What exactly does the doctor do when he/she interrogates my PM

I've had a PM for 5 years now. I also have a medical background. All this time I thought I understood what was going on when they interrogated my PM but, apparently, I don't.

I have an excellent cardiologist. He's 77 years old but he can still keep up with the best of the 40 year olds. They stand in awe at his skills---EXCEPT! He dabbles at technology but he hates it and he isn't as sharp at it as he probably could be. I'm not seeking advice about my cardiologist. For reasons way beyond this forum, switching doctors is NOT an option.

On occasion I've had other doctors interrogate my PM. While I might not have felt grand I didn't feel as scary/miserable as I do when my regular doctor does it. It may only last a second but I assure you it is a second too long. For that second I feel like I'm going to do a face plant right off the table and out cold---or permanently cold---onto the floor. As I said, it is a second, but OH how I dread this every 6 months.

My heart is doing very well. I have no problems. OK---FINALLY---ON TO MY ACTUAL QUESTION--

Can someone explain to me in plain language what exactly is being done during an interrogation? This really came to mind for me yesterday at my 6 mos check up because a friend was holdng my hand during the interrogation. The friend has a titanium rod down his leg from a hip replacement. He said it was the weirdest feeling for a second he felt this tingle down that rod. That has prompted my question. Apparently, errantly, I've always thought that the doctor just takes my heart beat way down and sees what happens when the PM kicks back in. Apparently---I'm wrong.

Any explanation in laymen's terms would be appreciated. Thanks.



They lower the rate at which you are paced

by LondonAndy - 2018-10-10 13:04:12

Others on here will be able to say much more than me, but I suspect that the particular issue you raise is because they lower your pace rate. I am 100% paced, so in my case it may be to see if there has been any recovery in my natural pacing. The technician always tells me first before lowering it, and warns I might feel odd, and as I have a mechanical aortic valve that ticks I can tell they have dropped it probably to about 30bpm. 

So you are right, and logically I can think of no reason you friend would feel something when they do this! I shall come back to this post, curious as to what others say ...

Hmmm 77 yr old Cardiologist who hates technology …… Best of luck !

by IAN MC - 2018-10-10 13:18:40

Hi VERNE   It really is simple :-

That magnet which they place on your chest communicates with the computer which your cardiologist is trying to understand.   It will then spew out loads of paper and decimates many rainforests. What does all the paper tell him :-

- ALERTS   It will flag anything out of the ordinary , spells of very fast or slow heart-rate, battery  running out,   or problems with the leads not sending messages to the heart to make it beat .

- HISTORY :  It shows loads of graphs which give the spread of your heart-rate. Has it been stuck at 60 or has it being going up as it should when you exercise ?

-PERCENTAGE PACING :  Is your heart generating heart-beats or is it relying on  the pacemaker to do so ?

MODE SWITCH : Tells the Dr how often your PM is pacing the top chamber and how often it switches to the bottom chamber

BATTERY : Gives an estmate of how long your battery will last

At some stage , as Andy said, he may say " I'm going to slow your heart down a little " . He may then slow it right down to 30 bpm and you feel awful. All he is trying to find out is if and when your heart kicks in and takes over from the pacemaker. In other words he is finding out if you are totally dependent on your PM or not.

At another stage he speeds up your heart and you feel as though you are running a marathon. He has hijacked your heart at this stage so I'm glad you have faith in your 77yr old cardiologist !   I think he is trying to  find a threshold moment if and when your PM acts as it should re its maximum setting . . He is also checking that the PM behaves as it should when your heart rate increases.

With a bit of luck after a brief chat you will probably be then allowed to escape. Your cardiologist will give a knowing look as you leave because he now knows just how little you exercise (  not to mention your lack  or abundance of sex-life )

Hope this is helpful


Ian Mc

by verne8 - 2018-10-10 13:28:25

Thank you. I can't say I've ever felt bad when he increases my heart rate. That is just my usual (which I live with a lot) anxiety feeling. Then he says, "Hold still" and that's when the AWFUL happens. Ugh! I'm alway terrifed the machine will decide to crash when my heart is in that 30's range and then it would be bye, bye, Verne if I didn't believe that, ultimately, God determines when I die---not the technology at Boston Scientific.

Greatly appreciate your explanation. The only event I had this time was a very brief period of what he called "PM mediated tachycardia". I'm not even sure what that means any more.


by AgentX86 - 2018-10-10 15:04:31

They're testing for pacemaker dependency. Basically, they turn off your pacemaker for two seconds (the equivalent of 30bpm) to see if your heart takes over. What you're feeling is a  "fail". If you weren't dependent your heart would have taken over, though perhaps at a lower than desired rate. AIUI, they're not allowed to test below 30bpm.


by verne8 - 2018-10-10 15:19:23

I'm not 100% dependent so I guess my heart does what it is supposed to do at that point. It still feels pretty miserable. That was very helpful. Thank you.


by ROBO Pop - 2018-10-10 17:03:52

The big ring they place over your shoulder is a magnet which activates a reed switch in your device. That switch sllows the computer to access your device program.

Your device records what is going on with your heart between interrogations. They can program it to record information they feel important based on your heart condition.

They download and print this information. They can also upload program changes to your device and will test things by changing your settings temporarily. You may or not feel it when they do this.

Based on your discussion during thr interrogation, they may change some settings to better meet your personal needs.

It's no big deal to have an interrogation.

ROBO Pop --- What if...?

by verne8 - 2018-10-10 17:14:58

As I discussed with another member, I don't quite understand if they can print out all the data of what my heart has done for the past 6 months, and, at a glance see a list of anything abnormal, why do they have to risk an interrogation?  I always have that "what if?" fear... What if the computer they use to interrogate fails when they have your heart rate at 30? What if your (my) ancient (or, on the other hand, young and not very experienced somewhere else) doctor hesitates just that second...or 3...too long? Seems like a great deal of risk to the patient for not a lot of gain but that's why I'm just an old lady and not a cardiologist.  Thanks so much for your input. I do appreciate people who take the time to help. This group has always been fantastic about that.

Not to fear....

by BOBTHOM - 2018-10-10 19:29:41

Nothing to fear, they are downloading history and then running through a function test so if it needs to go to one of the extremes they know it will still work as planned.  Mine is just an ICD (implantable cardiac defibrillator) but has pacing function so they always crank up my heart rate to sprint level, which sucks and I have to always ask them to take it up a little slower which seems to work better for me.  These tests also help measure lead impedence so they know it's all still connected right.  The fun stuff about the history, they can tell if your retaining fluid, if your day/night heart rate is in normal range, it's really pretty amazing how much info they can actually get.  Now if only they could take all that, figure out what's really wrong and fix it that would be great!  As for your freind being able to feel it, I've been told that when my ICD goes off, if someone is touching me, to them it will feel like a static shock you would get from touching a door knob.  So, the current is moving through our bodies and electricity always looks for the fastest way to ground, in this case probably your friends leg.  Next time have your friend stand on a rubber mat and see if it still happens.

"I guess my heart does what it is supposed to do"

by AgentX86 - 2018-10-10 23:02:19

Verne, you're probably right.  I was speaking only of my experience.  I wouldn't feel anything odd at low heart rates - spent too long there.  At 30bpm it just feels like I'm in an elevator so it's not awful, just odd.  I get such feelings relatively often so it's no big deal for me.  You're probably more sensitive to low rates.  They should be running the rate down slowly until your heart beats on its own.  It shouldn't be that bad but as we're all learning here, we are different and react to all of this crap differently.

Battery life

by DAVID H - 2018-10-14 13:50:31

In my case, my PM interrogation(s) is mainly focused on battery life remaining. Due to the placement of one lead, battery use has been depleted faster than usual. EP's nurse has stated, "Once the battery level drops to a certain value, your device will sound like a UK police siren at 8am every morning!"  Give us a call when that happens.

test leads

by dwelch - 2018-10-16 12:20:32

I think folks have basically covered it above.  it is not downloading everything that happened in a year, the device has software just like your laptop or phone but much more highly regulated (think software that flies a passenger jet), and there is only so much they can do or store and stil use such a tiny amount of power to live off of a battery for 10 years.  The software is looking for and storing specific events that it was programed to look for and store.  When I started there was none of this each new device offers more storage and more events it is looking for.  So its more like looking at a few days worth of emails rather than a log of every heart beat or step on your fitness tracker, etc.  

The thing I dont think was mentioned above is they test each lead, depending on the lead they have ways to isolate that lead, the go faster go slower and such are possibly part of that I have not researched this.  I have a third lead now so a new test.

it is a diagnostic as the term implies.  download anything they can download, do some measurement so to see it is not grossly broken (while in the room at that moment is the device pacing, or is something broken).  push some boundaries a little to see that the device keeps working with those boundaries and then do some electrical tests where possible on the leads.  

dont believe the battery life report, its a rough estimate at best can be weeks months or years off.

I talked to Boston Scientific

by verne8 - 2018-10-16 12:38:07

I got far enough up the food chain to get a man that has been part of designing and upgrading the programmers and devices for the past 27 years. It was very helpful. He answered my every question.

He said the programmer is set that if anything interrupts the power source that in 1/20th of a millisecond that the PM automatically returns to pacing as it was programmed. It does not stay in testing mode. He also told me they are expecting FDA approval for a tablet version of the programmer with some new things on it sometime around April. It will then take time to get the new systems distributed around the country so this isn't an any day now sort of thing.

He did understand my concern with the slowed reactions of my cardiologist. He did say that could be a problem. But I've seemed to have helped that problem by asking, nicely, that he (cardiologist) please not slow my rate down one beat slower than he must and not for one second longer than he absolutely has to. I think that makes him alert to how badly this affects me. Well, at least I hope it does. I told my friend that always goes with me if I start to head to the floor and the doctor doesn't seem to be doing anything to fix that on the programmer to pull the plug so my PM goes back to working again. :-)

Thank you all for your responses. They have been very informative and helpful...not to mention, kind.

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