New PM Triggered When Sedentary and/or Bending Forward

Greetings, All

Six day-old Medtronic W3DR01 for bradycardia and pausing. All so far well except for scariness of its triggering while sedate (right now, in fact) and while simply bending down.

From my first scan of comments here it appears body posture and movement can influence pacing even with leads properly positioned and stable. Unfortunately it won't be for another eleven days yet that I go to my pacemaker clinic for some enlightenment and an interrogation of the unit. I understand their need to gather sufficient operating data from it and I don't want to appear a helicopter patient to them with pestering, but a new PM recipient will have concerns.

It HAS removed the near-blackouts and accompanying waves of nausea that became increasingly frequent my last few days before reporting to the ER and their ultimately discovering the brady and pauses of up to seven seconds.

I'm tremendously grateful to have this thing in my chest and should welcome the pacing I can feel whenever it occurs. I would just hugely appreciate any of your collective musings as to whether things like body position, caffeine consumption, stomach fullness etc. may influence a PM's on-switch, possibly through complex vagal interractions.

Thank you in advance for any help to this poor noob.  :-)

Joe

5 Comments

Hmm. How do you knw?

by AgentX86 - 2019-05-19 22:11:06

How do you know that it's "triggering"?  What does "triggering" mean?

I'm curious because I hear people who say that they can feel it pacing.  I guess I can't because I'm dependent so am always pacing. AFAIK, no one should be able to tell when the PM is doing the pacing, rather than the SI node.  Some, particularly newbies can feel it because it's pacing their diaphragm. This shouldn't be happening but sometimes the leads are misplaced and when it's new, they'll crank up the voltage to the heart to make sure it "captures" the pacing signal.  This can cause the diaphragm to twitch which, understandably, can feel weird. Further, I suspect this because your complaint is positional.  When you move, the leads move around, so can touch something they usually don't.  This is certainly something to discuss with your EP and PM tech. Relief may be as simple as turning down the pacing voltage, which they'll likely do anyway, during your first PM clinic visit.

Don't be afraid to tell your doctors and PM tech about things that bother you.  I understand not wanting to be "that patient" but they don't want you uncomfortable, either.  They should be teaching you anything you want to know about your new friend, as well.

Nailed it in One!

by CatDad - 2019-05-20 10:07:38


Agent 86, thanks for your response. You've precisely captured my recent somatic sensations. The onset of my pacing is very palpable because it feels like someone flicking their fingernail against the interior of my lower left ribcage.

Positionally, I will begin pacing with any deviation from a straight torso: bending down, slouching in a chair, sitting up in bed to read..etc.

Fortunately my cardiologist happened to be on call this past weekend so the triage nurse was able to describe my symptoms for him and get his reccommendation to have an interrogation done today. :-)

Oh, Duh....

by CatDad - 2019-05-20 10:22:53

"The onset of my pacing is very palapable.."

That should probably read: "My pacing can be very palpable because..."

I may still be pacing when my torso is straightened but merely unaware of it.

Defibrillator Pacing

by Amarillo - 2019-05-20 17:52:43

I had defibrillator installed 30 days ago.  This is the problem I was having and maybe you problem.  Found below online.  I have a Medtronic Defibrillator and went back to Doctor today for adjustment by Medtronic Tech.  After about 15 minutes he was able to adjust defibrillator wires/leads to eliminate the problem.  Hope it works on you.  

Phrenic nerve stimulation has been described in up to one-third of patients with traditional cardiac resynchronization-defibrillator devices because of the proximity of the phrenic nerve to the pericardial veins, which makes the nerve susceptible to stimulation by the high-amplitude left ventricular lead.2 This problem has become much less common with the recent development of quadripolar lead technology.3

Phrenic nerve stimulation can be continuous or paroxysmal and can cause dyspnea, uncomfortable muscle twitching, hiccups and general malaise.2 It can be challenging to diagnose for those not familiar with cardiac resynchronization-defibrillator technology.4

Phrenic nerve stimulation is highly posture-dependent. It occurs more often when the patient is in a left-lateral position rather than in a supine position.2 Although phrenic nerve stimulation is not life-threatening, it can cause substantial discomfort to the patient.2 The problem can almost always be mitigated noninvasively with electrical reprogramming of the cardiac resynchronization-defibrillator.5

Update

by CatDad - 2019-05-20 22:02:59

Had PM interrogated this AM; nurse immediately called cardiologist who brought me in this afternoon to "revise" a displaced lower lead (right atrial?).

Op is over with now and I'm overnighting at the hosp for observation. Popping/thumping feling is gone. God bless my very excellent health provider!

Thanks for the info on phrenic stimulation. I had just begun reading about it and diaphragm pacing when I had to leave for the PM clinic.

You know you're wired when...

You have rhythm.

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