the atrium. My doc told me I was paced at 100% even though I am not being paced at 100%. I thought I understood and now I am not sure. She told me that with a ventricular block they can't wait for the heart to decide to beat so they always set the PM at 100% for a clean bump, bump beat. But sometimes my heart will beat on its own. I thought 100% meant that the PM was beating 100%, but now from what she told me, that is not true? She said my heart was beating "by itself" the whole time we were talking. If the PM is set at 100% wouldn't it kick in for 100% of the time. If anyone can enlighten me, I would greatly appreciate it.

3 Comments

I'm confused too

by Angelie - 2010-07-07 04:07:54

If you're "pacing" at 100% then the pacemaker is giving your heart the electrical signal for every beat when the pacer doesn't "see" a natural signal coming from your own heart.

I am 100% atrial paced, and about 3% ventrical paced meaning that my sinus node (which is responsible for initiating the first electrical signal) doesn't work anymore. The pacer waits to see if my natural signal will fire. When my sinus node does not fire off a signal, the pacemaker kicks in and sends a signal in it's place. This is happening 100% of the time, and this completes the work of the Atria or top chamber.

The electrical signal continues on down to the AV node which communicates that electrical signal to the ventricles. After the signal travels through the AV node, my bottom chambers beat. My AV node is perfectly intact and healthy so the pacer does not have to create a electrical signal to continue the circuit. If your AV node was diseased then the pacer would help create a "paced" electrical beat for the AV node as well.

Some people are paced 100% top, or 100% bottom, or a combination of the two. What matters is if you're feeling better. The pacer just picks up the slack when your own natural heart signal isn't generated.

Happy healing, and welcome-
Angelie

Doc is confused

by ElectricFrank - 2010-07-08 02:07:39

From your description you have one of the types of electrical block between the atrium and ventricles. The job of the pacemaker is to sense the natural atrial beats and use them to time an electrical stimulus to the ventricles, which puts everything back in good timing.

While it is common for the block to be complete where the pacer has to pace work 100% of the time, all the modern pacers sense the ventricle and if a normal beat starts to happen pacing is with held. This is often called demand pacing. This feature could be turned off, but there is rarely a reason to do it.

By the way there is a backup pacing center in the ventricles that will pace them at somewhere in the 25-40 range which is why we don't die before getting the pacer. The result though is anything from feeling lousy to passing out.

Having an intact atrial rhythm that the pacemaker can use to time beats is the best type of problem to have. With the pacer your heart responds normally to activity. This is what I have and I've hiked around at 13,000' in the Rockies.

hope this helps,

frank

Thanks!

by travlin50 - 2010-07-08 09:07:55

I love this site. Everyone is so knowledgable and eager to help. I was told that my problem is the one you want to have, if you have to have a heart problem. That does make me feel a bit better about the situation, because I am rather young to have this happen to me. At least I feel young when I am sitting at the heart clinic!! I believe I understand it much better now. Thanks Angelie and Frank for your comments. Both were very helpful.

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I am 100% pacemaker dependant and have been all my life. I try not to think about how a little metal box keeps me alive - it would drive me crazy. So I lead a very active life.