Pacemaker exit block

Had pm implant for about 3 years now due to bradycardia (30 bpm). Felt pretty good for the 1st year, then progressively started to feel tired. I almost felt better before the pm with 30 bpm). Anyone out there ever experience pacemaker exit block? I think another term is 2 to 1 pacing. What I am experiencing is anytime I get my heart rate up during exercise, the pm drops to about half of what its suppose to be at. Example, I am 47 and should have a max hear rate of 173 (220 minus age 47). Max track was initially set at 180. What happens is that everytime I get on the treadmill for a stress test (Standard 2 minute Bruce protocol), when I get to about 6 minutes and heart rate of around 140-145, the pm rate drops to 70-77 bpm and my legs feel like mush. This had been going on for about 2 years, with no change regardless of the multiple interrogations/setting changes. Was told by EP that the cause was a spot in the heart which was causing the pm to be caught in a loop. Had an ablation, but problem continues. Current solution was to lower max heart rate to 130 (theoretically keeping the heart lower than the 140 which caused the drop). Ran the stress test and same problem, dropped to 70's. Now I'm told that it may be due to scar tissue buildup around pm lead insertion. Now looking at pm lead replacement.

My concerns are, If my employment was just a normal 9-5 desk job, I could accept the heart issues. I am currently employed as a law enforcement officer in a large agency, and may be possibly forced to retire if I can not get this under control. I can not afford to tire after such minimal excercise in my line of work. Anyone out there under similar circumstances?

Thx,

Al

7 Comments

hmmm

by COBradyBunch - 2009-07-26 02:07:04

noticed the same thing with the machines HR dropping to half since I got my PM so I started to wear both my HRM watch and see what the machine says. HRM watch never shows the same drop as the machines do. Might want to check with Polar (or whoever your HRM manufacturer is) and see what they have to say. Also have not noticed anything that indicates a HR drop from the excercise (1 hour at about a 136 average with pushes up to the low 150's. I am 50 so my theoretical max is 170 although I know from riding and hiking I was closer to 180-185 at least two-three years ago).

Seeing a similar problem

by DC Pacer - 2009-07-26 08:07:01

I am in sales, and have had PM for about 4 months now. When I travel, I use exercise equipment where I am staying, and am seeing a similar occurrence. Using a stationary bike with a HR monitor I will see that my HR runs around 140 during fat burn / cardio stages, but then the bottom occasionally drops out to around 40-44.

I have been attributing it to the poor HR monitors on the equipment, because I haven't had any other adverse effects like loss of energy etc.

DC Pacer

by Tracey_E - 2009-07-26 08:07:17

You can't depend on those machines to tell you your hr, go by how you feel. Sometimes the pm interferes with their signal and they miss beats so the number is way too low, other times it picks up the pm spike as a second beat so the number is way too high. The only way to be sure how fast your heart is beating is to stop and count it.

settings

by Tracey_E - 2009-07-26 08:07:50

It's not surprising your legs feel like mush when your hr drops like that! I had something similar happen- hr got up to the max, dropped suddenly, then it jumped back up where it should be and I suddenly found myself unable to work out. Have you considered a second opinion?

An aside... you're paced so ignore the formula for where your heart should be for your age. If you feel good while exercising, your heart is beating fast enough for you. How fast is less important than how regular you are beating.

I can't see where lowering the upper limit will help. Any time the atria is going faster than the ventricle can keep up you're going to feel lousy and tire quickly. A lower upper limit will just cause different problems.

They should be able to control how fast your hr drops so the pm steps in with atrial pacing when your rate drops off naturally too quickly, and/or they should be able to program it to prevent the pm from putting you into the artificial 2:1 block. The artificial block is a safety setting for people with afib, if you don't have afib they should be able to turn it off.

My problem was eventually fixed with settings. It did not happen quickly or easily! At one point I was going back every three days. They'd try a new setting, I'd take it easy for one day, go test drive it at the gym the second day, then go back for a follow up the next day so they could look at what happened and tweak it some more. My dr and St Judes rep are wonderful. They don't have many young active pm patients so sometimes things just come up that they haven't dealt with before and it takes some experimentation to fix it.

I had two stress tests, one regular then one with the pm computer hooked up. They finally put their finger on what was going on but weren't sure how to program to fix it, ended up faxing the whole mountain of reports to the engineers at St Judes who made me a case study because they hadn't seen my combination of problems before either. The engineers had a powwow and came back a few days later with recommended settings. I'm still not 100% because sometimes my atrial rate gets higher than the pm can go - I'm at the highest upper limit setting avail on the pm so it can't go any higher- but I can work out again and my stamina is decent as long as I keep my hr lower than that upper limit.

Is your pm St Judes? If it is, your rep should be able to find the case study they did on me. May not help because similar symptoms doesn't mean similar diagnosis, but it can't hurt to check it out either.

I hope you can get it worked out! Could they move you to a desk job rather than retirement if it came to that? I don't think it will tho. I'm not a doctor, but I know from my own experience that they can program a pm to prevent sudden drops so there's gotta be more they can do for you with settings. Good luck getting it worked out!

PM

by Jake93 - 2009-07-26 12:07:09

I sent you a private message...

follow up answers

by BuddyOne - 2009-07-28 01:07:44

DC Pacer
events happened in multiple settings, such as on the treadmill, real time run in the neighborhood with hills, on the treadmill during stress test with 12 lead hookup. Sounds like you have similar symptoms but you are coping with it. Mines come with the fatigue, sob, wobbly legs and extended recuperation time.

I do use a MIO heart monitor with Polar strap on the treadmill or at home and the results are the same in the doctor's office with the 12 lead hookup.

TraceyE

I do have a St Judes, ditto with the case study, at least according to the reps. I've seen about a dozen of them, one I think that's been with the company for 30 plus years. Had a least a couple dozen stress tests, also with the "donut" hooked up during the tests. I always ask for a copy of the settings in case they adjust the settings to a previous setting tried before.

In regards to desk job, my agency does not have provide permanent desk jobs for my job classification (civil service rules).

COBradyBunch

When you refer to the machines, I am assuming you are referring to a treadmill (I know don't assume). As stated above, the readings I get on the treadmill and my Mio watch are consistant with the readings in the doctor's office. You are correct in that some heart rate monitors will not work with patients with pms. The one I use does work (get one that is not "coded.")

Boy, I wish I could reach 180-185 bpm

Al


Hmmmm again.

by COBradyBunch - 2009-07-29 05:07:33

I have found my issue is limited to specific machines at the gym so I totally think it is a different issue but it is weird how it drops to exactly half of my actual HR at the time per my Polar watch.

As for 180, well I get to see what my max is next week (if I can talk the tech into it again) when they put me through a stress test. My 182 was done 3 years ago in my last stress test after the tech and I decided to see just how much I could handle. Damn near fell off the treadmill but it was fun.

OBTW, hit 163 this week at the gym time trialing on a spin bike.... shhhh don't tell my doc.

You know you're wired when...

Your signature looks like an EKG.

Member Quotes

I am not planning on letting any of this shorten my life. I am planning on living a long happy battery operated life. You never know maybe it will keep me alive longer. I sure know one thing I would have been dead before starting school without it.